Vocal fold augmentation for unilateral recurrent laryngeal nerve palsy

In unilateral paralysis of the recurrent laryngeal nerve, the vocal folds no longer close completely. Typical consequences are a hoarse, breathy voice, rapid vocal fatigue and choking. Causes include thyroid or chest surgery, tumours or viral infections.

Principle of augmentation

In augmentation, a filler such as hyaluronic acid, calcium hydroxylapatite or the patient's own fat is injected into the paralysed vocal fold. This adds volume and moves it towards the midline, so that the healthy vocal fold can reach it again when speaking and swallowing.

Procedure

Depending on the findings, the injection is performed under local anaesthesia with endoscopic guidance or under brief general anaesthesia using the microscope. Resorbable materials are suitable as a bridge while the nerve may still recover; in permanent paralysis, longer-lasting materials or surgical medialisation can be considered. Speech therapy supports voice rehabilitation.