Teflon injection: pointers and pitfalls.

Our objective is to clarify the procedure used in a series of 335 cases of injection of paralyzed vocal cords. Over 29 years, questions have arisen about the procedure, mostly from trainees. They relate to timing, indications, method, and follow-up. Results of the procedure, when properly performed, have been highly successful. Where indications are appropriate, injection is usually uncomplicated, relatively safe, and done with minimum instrumentation. This is our response, in a question-and-answer format, to the most frequent queries.

Teflon injection of the vocal cord: complications, errors, and precautions.

An effort is made to summarize errors and complications in Teflon vocal cord surgery. This represents accumulated experience from 240 cases. Concentrated advice and precautions are given to improve results and expectations of the surgery.

Validation of a vocal cord lateralization procedure.

Various corrective procedures have been described to move the midline paralyzed vocal cord laterally in order to create a more desirable air exchange position. They have been complicated and often unsatisfactory, even for the skilled operator. A newer, direct approach by direct laryngoscopy, including incision and debulking of the paralyzed vocal process, as first reported by Fernando Kirchner, M.D. is described. The direct laryngoscopic method permits easier accessibility for this problem. In three involved surgical cases discussed, the air exchange in each was improved. The patients have continued to have good functional voices and no longer require tracheostomy.

Immediate local tissue reactions to Teflon vocal cord implants.

From the beginning of the teflon injection technique for paralyzed vocal cords there has been an obvious interest in its role as a foreign body. There are a number of previous reports after varying periods of time of residence. This case report describes the tissues response of the foreign body reaction very early, 48 hours after the injection of teflon. It is consistent with early inflammatory foreign body reaction.

Experience with vocal cord injection.

For 14 years investigators accredited by the FDA have been injecting a Teflon - glycerin mixture into lateral-lying, paralyzed vocal cords. This paper represents a summary of the work of this author, including successes, failures, and complications; it is the largest reported series, plus that of accredited investigators. The method described is exceptionally useful; it has restored voices, laughter, the ability to strain, and has prevented aspiration. A new surgical technique involving the injection of sterile glycerin into comparable vocal cords in acute new situation is also described. This is done by direct or indirect laryngoscopy, and has been used to eliminate some tracheotomy surgery by virtue of the immediately improved cough effectiveness.

Difficult direct laryngoscopy.

This article reviews some of the problems involved in direct laryngoscopy. It suggests adequate preparation and evaluation of the patient to avoid complications. An evaluation of laryngospasm is given. Solutions of the problems are suggested using gear power assistance and adequate drugs for relaxation. The importance of correct positioning of the patient is emphasized and illustrated. This summarizes clinical judgment and successful evaluation of the difficult mechanical problems in the exposure of the vocal cords.