Airway Complications Following Vocal Fold Injection Augmentation: A Case Series and Review of Literature

Abstract

ObjectiveThis case series seeks to describe three specific airway complications following vocal fold injection augmentation procedures involving carboxymethylcellulose gel. The literature review focused on adverse events linked to carboxymethylcellulose within the field of otolaryngology as well as beyond. Study DesignCase series MethodsThis series reviews the management of three patients whom suffered severe airway complications following vocal fold injection augmentations from December 2020 to August 2021 ResultsAll three of these patients received the Renu brand carboxymethylcellulose injection material. All three patients developed respiratory distress and stridor shortly following the injections, two before leaving the operating room and the third in the post anesthesia care unit. Both patients re-intubated in the operating room were found to have supraglottic edema upon direct laryngoscopy. All three patients required prompt re-intubation, and one patient required a temporary tracheostomy. None of these three patients were known to have a history of angioedema or anaphylaxis. ConclusionsVocal fold injection augmentation has long been considered a safe and effective means to improve glottic closure and treat dysphonia in patients with anatomic deficiencies of the vocal folds. While the listed ingredients are consistent between Prolaryn and Renu, studies directly comparing the two materials has only been performed in animals. This case series recognizes an important cluster of complications worth further study and post-market surveillance.