Intralesional Steroid Injection Research Articles

Presentation and Management of Granulomatous Mastitis in the United States: Results of an American Society of Breast Surgeons Registry Study.

Granulomatous mastitis (GM) is a benign, chronic, inflammatory disease lacking clear treatment guidelines. The purpose of this American Society of Breast Surgeons (ASBrS) prospective, multisite registry was to characterize the presentation of GM and identify treatment strategies associated with symptom resolution and optimal cosmesis. ASBrS members entered data into a registry on patient demographics, treatment, symptoms, and cosmesis over a 1-year period. Initial symptoms were graded as mild, moderate, or severe. The Chi-square test and logistic regression were used to identify factors related to symptom improvement and cosmesis. Overall, 112 patients with a mean age of 36years were included. More patients were Hispanic (49.1%) and from the Southwest (41.1%), and management included observation (4.5%), medical (70.5%), surgical (5.4%), or combination treatment (19.6%). Immunosuppression was used in 83 patients (74.1%), including 43 patients who received intralesional steroid injections. Patients with severe symptoms were more likely to undergo surgical intervention compared with those with mild or moderate symptoms (21.4% vs. 0% and 7.5%, respectively; p=0.004). Within 1year, 85 patients (75.9%) experienced symptom improvement and/or resolution at a median of 3 months. Receipt of immunosuppressive therapy was predictive of improvement or resolution at 1month (odds ratio 4.22; p=0.045). One-year physician-assessed cosmesis was excellent or good for 20/35 patients (57.1%) and was not associated with type of treatment or symptom severity. Although GM can have a protracted course, the majority of patients in this registry resolved within 1year, with good cosmetic result. Treatment with immunosuppression appears to be most beneficial, and a symptom-based algorithm may be helpful to guide treatment.

Fibrotic reaction to hyaluronic acid fillers in the face.

Hyaluronic acids (HAs) can have very different actions not only depending on injector and host factors but also depending on their molecular weight. Whereas short chain HA has immunological activity long chain HA influences fibroblasts and may stimulate them to produce collagen. Although this is generally thought to be a positive feature it may be disadvantageous in certain localizations. We have encountered 23 patients who developed fibrous tissue next to the nasolabial folds accentuating them and becoming very obvious while smiling. Hyaluronidase injection did not reduce this mass. Intralesional triamcinolone acetonide injection led to rapid improvement. Fibrotic tissue reaction not responding to hyaluronidase may be the result of HA injection and can effectively be treated with intralesional steroid injection.

Comorbidities and Treatment Options for Acne Keloidalis Nuchae

Acne keloidalis nuchae (AKN) is a condition that involves chronic inflammation of the hair follicles on the occipital scalp and posterior neck that often progresses to keloid-like plaques. AKN has most commonly been reported to affect postpubertal males of African descent. The cause of AKN has not been definitively described; however, it is likely an inflammatory response to trauma or infection of the scalp. AKN is associated with chronic scalp folliculitis, hidradenitis suppurativa, folliculitis decalvans, acne mechanica, keratosis follicularis spinulosa decalvans, cutis verticis gyrata, metabolic syndrome, acanthosis nigricans, and hypothyroidism. Treatment for AKN begins with topicals, antibiotics, and intralesional steroid injections. Refractory cases are treated with laser and surgery. Isotretinoin, cryotherapy, phototherapy, electrosection, and radiotherapy have also been effective in treating AKN but are less commonly used. In this review, we describe the existing understanding of AKN with a focus on comorbid conditions and available treatment options.

Eruptive Epidermal Inclusion Cysts in a Renal Transplant Patient on Tacrolimus

Epidermal inclusion cysts are common cutaneous lesions that can develop anywhere on the body. While benign, these cysts can become inflamed and symptomatic. Symptomatic epidermal inclusion cysts can be treated with intralesional steroid injections or antibiotics, but surgical excision is often necessary for definitive treatment. We present a unique case of tacrolimus-induced eruptive epidermal inclusion cysts on the head and trunk of an adult male post-renal transplantation. Physicians should be familiar with this potential adverse effect, especially due to the difficulty of obtaining definitive treatment for a multitude of epidermal inclusion cysts.

Treatment of histiocytic neoplasms with intralesional steroids: A case series report

Introduction and importanceRosai-Dorfman disease was first described in the 1960s and is characterized by hyperproliferation of histiocytes, which presents as painless lymphadenopathy with fever, night sweats, and weight loss. This disease often affects young adults and children of African descent. Different types of RDD exist, including familial, classical (nodal), extranodal, neoplasia-associated, and immune-associated. While this disease can cause significant pain, there is currently no consensus on treatment. Case presentationThis case series outlines three cases of bony involvement of histiocytic neoplasms and our technique for intralesionoal steroid injections. Two cases were successfully treated with intralesional steroid injections and one patient was treated with oral steroids. Clinical discussionHistiocytic neoplasms can cause significant pain for patients and there is no standardized treatment as of yet. An interesting finding on MRI was a characteristic peripheral edema we termed the “Halo Sign”. Steroids are believed to exert their benefit in treating this disease by apoptosis and reducing tumoral swelling. ConclusionThis case series demonstrates the successful management of bony involvement of RDD with intralesional steroids similar to eosinophilic granuloma. While intralesional steroid injection has previously been described for other types of RDD, this is the first description of bony RDD treated with this technique to our knowledge.

The clinical efficacy of single-hole punch excision combined with intralesional steroid injection for nodular keloid treatment: a self-controlled trial

There are many methods to treat keloid, including various excision operations, laser, injection and radiotherapy. However, few studies have explored the effectiveness of single-hole punch excision in keloid treatment. This study aimed to investigate the efficacy and safety of lateral punch excision combined with intralesional steroid injection for keloid treatment through self-control trial. In this self-controlled trial, 50 patients meet the diagnosis of nodular keloid, and try to choose left–right symmetrical control, one skin lesion in the control group (50 skin lesionsin total) and the other in the observation group (50 skin lesions in total).The keloids in the treatment group were initially treated with punch excision combined with intralesional steroid injection, followed by injection treatment alone. Keloids in the control group received intralesional steroid injection alone. The Vancouver Scar Scale (VSS) of the keloid before and after the punch excision was evaluated; the keloid scores at different time points and the number of injection treatments required in both groups were compared, and adverse reactions were observed. The effective rate of the observation group was 86.0%, which was significantly higher than that of the control group (66.0%), and the recurrence rate of 22% was lower than that of the control group (χ2 = 4.141,63417), all of which were statistically significant (all P < 0.05). At the end of treatment, the VSS and total injection times in the observation group were significantly lower than those in the control group (t = 5.900,3.361), with statistical significance (P < 0.01). The combination of single-hole punch excision and intralesional steroid injection is an effective method to treat multiple nodular keloids, shortening the treatment course of tralesional steroid injection without obvious adverse reactions.

Incidence, treatment method and recurrence rate in giant cell granulomas: Retrospective study

Central and peripheral giant cell granulomas are benign entities mostly seen in mandibular anterior region at female individuals, usually with observed recurrence. Their etiology is still unclear, as is the optimal method for treating them. The aim of this study was to evaluate the incidence, treatment methods, recurrence rates, and initial and definitive correlation of central and peripheral giant cell granulomas.Patients who were referred to our clinic between 2013 and 2023 and who had the lesions’ definitive diagnosis as “central giant cell granuloma” (CGCG) or “peripheral giant cell granuloma” (PGCG) were included in the study. Demographic data, recurrence rates, treatment methods, lesion location, clinical behaviors, and sizes were noted on the reports.A total of 30 lesions in 23 patients (14 PGCG and 9 CGCG) were evaluated in this study. The mean follow-up time was 62.6 months; 8 of 23 patients had systemic disease. While only 1 patient was observed to have cortical bone destruction in PCGC, all patients were found to have cortical bone destruction in CGCG (p < 0.05). In both lesions, the correlation of preliminary and definitive diagnosis was evaluated, and it was found to be 50% in PGCG while it was 77.7% in CGCG. The recurrence rates were 21.4% in PGCG and 33.3% in CGCG. Curettage was applied in all patients. Additional treatments (intralesional steroid injections, denasumab applications, resection, and graft application) were performed in 5 patients who were found to have CGCG (p = 0.004). However, there was no significant relation between treatment method and recurrence in CGCG (p > 0.05).Various peripheral lesions could mimic PGCG; thus, curettage therapy could be appropriate in the treatment of PGCG. Nevertheless, in some cases of CGCG, additional treatment methods could be more effective for preventing recurrence and any other complications.

Cost benefit analysis of intralesional injections in keloids using Luer lock and non-locking syringes

Background: For keloid scarring, intralesional corticosteroid injections continue to be the most often utilised first therapeutic option. This is a common procedure done on an outpatient basis by surgeons and orthopaedists. Luer lock syringes which lock the needle with syringe prevent any leakage or spillage of drug while pushing it near the keloid compared to normal syringes. Methods: We intend to do a cost benefit analysis based on the retrospective data of intralesional steroid injections done by the authors (AP and SK) in their private practice. Results: The time between 2021 to 2022, 200 injection data was retrieved, 100 each using non locking syringes and Luer lock syringes. The spillage rate with non-Luer lock syringes was 14%. Conclusions: We found that luer lock syringes prove to be cost effective after giving more than 200 injections in keloids than non-locking syringes.

In‐office serial intralesional steroid injection for subglottic stenosis: Case series of 14 patients with multiple etiologies

AbstractObjectiveSubglottic stenosis (SGS) is commonly treated with endoscopic dilations or tracheal resection. Since office‐based serial intralesional steroid injections (SILSI) were first reported in 2017, they have been established as an effective, less invasive treatment alternative or adjunct. The aim of this study is to add to the literature investigating the efficacy of office‐based SILSIs for idiopathic and post‐intubation SGS patients, specifically studying surgery‐free intervals (SFIs) and discussing our experience with SILSI treatment order and stenosis grade.MethodsThis study is a retrospective case series of 14 patients with subglottic stenosis treated with in‐office serial intralesional steroid injections as a primary or adjuvant treatment from 2018 to 2022 in an academic tertiary care center.ResultsOf seven patients with calculable SFI, a mean SFI increase of 481.28 days was observed following SILSI treatment (p = 0.042). Ten patients in our cohort presented with idiopathic or post‐intubation grade 2 SGS and were managed successfully with a combination of endoscopic dilation and SILSI. Two patients with post‐intubation grade 1 SGS were managed successfully with SILSI as their primary treatment. Two patients with post‐intubation grade 3 SGS required a tracheal resection and did not benefit from SILSI.ConclusionsWe have found that SFI significantly increased following SILSI initiation. Although statistical power was limited given the small sample size, our findings suggest that SILSI may be an effective primary treatment in low‐grade stenosis. SILSI as an adjuvant to endoscopic dilation may be most effective in intermediate‐grade stenosis. SILSI may not be effective in high‐grade stenosis patients who failed prior endoscopic treatment.

The Application of I-Scan Imaging for Evaluating Benign Vocal Lesions

Current standard methods for evaluating benign vocal lesions, including white light laryngoscopy and video laryngostroboscopy, may struggle to identify smaller lesions. While histopathological results obtained from laryngeal microsurgery provide definitive results, their invasiveness can lead to scarring and impaired phonological outcomes. Intralesional steroid injection has recently gained acceptance, but it lacks pathological diagnostic capabilities. Therefore, there is a growing need for a simple examination that can enhance the diagnosis of benign vocal lesions. NBI, from Olympus Corporation, has shown promising outcomes in detecting and characterizing laryngeal lesions. The i-scan technology by PENTAX, while providing the ability to improve visual clarity during endoscopic procedures, has been addressed less in this field. Our study aims to further investigate the application of i-scan imaging in benign vocal lesions, enrolling patients diagnosed with vocal cysts, polyps, and nodules. We conducted i-scan imaging prior to office-based intralesional steroid injection, assessing the possibility of its providing additional diagnostic information for benign vocal lesions without additional burden.

DERMATOFIBROSARCOMA PROTUBERANS: THE EXPERIENCES OF DIAGNOSIS AND TREATMENT THROUGH A RARE CASE REPORT

Background: Dermatofibrosarcoma protuberans (DFSP) is classified as a soft tissue sarcoma, representing a rare form of skin cancer. Despite its rarity, DFSP is acknowledged as the most common skin sarcoma. The clinical features of DFSP are highly varied, making early-stage diagnosis challenging. Treatment initiated at an advanced stage significantly increases the risk of DFSP recurrence. Case Report: A 65-year-old female patient sought medical attention at our hospital due to a giant tumor on her central back. The lesion had initially appeared two years prior and had been initially misdiagnosed as keloids. Subsequently, the patient underwent intralesional steroid injections and surgery at a private clinic, but the lesion exhibited no improvement and relapsed within two months. Upon presenting to the National Hospital of Dermatology and Venereology, the patient displayed a brown-red raised tumor measuring approximately 8x4cm on her back. Given the suspicion of a cutaneous carcinoma, a biopsy was conducted. The histopathology and immunohistochemistry tests confirmed the diagnosis of DFSP. Consequently, the patient underwent wide excision of the lesion, including 3 cm of normal skin around it and deep into the fascia. No recurrence was recorded after one year of follow-up. Conclusion: DFSP, a rare form of skin carcinoma, can be challenging to differentiate from various other conditions, including keloids. In cases where conventional treatments such as intralesional triamcinolone acetonide injection show poor improvement for suspected keloids, DFSP should be considered and confirmed through histopathology and immunohistochemistry tests. Received 28 June 2023Revised 26 September 2023Accepted 29 November 2023

Practical management of hypertrophic scarring: the mayo clinic experience.

Hypertrophic scarring is a potential consequence of wound healing that causes functional and aesthetic disability. Common treatments include intralesional pharmacotherapy (e.g., triamcinolone), surgical excision, and energy-based laser devices. While numerous treatment methods have been described for hypertrophic scarring, an optimal treatment strategy has yet to be established given variability in clinical presentation. This study aims to identify patient- and provider-preferred treatment patterns. This is a single-center, retrospective study of adult patients that developed post-surgical hypertrophic scarring between 2007 and 2017. Specifically, trends in procedural management for hypertrophic scarring among this cohort were examined. A total of 442 procedures (intralesional steroid injection, surgical excision, laser-based treatment) were identified in 218 patients with a clinical diagnosis of hypertrophic scarring. Approximately 73% were female; 87% were Caucasian. The median age at first procedure was 45.6years (SD = 17.4). The most frequent anatomical locations for procedures were the trunk (n = 242; 54.8%), followed by head/neck (n = 86; 19.5%), upper extremities (n = 67; 15.2%), and lower extremities (n = 45; 10.2%). Procedural therapies included intralesional steroid injection (n = 221; 50%), surgical excision (n = 112; 25.3%) and laser (fractional non-ablative laser vs. pulsed dye laser; n = 109; 24.5%). Treatment modality varied by stage of treatment, scar anatomical location, and scar size. This single-center series of patients with hypertrophic scarring highlights a patient-centered management approach and offers clinical guidelines for provider-patient shared decision making.

Effect of Intralesional Steroid Injections Among Patients with Acquired Laryngotracheal Stenosis Undergoing Endoscopic Balloon Dilation Using Pulmonary Function Tests.

Objectives: Laryngotracheal stenosis (LTS) is characterized by an abnormal decrease in the upper airway diameter. The pulmonary function test (PFT) is an effective adjunctive diagnostic tool for upper airway obstruction. LTS can be managed with either open surgery or less invasive endoscopic approaches, among which endoscopic balloon dilation is the main method; this may include concurrent intralesional steroid injection (ILSI), which has the potential of improving the outcomes. However, the effectiveness of ILSI is unclear. We aimed to compare the improvement in PFT parameters among patients with acquired LTS following endoscopic balloon dilation who received and did not receive ILSIs. We also compared the recurrence times and rates between the 2 patient cohorts. Methods: We retrospectively collected data regarding pre- and postoperative PFTs, as well as inter-dilation interval records, obtained between June 2015 and April 2020. Results: We included 34 patients with acquired etiologies. The most common cause of stenosis was intubation (52.9%), followed by trauma (29.4%). Further, 52.9% of the patients received ILSIs. Symptom recurrence was reported in 23 (67.6%) cases, with no significant between-group difference -0.1389 [95% confidence interval (CI): -0.4483, 0.1705]. The mean (standard deviation) duration of the first reintervention was 8.62 (8.00) and 7.38 (3.20) months among patients who did and did not receive ILSIs, respectively (mean difference -1.23, P = .614, 95% CI -6.30, 3.84). Conclusion: Our findings indicated that PFT parameters improved following endoscopic balloon dilation, with forced expiratory volume in 1 second being significantly higher with concurrent ILSI. However, there was no between-method difference in the treatment effectiveness. Additionally, the restenosis recurrence rate was consistent with that reported in the literature.

Granuloma Annulare: A Rare and Unusual Lesion of the Eyelid.

Granuloma annulare (GA) is common in children, but the eyelids are not a common site of involvement. Due to the infrequent association of eyelid lesions with GA, patients are unable to receive early and effective treatment. Our eleven-year-old female patient presented with the complaint of a painless mass on the right upper eyelid that did not respond to the topical drugs prescribed in clinics. An incisional biopsy was performed to diagnose the patient with an unusual subcutaneous raised lesion on the eyelid. The histopathological result was consistent with immunohistochemical staining and granuloma annulare showing CD68 positivity. Intralesional steroid injection was performed because the lesion caused the patient cosmetic problems. The lesion began to regress significantly in the first week and did not recur. The atypical location of the GA lesions in the eyelid seen at a young age should be kept in mind and treated effectively.

Managing Surgical Site Scarring as a Complication of Permanent Pacemaker Implantation

ABSTRACT Pathologic collagen deposition in the form of keloid or hypertrophic scarring can result from any procedure that involves skin barrier disturbance. In this case report, we present a case of a patient who developed hypertrophic scarring complicated by the uncommon symptom of dysesthesia after pacemaker implantation and was successfully treated with intralesional corticosteroids. Although intralesional steroid injection is a well-known treatment option for hypertrophic scarring, both the rarity of hypertrophic scarring after pacemaker implantation and the seriousness of the complications that can result from pocket seeding and infection after injection at a pacemaker site are noteworthy. This case thus serves as a precautionary guideline for providers who will encounter similar cases.

FRI554 Pretibial Myxedema Associated With Hashimoto Thyroiditis Treated With Teprotumumab

Abstract Disclosure: E.M. Niedzialkowska: None. B. Ajaz: None. A. Pokharel: None. Introduction: Pretibial myxedema (PTM) is a localized thyroid-associated dermopathy characterized by local thickening of the skin of the lower extremities. It mostly develops after the onset of thyroid eye disease (TED). Majority of the cases are associated with Graves disease (GD) but infrequently it can occur in Hashimoto thyroiditis (HT) in the presence of thyroid stimulating immunoglobulins (TSIs). Orbital fibroblasts and the pretibial dermis share antigenic sites that underlie autoimmune thyroid disease. IGF-1 has been reported to potentiate the effects of TSH and TSI on TSHR signaling and fibroblast proliferation. Teprotumumab, a novel monoclonal antibody that blocks IGF-1R receptors, is registered for TED treatment. It is plausible it also improves outcomes in PTM through the same mechanism. Clinical case: 52 year old female reported to our Endocrinology clinic with proptosis and myxedema. The patient was diagnosed with hypothyroidism at the age of 21 and was on substitutional dose of levothyroxine, 125 mcg daily. She developed TED 7 years prior with bilateral exophthalmos with medial rectus muscle infiltration. She underwent 5 decompression surgeries and steroid courses due to concern for optic nerve compression. 4 years prior to the visit she developed bilateral, erythematous pitting edema of the lower extremities with involvement of the pretibial areas, ankles and toes and underwent excess left toe callus excision. Despite multiple courses of intralesional steroid injections and topical ammonium lactate use the patient reported persistent edema, pruritus, and restriction of motion. Laboratory results were significant for TSH of 1.73 uIU/mL (n 0.40 - 4.50 uIU/mL), TRAB &amp;gt;40 IU/L (0.00 - 1.75 IU/L), TSI 4.95 (n &amp;lt;0.10 IU/L), TPO antibody &amp;lt;=35 IU/mL, free ft3 2.5 pg/ml (1.7 - 3.7 pg/mL), free ft4 1.0 (0.7 - 1.5 ng/dL). The patient underwent thyroidectomy with pathology results consistent with Hashimoto thyroiditis (thyroiditis with thyroid follicles, Hurthle cell change, marked lymphoid and fibroadipose tissue). Following the procedure she experienced PTM and TED flare up. Subsequent orbital decompression and orbital steroid injections provided minimal improvement. The patient was started on Teprotumumab (8 infusions every 3 weeks) with marked improvement of orbitopathy (CAS reduction from 6/10 to 1/10) and significant reduction of lower extremity edema and rash. Conclusion: We present the case of Hashimoto thyroiditis associated with TED with PTM successfully treated with Teprotumumab. In TED, TSI binds to IGF-1R creating a complex that promotes orbital inflammation. Teprotumumab is believed to degrade antibody-receptor complex and downregulate fibroblast activation and glycosaminoglycans deposition. We postulate the same process may occur in dermal fibroblasts in the light of PTM improvement after teprotumumab treatment. Presentation: Friday, June 16, 2023

Local steroid injection in severe idiopathic granulomatous mastitis as a new first-line treatment modality with promising therapeutic efficacy.

Intralesional steroid injection has recently evolved as a novel treatment modality for localized idiopathic granulomatous mastitis (= IGM). We aimed to explore the therapeutic efficacy of local steroid injections (LSI) in patients with severe IGM. Fifty-one patients diagnosed with severe IGM were included in the study and treated with either local steroid injection (LSI) alone (n = 25) or combined LSI with systemic oral steroid treatment (OST) (n = 26). The local steroid injection protocol included an intralesional triamcinolone acetonide injection into the palpable granulomas every 4-week, and topical administration of steroid-containing pomades twice a day on the affected surface of the breast. Patients with a combined LSI and OST received low-dose oral methylprednisolone (<16 mg). Patients with LSI alone required more LSI applications than those in the combined LSI with OST group (LSI: 5 ± 2.9; vs. LSI/OST: 3.5 ± 2.5; p = 0.080) to obtain an effective optimum therapeutic response. At a median of 12 months (range, 4-42), no difference was found in complete response rates between patients in the LSI group and the combined LSI group with OST (52 vs. 53.9%, p = 0.999). However, steroid-related systemic side effects were lower in the LSI alone group (p < 0.008). Local steroid injection could be considered as the first-line treatment in patients with severe IGM until a therapeutic response has been obtained either as the sole treatment modality or combined with oral steroids. Compared with systemic oral steroid therapy, local steroid administration can be considered a new treatment modality with fewer side effects.

Framework and guide for intralesional steroid injections in idiopathic granulomatous mastitis

PurposeLiterature on how to perform intralesional steroid injections, a valuable therapy for idiopathic granulomatous mastitis (IGM), is limited. This technical note offers a detailed technical guide on intralesional steroid injections for IGM and provides a framework for long-term follow-up. MethodsUltrasound characterization of IGM severity considering breadth, depth, and ancillary findings was used to guide steroid dosing and injection frequency. Clinical and sonographic breast diagrams were designed for accurate longitudinal tracking of IGM. A step-by-step guide for ultrasound-guided IGM aspirations and intralesional steroid injections was developed. ResultsA detailed approach for ultrasound-guided IGM interventions with clinical and sonographic breast diagrams for longitudinal follow-up is now in practice. ConclusionsThe treatment approach described provides a framework for multidisciplinary treatment of IGM and offers insights that may contribute to the ongoing development and improvement of management strategies for this challenging disease.

Beyond Belief: A Rare Encounter with Eye Teratoma

A 7-year-old boy presented with progressive swelling in left eye since childhood. Examination revealed a soft cystic mass in the medial aspect of the left orbit. Rudimentary eye structures were present in left eye. There was no evidence of any exposure keratitis. A clinical diagnosis of congenital cystic eyeball was made and patient underwent cystic fluid aspiration followed by intralesional steroid injection followed by enucleation. Histopathology showed mature neuroglial tissue, fibro collagenous and vascular proliferation with mature cartilage suggestive of congenital mature teratoma. This case report tends to highlight the features of this rare case of congenital mature teratoma of eye.

Effect of Intralesional Steroid Injection in Bilateral Benign Vocal Fold Lesions

Abstract Background Corticosteroids are one of the most potent inhibitors of inflammation and wound repair. Local injection of steroid gives the option of administration of a potent drug locally, thereby avoiding the systemic side effects of them. They have been used in the last decade in managing benign vocal fold lesions as intralesional steroid injection has the advantages of rapid subsidence of the inflammation and edema with rapid improvement of voice postoperatively Ailil of the work This study is designed to show clinical ancl encloscopic voice Iinprovelnent of microlaryngeal surgery alone versus microlaryngeal surgery of the prilnary lesion combined with steroid injection in the opposing lesion in patients with bilateral vocal fold benign lesions. Patients and methods 40 patients with bilateral benign vocal fold lesions with Inoclerate to severe dysphonia are divided into two groups, one group underwent microlaryngo-surgery with excision of the primary lesion and injection of steroids into the contralateral lesions. The second group underwent microlaryngo-surgery with excision of the primary lesion only. Each subject was evaluated, preoperatively and postoperatively through a protocol including auditory perceptual assessment, laryngoscopic picture and self-rating by the patient using VHI. Results Comparing pre and post therapy results for each group, there was statistically significant improvcmcnt (reduction) in the size of thc contralatcral lesion and significant improvement in the quality of voice quality resulting in overall improvement in VHI. Conclusion Intralesional steroid injection in the contralateral lesion in bilateral benign vocal fold lesions is effective in improving voice quality postoperatively