Foreign Body Reaction to Calcium Hydroxylapatite Vocal Fold Augmentation

Abstract

We report a case of inflammation with foreign body cell reaction following injection of the true vocal folds (TVFs) with Radiesse (Bioform Inc, San Mateo, Calif), a synthetic calcium hydroxylapatite (CaHA) material. The patient underwent injection laryngoplasty for a 10-year history of persistent hoarseness and documented bilateral vocal fold paresis. Initial postoperative examination revealed overaugmentation with migration of the material. The material was removed in 2 successive procedures. Results of histological examination revealed the presence of chronic inflammation and foreign body giant cells (FBGCs). This is, to our knowledge, the first published case of an apparent FBGC reaction to vocal fold augmentation with Radiesse and leads us to conclude that rare CaHA rejection reactions can occur in human subjects.