Injection Laryngoplasty for Unilateral Vocal Fold Paralysis: A Comprehensive Review of Complications

Abstract

Unilateral vocal fold paralysis (UVFP) is a condition characterized by impaired vocal fold movement, leading to significant voice, breathing, and swallowing difficulties. Transoral injection laryngoplasty (TIL) with hyaluronic acid (HA) has emerged as a minimally invasive and effective intervention for restoring vocal fold closure and improving phonatory outcomes in patients with UVFP. This review article examines the current evidence on the use of HA for TIL, highlighting its biomechanical properties, safety profile, and efficacy in achieving durable vocal fold medialization. Key clinical outcomes, including voice quality improvements, procedural techniques, and patient-reported satisfaction, are critically analyzed. Additionally, this review explores the limitations of HA-based laryngoplasty, such as variability in resorption rates, and compares its performance to other injectable materials. Future directions for optimizing HA formulations and integrating advanced imaging techniques for precise injection are also discussed. Injection laryngoplasty is a widely used procedure for managing unilateral vocal fold paralysis (UVFP), aiming to improve voice quality, glottal competence, and airway protection. Despite its efficacy, the procedure is associated with a range of complications that can affect outcomes and patient satisfaction. This review explores the complications of injection laryngoplasty, including procedural risks, material-related issues, and long-term effects. Common procedural complications include pain, bleeding, and vocal fold overinjection, leading to airway obstruction or phonatory instability. Material-related issues such as granuloma formation, foreign body reactions, and migration of injectable materials are significant concerns. Long-term complications include scarring, recurrent paralysis, and diminished effectiveness, necessitating repeat interventions. Additionally, rare but severe risks like infection and allergic reactions have been documented. Factors contributing to complications include the choice of injectable material, injection technique, and patient-specific variables such as comorbidities and vocal fold anatomy. Strategies to minimize these risks include the use of advanced imaging for precise delivery, selecting biocompatible materials, and individualized patient assessment. By synthesizing current evidence, this review highlights the importance of a multidisciplinary approach to optimize outcomes and mitigate complications in injection laryngoplasty. Future research should focus on novel materials and techniques to enhance procedural safety and effectiveness.