A Complication of Injection Laryngoplasty Using Radiesse

Abstract

CASE A 50-year-old male presented to a community-based otolaryngologist with a four year history of hoarseness. Fiberoptic laryngoscopy revealed mild, bilateral atrophy of the true vocal folds with incomplete closure. The patient underwent bilateral true vocal fold injection laryngoplasty with Radiesse. He continued to have a breathy voice postoperatively. Three months after the first injection, bilateral injection laryngoplasty with Radiesse was repeated. Following this operation, the patient's voice became significantly worse. He presented to our center where videostroboscopy revealed significant loss of mucosal wave. There was evidence of calcium hydroxylapatite bilaterally within the superficial lamina propria of the true vocal folds. We cared for this patient conservatively using a combination of medical management, voice therapy and serial videostroboscopy. His voice improved and videostroboscopy confirmed partial resorption of Radiesse. The patient’s voice has returned to eighty percent of baseline. REFERENCES 1. Rosen CA, Gartner-Schmidt J, et al. Vocal fold augmentation with calcium hydroxylapatite (CaHA). Otolaryngol Head Neck Surg 2007;136,198-204. 2. Rosen CA, Thekdi AA. Vocal fold augmentation with injectable calcium hydroxylapatite: Short-term results. J Voice 2004;18:387-391. 3. Hughes RGM, Morrison M. Vocal cord medialization by transcutaneous injection of calcium hydroxylapatite. J Voice 2004; 19:674-678. 4. Belafsky PC, Postma GN. Vocal fold augmentation with calcium hydroxylapatite. Otolaryngol Head Neck Surg 2004;131:351-4. 5. Chheda NN, Rosen CA, et al. Revision laryngeal surgery for the suboptimal injection of calcium hydroxylapatite. Laryngoscope, 2008;118:22602263. 6. Chhetri DK, Jahn-Parwar B, et al. Injection laryngoplasty with calcium hydroxylapatite gel implant in an in vivo canine model. Ann Otol Rhinol Laryngol 2004;113:259-264. CONCLUSIONS This case illustrates that subepithelial injection of Radiesse can be treated conservatively. There is at least partial resorption of Radiesse which is documented photographically in this report. However, given the evidence in prior studies regarding calcium hydroxylapatite's long term stability, complete resorption of Radiesse would not be expected.6 BACKGROUND In the treatment of unilateral impairment of vocal fold motion and glottic insufficiency, an injectable form of calcium hydroxylapatite (Radiesse) has shown some promise in true vocal fold augmentation secondary to its inert properties and relative long-term stability.1-4 In preliminary case series, few complications have been reported. Subepithelial injection with poor voice outcome has been reported and managed most often with surgical excision after observation for a period of months.3,5 We present a complication of bilateral subepithelial injection with Radiesse that we managed without surgery. Photodocumentation of this case shows partial resorption of the implant and the patient’s voice improved significantly.