Transcutaneous Intrafold Silicone Injection

Abstract

Since 1983, at Kurume University Hospital, transcutaneous Intrafold silicone injection (TCIFSI) has been employed as the first choice in almost all cases with unilateral vocal fold paralysis (UVFP) . The reliability, long-term effectiveness, and factors affecting vocal function after this procedure were examined based upon 325 patients with UVFP who underwent TCIFSI.
TCIFSI resulted in a dramatic improvement of vocal function, with stability enduring for a long period. In addition, the safety of TCIFSI was also shown. Repeated injections of silicone were also effective.
With respect to factors affecting vocal function after TCIFSI, the following eight factors were seen to have no singnificant relationship with vocal function after TCIFSI : gender, laterality, period after onset of UVFP, EMG findings, extent of aspiration, position of paralyzed vocal fold, volume of injected silicone, and extent of bowing of paralyzed vocal fold. On the contrary, the following cases were shown to be good indications of TCIFSI : 1) young patients with UVEP due to neck disease, 2) patients with width of posterior glottal gap during phonation less than 10 % of the length of the membranous portion of the vocal fold, 3) patients with maximum phonation time more than 3 sec, and 4) patients with mean air flow rate during comfortable phonation less than 400 ml/sec.