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26-09-2011 | Physical rehabilitation | Article

Injection laryngoplasty improves vocal function in oncology patients


Free abstract

MedWire News: A single injection with a tissue repair implant material can significantly improve vocal function in cancer patients with laryngeal dysfunction, show study findings.

"Despite the significant impact on quality of life (QoL) and function that vocal cord paralysis has on this population, the role of injection laryngoplasty (IL) in the oncology patient has received little attention to date," explain Michael Kupferman (The University of Texas MD Anderson Cancer Center, Houston, USA) and colleagues.

They therefore carried out a retrospective investigation including 61 cancer patients with laryngeal dysfunction who were treated with IL. Most of the patients had lung cancer, with head and neck and esophageal cancer the next most common diagnoses.

The patients had a mean duration of symptomatic laryngeal dysfunction of 6.4 months prior to treatment and the investigators estimated that an iatrogenic injury to the recurrent laryngeal or vagus nerve was the most common cause of the dysfunction (42.6% of patients).

Following a single injection with a suitable human tissue filler material (Cymetra - Lifecell, Branchburg, New Jersey, USA or Radiesse - Bioform, San Mateo, California, USA), all the patients had a significant self-reported improvement in their symptoms. These improvements were maintained at 3 months in 90% of the group.

Kupferman and team used videostroboscopy to visually assess the impact of the injection and confirmed that true vocal fold closure was significantly improved after vocal fold injection.

Maximum phonation time also increased two fold, from 5.0 to 10.5 seconds, in patients who had pre- and postoperative voice analysis (n=33).

Also, of the 14 patients with aspiration symptoms at baseline, 10 no longer required a modified diet at follow-up.

In total, only seven patients needed a follow-up injection and all had subjective and objective improvements in their symptoms as a result.

No major complications of IL were reported by the researchers. Two patients had minor dyspnea as a result of the procedure, but both were treated successfully with steroids.

Writing in the Annals of Oncology, Kupferman and colleagues say that "IL is a safe and efficacious technique for augmenting glottic function in select patients with vocal fold paralysis or paresis."

They conclude: "This minimally invasive approach obviates the need for interruptions in chemotherapy or radiotherapy. The procedure also eliminates [surgery] associated blood loss."

By Helen Albert

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