Early versus late injection medialization for unilateral vocal cord paralysis

Aaron D. Friedman, James A. Burns, James T. Heaton, Steven M. Zeitels

Research output: Contribution to journalArticlepeer-review

145 Scopus citations


To evaluate whether the timing of early (≥6 months from time of nerve injury) vs. late (<6 months) injection medialization laryngoplasty impacts the need for subsequent open-neck reconstruction to restore vocal function in patients with unilateral vocal cord paralysis. Study Design: Retrospective chart review. Methods: A total of 112 outpatient or hospitalized adults with dysphonia resulting from postsurgical or idiopathic unilateral vocal cord paralysis were identified who were injected as initial treatment within 1 year of onset of their paralysis. All subjects underwent awake, transoral, paraglottic injection with absorbable hyaluronic-acid gel. Patients with documented recovery of vocal cord mobility (22), active disease directly affecting the recurrent laryngeal nerve (8), >3 months of follow-up after injection (time for gel to be reabsorbed) (34), or deaths within 1 year after the onset of paralysis (13) were excluded, leaving a study population of 35 patients. Results: Twenty of 32 (62.5%) patients with early injection medialization maintained an adequate voice, obviating the need for open-neck phonosurgical reconstruction; their follow-up from onset of paralysis ranged from 4.0 to 41.8 months (mean 15.2). None of the three patients undergoing late injection (<6 months postparalysis) avoided phonosurgical reconstruction (P=.03, v2 test). Conclusions: Patients receiving early injection medialization for vocal cord paralysis were less likely to require transcervical reconstruction. We believe that early medialization creates a more favorable vocal cord position for phonation that can be maintained maintained by synkinetic reinnervation, in contrast to the final position of a lateralized vocal cord being determined solely by reinnervation.

Original languageEnglish (US)
Pages (from-to)2042-2046
Number of pages5
Issue number10
StatePublished - Oct 2010


  • Dysphonia
  • Injections
  • Larynx/surgery
  • Vocal cord paralysis

ASJC Scopus subject areas

  • Otorhinolaryngology


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