Paraglottic fat injection (injection laryngoplasty)
by Vicky S Khattar, Vicky Bachi T

Jaypee’s Video Atlas of Operative Otorhinolaryngology AND Head & Neck Surgery

by Vicky S Khattar, Bachi T Hathiram
About Video

This video demonstrates the technique for injection of autologous fat into the paraglottic space to overcome glottic insufficiency. The fat can either be harvested by liposuction or surgically excised. In case of the latter, it is washed in insulin followed by saline and subsequently cut into very fine pieces. It is then loaded into the syringe and injected in a controlled fashion at two or three points in the paraglottic space. One of them is being just lateral to the vocal process of the arytenoids, so as to cause its medial rotation. In the case of fat, a slight over-correction is recommended to account for the loss due to partial absorption over a period of time. The choice of the needle is vital, as finer bored needles tend to get easily blocked with the fat particles, and the use of a 16- or 18-guage needle is recommended, especially when the fat has not been harvested by liposuction, but by open techniques. Depending upon the indication for the injection, it may be performed bilaterally in the same sitting as well; however, in such a situation, one must be wary of causing airway compromise, and the ‘overcorrection’ has to be very much controlled. Alternatively, one may defer the two sides by one or two weeks to obviate the worry of airway compromise. Vocal fold injection is also being carried out as an office procedure under topical anesthesia using flexible fiberoptic laryngoscopes today.

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