Technical tip for difficult injection laryngoplasty: The use of a hypodermic needle as a retractor.

INTRODUCTION Local anesthetic injection medialization of the paralyzed or paretic vocal fold has become the mainstay of management in the voice clinic in recent years. The popularity of this technique compared to suspension microlaryngoscopy and injection has grown for several reasons: avoidance of general anesthesia, avoidance of risks of rigid laryngoscopy, short procedure time, real-time assessment of voice outcome, and possibly most importantly, a significant reduction in costs. Several approaches have been described for officebased injection, including peroral, transthyrohyoid, transcricothyroid, and transthyroid. Each of these procedures has their advantages and disadvantages; they all have comparable success rates and complication rates. Although the procedure can be completed successfully in most patients using any of the above approaches, the procedure may fail in 2% to 8% of cases. Several modifications and alternative techniques have been described to avoid failure of the procedure. However, one of the most common anatomic obstacles—an overhanging arytenoid and/or false cord—continues to be a technical challenge. We describe a modification of the transthyrohyoid technique to achieve successful injection of the vocal cord despite the presence of overhanging supraglottic structures. MATERIALS AND METHODS