Surgical management of calcium hydroxyapatite in the superficial lamina propria of the vocal fold

Abstract

Objectives: To describe surgical management of calcium hydroxylapatite (CaHA) inappropriately located within the superficial lamina propria (SLP) in patients undergoing injection laryngoplasty (IL) for unilateral vocal fold paralysis (UVFP). Methods: Retrospective chart review. Results: Three patients with persistent or worsening dysphonia after previous CaHA IL underwent attempted endolaryngeal excision of superficially located CaHA. In the patient with the least CaHA duration, a subepithelial CaHA mass was partially debulked via microlaryngoscopic cordotomy. However, in two patients with extended CaHA dwell time, residual CaHA took of the form of microspheres, which were either easily removed (if encapsulated) or diffusely scattered throughout the SLP, making extirpation impossible. Conclusions: CaHA can persist in the SLP for years following IL. Microlaryngoscopic explantation can improve voice in patients with malpositioned superficial injections; however, this may not be achievable, depending on the CaHA distribution, which may be a function of time elapsed since the initial IL.

Keywords

• Unilateral vocal cord paralysis
• Injection laryngoplasty
• Calcium hydroxyapatite
• Larynx
• Microlaryngoscopy