Percutaneous injection laryngoplasty.

INTRODUCTION Introduced a century ago by Bruening as a transoral procedure under general anesthesia, injection laryngoplasty is the oldest surgical management technique for vocal fold insufficiency. In 1985, Ward et al. introduced the office-based transcutaneous approach for vocal fold injection augmentation. They described the technique for Teflon injection under local anesthesia using the cricothyroid membrane approach while visualizing the injection using video laryngoscopy. This approach was developed to enable vocal fold augmentation in patients who could not undergo a transoral injection “due to anatomical deformity, trismus, or for other reasons.” Although initially described as a transcricothyroid membrane approach, percutaneous injection may also be performed in a transthyroid cartilage route or a transthyrohyoid membrane route. Office-based approaches are now commonly chosen for injection augmentation laryngoplasty. The authors’ technique for percutaneous injection laryngoplasty using the transcricothyroid membrane (TCM) and transthyroid cartilage (TTC) approach is described in this article.