Muhammed Kürşat YELKEN, Ahmet Hakan BİRKENT, Haldun OĞUZ, Ozan Bağış ÖZGÜRSOY, Emel ÇADALLI TATAR, Zahide Çiler BÜYÜKATALAY, Necat ENVER, Kayhan ÖZTÜRK, Elad AZİZLİ, Sevtap AKBULUT, Hakan COŞKUN

Inflammatory complications of vocal fold injection with hyaluronic acid: a multiinstitutional study

Background/aim: This study aimed to assess the inflammatory adverse reactions of vocal fold injection laryngoplasty with hyaluronic acid. Materials and methods: This study was a retrospective chart review of patients who underwent vocal fold injection augmentation with HA injection from January 2005 to September 2016 in nine different institutions. Demographic data, indication for injection, injection techniques, types of injection material, settings of procedure, and complications were reviewed. The types of complication, onset time, and management of complications were also noted. Results: In all, 467 patients were identified. The majority of patients had been injected under general anesthesia (n = 382, 84.7%). For injection material, two different types of hyaluronic acid were used: hyaluronic acid alone or hyaluronic acid with dextranomer. Complications occurred in nine patients (1.9%). The majority of complications were inflammatory reactions (n = 7, 1.47%). Main symptoms were dysphonia and/or dyspnea with an onset of 0 h to 3 weeks after the hyaluronic acid injection. Three patients were hospitalized, one of which was also intubated and observed in the intensive care unit for 24 h. Systemic steroids and antibiotics were the main medical treatment in the majority of cases. There was no statistical difference in complication rates between patients who received hyaluronic acid and those who received hyaluronic acid with dextranomer (P = 0.220). Conclusion: Hyaluronic acid can be considered as a safe substance for the injection of vocal folds with a low risk of inflammatory reaction.Key words: Vocal fold injection, hyaluronic acid, hyaluronic acid with dextranomer, inflammatory reaction, vocal fold paralysis, sulcus vocalis

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1. Song PC, Sung, CK, Franco RA. Voice outcomes after endoscopic injection laryngoplasty with hyaluronic acid stabilized gel. Laryngoscope 2010; 120 (Suppl. 4): S199. doi: 10.1002/ lary.21666
2. Brunings W. Uber eine neue Behandelungs methode der Rekurrenslamung. Verhandl Ver Deutch Laryngologie 1911; 18: 93-98.
3. Thibeault SL, Klemuk SA, Chen X. Quinchia Johnson BH. In vivo engineering of the vocal fold ECM with injectable HA hydrogels-late effects on tissue repair and biomechanics in a rabbit model. Journal of Voice 2011; 25: 249-253. doi: 10.1016/j. jvoice.2009.10.003
4. Kim YS, Choi JW, Park JK, Kim YS, Kim H et al. Efficiency and durability of hyaluronic acid of different particle sizes as an injectable material for VF augmentation. Acta Oto-Laryngologica 2015; 135: 1311-1318. doi: 10.3109/00016489.2015.1070966
5. Halderman AA, Bryson PC, Benninger MS, Chota R. Safety and length of benefit of restylane for office-based injection medialization-a retrospective review of one institution’s experience. Journal of Voice 2014; 28: 631-635. doi: 10.1016/j. jvoice.2014.01.010
6. Reiter R, Rudolf R, Brosch S, Sibylle B. Laryngoplasty with hyaluronic acid in patients with unilateral vocal fold paralysis. Journal of Voice 2012; 26: 785-791. doi: 10.1016/j. jvoice.2011.11.007
7. Traboulsi H, El Natout T, Skaff G, Hamdan AL. Adverse reaction to hyaluronic acid injection laryngoplasty: a case report. Journal of Voice 2017; 31: 245.e1-245.e2. doi: 10.1016/j. jvoice.2016.08.011
8.Dominguez LM, Tibbetts KM, Simpson CB. Inflammatory reaction to hyaluronic acid: a newly described complication in vocal fold augmentation. Laryngoscope 2017; 127: 445-449. doi: 10.1002/lary.26156
9.Tsai CC, Lin V, Tang L. Injectable biomaterials for incontinence and vesico-ureteral reflux: current status and future promise. Journal of Biomedical Materials Research Part B: Applied Biomaterials 2006; 77: 171-178. doi: 10.1002/jbm.b.30428
10. Oguz H, Demirci M, Arslan N, Arslan E. Long-term voice results of injection with hyaluronic acid-dextranomere in unilateral vocal fold paralysis. Acta Oto-Laryngologica 2013; 133: 513- 517. doi: 10.3109/00016489.2012.750034
11.Sulica L, Rosen CA, Postma GN, Simpson B, Amin M et al. Current practice in injection augmentation of the vocal folds: indications, treatment principles, techniques, and complications. Laryngoscope 2010; 120: 319-325. doi: 10.1002/ lary.20737
12.Perazzo PS, Duprat AC, Lancellotti CL. Histological behavior of the vocal fold after hyaluronic acid injection. Journal of Voice 2009; 23: 95-98. doi: 10.1016/j.jvoice.2007.05.006
13. DeLorenzi C. Complications of injectable fillers, part I. Aesthetic Surgery Journal 2013; 33: 561-575. doi: 10.1177/1090820X13484492
14. DeLorenzi C. Complications of injectable fillers, part 2: vascular complications. Aesthetic Surgery Journal 2014; 34: 584-600. doi: 10.1177/1090820X14525035
15. Enver N, Asya O, Abuzaid G, Gürol E. A very rare complication of hyaluronic acid injection for medialization laryngoplasty: a case with laryngeal abscess. Journal of Voice 2020; 34 (5): 812. e5-812.e8. doi: 10.1016/j.jvoice.2019.03.011
16. Shamanna SG, Bosch JD. Injection laryngoplasty: a serious reaction to hyaluronic acid. Journal of Otolaryngology - Head Neck Surgery 2011; 40: E39-42.
17. Abduljabbar MH, Basendwh MA. Complications of hyaluronic acid fillers and their managements. Journal of Dermatology & Dermatologic Surgery 2016; 20: 100-106. doi: 10.1016/j. jdds.2016.01.001
18. Hamdan AL, Khalifee E. Adverse reaction to restylane: a review of 63 cases of injection laryngoplasty. Ear Nose Throat Journal 2019; 98: 212-216. doi: 10.1177/0145561319835773