Superior Laryngeal Nerve Block in Transcutaneous Vocal Fold Injection: A Pilot Study

Do Won Kim; Hanju Lee; Jeong-Yeon Ji; Ramla Talib Mohammad; Gene Huh; Woo-Jin Jeong; Wonjae Cha

doi:10.1016/j.jvoice.2023.03.015

Superior Laryngeal Nerve Block in Transcutaneous Vocal Fold Injection: A Pilot Study

J Voice. 2023 May 9:S0892-1997(23)00108-X. doi: 10.1016/j.jvoice.2023.03.015. Online ahead of print.

Authors

Do Won Kim¹, Hanju Lee¹, Jeong-Yeon Ji², Ramla Talib Mohammad¹, Gene Huh³, Woo-Jin Jeong², Wonjae Cha⁴

Affiliations

¹ Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
² Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea; Department of Otorhinolaryngology-Head & Neck Surgery, Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
³ Department of Otorhinolaryngology-Head & neck Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
⁴ Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea; Department of Otorhinolaryngology-Head & Neck Surgery, Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: chawonjae@gmail.com.

PMID: 37164832
DOI: 10.1016/j.jvoice.2023.03.015

Abstract

Objectives: Topical lidocaine remains the mainstay for anesthesia in transcutaneous vocal fold injection (VFI). While using topical lidocaine, laryngologists sometimes encounter uncontrolled reflexes or poor compliance. Superior laryngeal nerve block (SLNB) provides deep and rapid anesthesia on the larynx above the vocal folds and abolishes the glottic closure reflex. Herein, we present a pilot study to evaluate the feasibility and safety of SLNB for transcutaneous VFI and explored its usefulness.

Methods: Fifty-nine patients were prospectively anesthetized with SLNB during transcutaneous VFI for unilateral vocal fold paralysis. In the SLNB group, 0.5 to 1 mL of 2% lidocaine was infiltrated on bilateral SLNs through the thyrohyoid membrane. As the control group, we included previous 47 patients who underwent VFI with topical lidocaine. In the control group, 10% lidocaine spray was applied to the laryngopharyngeal mucosa. Demographic data, laryngeal exposure, patient compliance, procedural interruption, and complications were investigated. Patient compliance was evaluated based on the frequency of cough and swallowing during VFI procedures.

Results: SLNB enabled endoscopic contact on the epiglottis and pharyngeal wall without gag reflex and provided good exposure of the procedure field on the vocal folds. In the SLNB group, the laryngeal exposure is significantly better than in the control (P = 0.005). The frequency of cough and swallowing was significantly lower in the SLNB group than in the control (P < 0.001). The number of procedural interruptions was lower in the SLNB group than in the control (P < 0.001). There was no acute or delayed complication related to SLNB such as bleeding, hematoma, delayed sensory/swallowing problems, or unscheduled hospital visits.

Conclusions: SLNB might be safe and effective for anesthesia in transcutaneous VFI. SLNB could be a good anesthetic option for patients with poor compliance despite the sufficient application of topical lidocaine.

Keywords: Injection laryngoplasty; Lidocaine toxicity; Superior laryngeal nerve block; Unilateral vocal fold paralysis; Vocal fold injection.