Vocal fold polyp resulting from calcium hydroxylapatite injection.

INTRODUCTION: Voice disorders resulting from glottic insufficiency create a significant burden for patients1. Treatment options have ranged from voice therapy to invasive laryngeal surgery. Over the past century, however, vocal fold injection augmentation has come forward as a safe and efficacious means to treat unilateral vocal cord paralysis, paresis, and atrophy2. Through extensive investigations several injectable materials have been utilized in the effort to find an ideal biologically inert and permanent substance. Materials have included Teflon, silicone, fat, and fascia each with variable results. One particular injectable, calcium hydroxylapatite has demonstrated impressive results3. As a biological agent, calcium hydroxylapatite is found in the microstructure of teeth and bones, offering rigidity and support. Its utility in orthopedic and head and neck reconstruction has been known for some time4. The combination of limited migration and causing only minimal inflammatory changes has made calcium hydroxylapatite suitable for injection laryngoplasty5. While seemingly well deserved, calcium hydroxylapatite’s record is not pristine. Used as a cosmetic filler, calcium hydroxylapatite has been associated with nodule formation6. Tanna et al reported a single case of foreign body reaction to calcium hydroxylapatite related to vocal fold augmentation7. In this report, calcium hydroxylapatite is associated with vocal fold polyp formation after injection laryngoplasty. Figure 1. Intraoperative laryngoscopy demonstrating a right vocal fold polyp (arrow).