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| Year : 1985 | Volume
: 31
| Issue : 4 | Page : 203-5 |
Vocal cord paralysis : rehabilitation by endoscopic injection of teflon paste.
Karnik PP, Ingle MV, Shah KL, Karnik PP
How to cite this article:
Karnik P P, Ingle M V, Shah K L, Karnik P P. Vocal cord paralysis : rehabilitation by endoscopic injection of teflon paste. J Postgrad Med 1985;31:203 |
How to cite this URL:
Karnik P P, Ingle M V, Shah K L, Karnik P P. Vocal cord paralysis : rehabilitation by endoscopic injection of teflon paste. J Postgrad Med [serial online] 1985 [cited 2023 Sep 21];31:203. Available from: https://www.jpgmonline.com/text.asp?1985/31/4/203/5381 |
Unilateral vocal cord paralysis in the abducted position causes the voice to be hoarse, and breathy and to tire out easily. The patient talks in bursts of a few sentences. Laughing is impossible and cough is ineffective.
In 1911, Brunings[3]first tried injection of paraffin in the paracordal tissue in ouch cases to correct glottic mechanism but it failed. Arnold[1]revived this cord injection treatment and after a trial of a number of material,[2],[7]teflon paste (mixture of teflon and glycerin) has been found to be an accepted material for injection treatment because of its properties of dispersion, easy injectability through 19 G or 20 G needle and nondriftability by mechanical cord vibration or via lymphatics. Teflon can be sterilized by autoclaving. It is an inert material as proved by the animal experiments.[4]
The study extended over a period of 2 years and it comprised 14 patients of paralytic dysphonia who were treated by injection treatment with teflon paste only after subjecting them to speech therapy and a waiting period of at least one year. This was to exclude self-resolution of the condition, or compensation by the opposite cord across the midline.
Teflon paste containing polyteflon and glycerin 0.74 gm each per ml of the paste with a specific gravity of 2.4 was loaded into a Brunings syringe with a special adapter, just prior to injection which was carried out with 19 G needle.
For endoscopy, a Klienssaer variety of direct laryngoscope was used under general anaesthesia along with a chest support. The operating microscope with a 400 mm objective lens was focussed on to the vocal cords. The first injection was made into the thyroarytenoid muscle, at the midlevel of the paralysed vocal cord and at a depth of 4 mm. Approximately, 0.3 to 0.4 ml of the teflon paste was needed to satisfactorily medialise the cord depending on the etiology, duration and position of the paralysed cord and also the build and sex of the patient. In case the vocal cord was not adequately medialised by this injection, a second site was chosen midway between the first site and the vocal process of arytenoid.
At the termination of anaesthesia, 8 mg of dexamethasone was administered prophylactically to the patient to prevent stridor.[5]The patient was kept under observation in the hospital for one day. Assessment of the improvement in voice was done by the same speech therapist independently who carried out, both preoperative and post-operative tape recording of voice.
[Table 1]gives the etiology of paralysis of vocal cord and the improvement of voice following injection treatment. There were no major complications. Most of the patients complained of residual soreness in the neck for a few days and they were treated with simple analgesics.
In two cases, the procedure had to be repeated due to inadequate improvement.
A fair to good results were obtained in 13 out of 14 cases, treated with injection of teflon paste.
General anaesthesia was found convenient because (a) a larger laryngoscope could be passed for better visualisation; (b) both the hands of the operator were free for manipulation due to the use of chest suspension; and (c) control of the injection was possible under vision through an operating microscope.
The main limitation of general anaesthesia was that the adequacy of injection could not be checked on the operating table by asking the patient to phonate. This resulted in injection of suboptimal amounts and the patients had to be called for repeat infection. Most of the complications of teflon paste injection reported are related to improper injection either so deep as to cause subglottic obstruction or so lateral as to cause extravasation into the neck or so medial as to be injected into the vocal cordx itself.[6],[8]A reaction to teflon may cause stridor. Use of operating microscope which was possible because of general anaesthesia and prophylactic administration of dexamethasone probably prevented complications in our study.
We thank the Dean, Seth G.S. Medical College and K.E.M. Hospital for permitting us to publish the hospital data.
| 1. | Arnold, G. F.: Vocal rehabilitation of paralytic dysphonia: Cartilage injection into a paralyzed vocal cord. Arch. Otolaryngol., 62: 1-17, 1955.  |
| 2. | Arnold, G. E.: Vocal rehabilitation of paralytic dysphonia: VI Further studies of intracordal injection materials. Arch. Otolaryngol., 73: 290-204, 1961. |
| 3. | Brunings, W.: Uber eine neue Behandlungsmethode der Rekurrenslahmung. Verh Detsch Laryngol., 18: 93-151, 1911. |
| 4. | Kirchner, F. R., Toledo, P. S. and Svoboda, D. J.: Studies of the larynx after Teflon injection. Arch. Otolaryngol., 83: 350-354, 1966. |
| 5. | Montgomery, W. W.: Laryngeal paralysis: teflon injection. Ann. Otol. Rhinol, Laryngol., 88: 647-657, 1979. |
| 6. | Nassar, W. Y.: Polytef (Teflon) injection of the vocal cords, experience with 34 cases. J. Laryngol. Otol., 91: 341-347, 1977. |
| 7. | Rubin, H. J.: Pitfalls in treatment of dysphonias by intracordal injection of synthetics. Laryngoscope, 75: 1381-1397. 1965. |
| 8. | Rubin, H. J.: Misadventures with injectable polytef (Teflon), Arch. Otolaryngol., 101: 114-116, 1975. |
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