make an essay answer on injection laryngoplasty , indications contraindications , materials used , technique, and complications of it and make it as a pdf
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Injection Laryngoplasty Essay
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Here is a summary of what the essay covers, sourced from Scott-Brown's Otorhinolaryngology Head & Neck Surgery (8th ed.) and Cummings Otolaryngology Head and Neck Surgery (7th ed.):
1. Introduction - Historical background from Brunings (1911) and Arnold (1962); place of injection laryngoplasty within phonosurgery.
2. Indications
- Unilateral vocal fold paralysis with glottic insufficiency (especially small glottic gap, anticipated recovery, dysphagia, high vocal demand)
- Presbyphonia (age-related vocal fold atrophy/bowing)
- Post-surgical soft tissue defects, sulcus vocalis, scar-related thinning
- Intraoperative temporary medialization during oncological procedures
3. Contraindications
- Absolute: large posterior glottic gap, height discrepancy between folds, inability to protect the airway, active infection, proven material allergy
- Relative: ossified cartilage, large glottic gap (>3 mm), coagulopathy, uncooperative patient, PTFE history
4. Materials - Full coverage of PTFE (historical), autologous fat, hyaluronic acid, calcium hydroxyapatite (Radiesse Voice - most durable, ~1 year), Cymetra, carboxymethylcellulose gel, glycerine, collagen, and silicone (Bioplastique).
5. Technique - Local vs general anaesthesia; all four transcutaneous routes (trans-thyroid cartilage, cricothyroid membrane, thyrohyoid membrane, transoral) plus direct laryngoscopy; injection site and depth (paraglottal space, lateral to vocalis muscle); over-injection principle.
6. Complications - Under-injection, over-injection with airway compromise, misplaced/superficial injection, granuloma (especially PTFE), material migration, foreign body reaction, haematoma, infection, and universal lamina propria stiffening.
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