Full text of DOI:10.1097/00005537-200106000-00033

The Laryngoscope
Lippincott Williams & Wilkins, Inc., Philadelphia
© 2001 The American Laryngological,
Rhinological and Otological Society, Inc.
How I Do It
A Targeted Problem and Its Solution
A Simplified Method of Micro-injecting
Vasoconstricting Solution Into the Vocal Cord
Boris L. Bentsianov, MD; Gady Har-El, MD
INTRODUCTION
Brunings first introduced the idea of intracordal in-
jection for the treatment of unilateral vocal cord paralysis
in 1911.1 The technique itself has undergone a number of
modifications, from the use of percutaneous needles to
flexible endoscopic guidance. More recently, over the last
decade, modifications have been aimed at improved sur-
gical precision and ease of operation. These advances,
including use of finer needles and flexible catheters, have
addressed some of the limitations of older methods.2–4
The demand for improvement and efficiency has been
driven by the new techniques of microscopic dissection
Poster presentation at the Triologic Eastern Section meeting, Janu-
ary 27, 2001, in Toronto.
Fig. 2. Butterfly with flanges cut, loaded with tuberculin syringe,
with the needle grasped with cup forceps.
From the Department of Otolaryngology, Long Island College Hos-
pital, Brooklyn, New York, and the Department of Otolaryngology, State
University of New York, Downstate Medial Center.
Editor’s Note: This Manuscript was accepted for publication March
6, 2001.
popularized over the last decade. These advances have
changed the materials we are injecting from viscous, per-
manent synthetic compounds to standard vasoconstricting
Send Correspondence to Boris L. Bentsianov, MD, Department of
Otolaryngology, 134 Atlantic Ave., Brooklyn, NY 11201, U.S.A. E-mail:
DrBLB@AOL.COM
Fig. 1. Standard 27-gauge butterfly.
Laryngoscope 111: June 2001
Fig. 3. Close-up of cup forceps grasping needle.
Bentsianov and Har-El: Micro-injecting Vasoconstricting Solution Into the Vocal Cord
1111

Fig. 4. Intraoperative example of injec-
tion of vasoconstricting agent prior to
microdissection of small vocal cord cyst.
agents. We have developed a simple, precise, cost-effective
technique for such injections.
nondominant hand (Fig. 4). Alternatively, the nondomi-
nant hand may be used for tissue retraction, with the
injection done by an assistant under direct microscopic
visualization. The tip of the needle may also be bent to
facilitate injection into difficult-to-access areas near the
perimeter of the laryngoscope.
Description of Device
The injection devise consists of a regular “butterfly”
needle with flexible tubing. These needles range from 18
to 30 gauge, although we have been using primarily the 27
gauge for infiltration prior to microdissection (Fig. 1). The
butterfly selected is then attached to a standard 1-mL
tuberculin syringe containing the vasoconstricting sub-
stance. The two plastic flanges of the butterfly needle are
trimmed. The tubing is then primed with the injection
solution desired (Fig. 2). The device may then be used
through any laryngoscope, including open, anterior com-
missure, or standard operating scopes with an operating
microscope.
CONCLUSION
We describe the technique of injecting a vasocon-
stricting solution for hemostasis and hydrodissection prior
to microdissection of laryngeal lesions. We think its ad-
vantages include 1) precise control of injection with finer
gauge needles (27 and 30 g) than allowable by previously
described methods; 2) unparalleled cost-effectiveness; 3)
availability in any setting; and 4) lack of time consuming
preparation. This technique has been used at our institu-
tion for the last 12 years with excellent results.
Use of Injection Device
The device may be used in several ways once the
suspension device and microscope are in place. The handle
of the butterfly needle is grasped with a cup forceps and
inserted through the laryngoscope (Fig. 3). The length of
tubing is sufficient to allow the syringe itself to stay com-
fortably away from the back of the laryngoscope. The
surgeon may then insert the needle into the desired loca-
tion and depth with his dominant hand, injecting with the
BIBLIOGRAPHY
1. Brunings W. Uber Eine Neue Behand-Lungsmethode Der
Rekurrens-Iahmung. Ver Dtch Laryng 1911;xx:18–83.
2. Rontal E, Rontal M. Vocal cord injection techniques. Otolar-
yngol Clin North Am 1991;24:1141–1149.
3. Ford CN. A multipurpose laryngeal injector device. Otolaryn-
gol Head Neck Surg 1990;103:135–137.
4. Lee EC, Kuriloff DB, Foyt D. Precision in vocal fold injection:
a new technique. Laryngoscope 1995;105:1358–1360.
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Bentsianov and Har-El: Micro-injecting Vasoconstricting Solution Into the Vocal Cord