Surgical correction of the convex vocal cord after Teflon injection.

Teflon injection of paralyzed and bowed vocal cords has been performed since 1962. It has been generally accepted that nothing could be done if an excess is injected or a granuloma reaction within the cord occurs causing an early or late convex cord which projects across the midline. A technique is described to correct such convex cord problems and the results are given for 12 patients for whom corrective surgery was done.

Intermediate results of 306 recurrent laryngeal nerve sections for spastic dysphonia.

Recurrent laryngeal nerve section for spastic dysphonia was first performed in 1975 because prior forms of treatment had failed. Virtually every patient has had a detailed postoperative follow-up which includes a tape recording and a self-assessment questionnaire. The majority of patients remain free of spasticity at this medium-term follow-up. In some, spasticity recurred with less than preoperative severity. A small percentage of patients have a persistent breathy phonation. The first group is treated with vocal fold lateralization procedure using the CO2 laser; the second, with Teflon. When needed, voice therapy is also given. This paper provides a basis for diagnosis, indications for surgery, primary and secondary surgical techniques, encountered problems, and medium-term follow-up results.

The endoscopic Teflon keel for posterior and total glottic stenosis.

Most cases of posterior commissure stenosis today result from endotracheal intubation. The problem has been very difficult to repair. Posterior commissure stenosis has been treated by repeated dilations, which do not work, and reconstructive measures by means of laryngofissure to excise the scar followed by the placement of round stents alone or round stents in combination with mucosal or skin grafts. This treatment also fails frequently. Some, but not all, cases have been cured with laser surgery via microdirect laryngoscopy. An endoscopically placed Teflon keel has been useful in the treatment of posterior glottic and total glottic stenosis when laser surgery is not feasible. Nine patients with posterior glottic stenosis, two of whom initially had total glottic stenosis, have undergone placement of the posterior commissure Teflon keel. Six patients had resolution of the stenosis and were decannulated. One required an arytenoidectomy for a fixed cricoarytenoid joint before successful decannulation. Two patients had marked improvement of their laryngeal airway with this approach, but have not yet been decannulated because of fixed cricoarytenoid joints.

Endoscopic Teflon keel for anterior glottic web.

Anterior glottic webs are generally repaired with a McNaught keel placed and removed by laryngofissure. Attempts have been made since 1922 to repair these webs endoscopically. An endoscopic technique using a Teflon keel which has been successful in properly selected cases is presented.

Injection and removal of Teflon for unilateral vocal cord paralysis.

For over 70 years, reinnervation attempts have been unsuccessful in restoring motion to paralyzed vocal cords, in spite of occasional claims to the contrary. Fortunately, the major defect of unilateral vocal cord paralysis, a soft and breathy voice, can be eliminated if the edge of the paralyzed vocal cord is moved to the midline. This permits the mobile vocal cord to adduct and therefore to vibrate firmly against the edge of the paralyzed vocal cord during phonation, eliminating the air leak between the vocal cords. Teflon injection of the paralyzed vocal cord does this effectively. It is accomplished most easily and reliably via indirect laryngoscopy under local anesthesia, so the effect on the voice can be monitored during the injection. Teflon can be easily removed from the vocal cord via direct laryngoscopy. The disadvantages of trying to medialize the edge of a paralyzed vocal cord via a window in the thyroid cartilage (laryngeal framework surgery) will be discussed.

Histologic evaluation of Teflon granulomas of human vocal cords. A light and electron microscopic study.

It is sometimes necessary to remove Teflon from convex vocal cords to improve the quality of voice. This has provided material which shows the histologic effect of Teflon injection in the vocal cord at intervals varying from four weeks to sixteen years after injection. In the study, vocal cord specimens were obtained from twelve patients. These were all examined with light microscopy and some observations have also been made with electron microscopy.

Ultrastructure of multinuclear giant cells of a human vocal cord Teflon granuloma.

The ultrastructural characteristics of multinuclear foreign-body giant cells (MCG) in a human vocal cord Teflon granuloma are described. The cells were found to contain varying numbers of Teflon particles within their cytoplasm. The particles, rounded or oval in shape, were surrounded by a rather electron-dense membrane. Numerous lysosomal structures were discerned within the cells. The fine structure of MCG in granulomas induced by foreign materials other than Teflon has already been described in man as well as in several experimental animals, and the Teflon MCG resembled these cells in many respects. No evidence of malignant change was found.