Use of the video-laryngoscope (GlideScope) in vocal fold injection medialization.

INTRODUCTION Vocal fold injection medialization is a safe and effective method to treat glottic insufficiency. Two methods of injection are most widely used: transorally via suspension laryngoscopy under general anesthesia, and percutaneously or transorally via flexible laryngoscopy in the office under local anesthesia. Although an office procedure can be advantageous due to procedure cost, the ability to titrate injectate, or patient factors (such as risk for general anesthesia, body habitus, and laryngeal exposure), surgeon or patient preference may tip the balance toward the operating room. In some cases, adequate laryngeal exposure under general anesthesia may prove impossible with traditional equipment. For these cases, we developed a novel technique using the GlideScope video-laryngoscope (Verathon, Inc., Bothell, WA) and a curved needle for injection. The GlideScope is a curved-blade rigid laryngoscope with a high resolution complementary metal-oxide semiconductor camera embedded along the undersurface of the blade with a 60 midblade angulation. The Macintosh-like blade is placed in the vallecula for anterior retraction. The resulting airway view is high resolution, wide angled, and magnified. Additionally, the curved laryngoscope enables exposure in the neutral “sniff” position, which obviates overextension of the neck. Once exposure of the glottis is achieved, injection can be performed using a malleable needle formed to mimic the shape of the GlideScope intubating stylet (Fig. 1).