Difficulties in endoscopic removal of Teflon granulomas of the vocal fold

• Published in: Annals of otology, rhinology & laryngology Vol. 102; no. 6; p. 405
• Main Authors: Ossoff, R H, Koriwchak, M J, Netterville, J L, Duncavage, J A
• Format: Journal Article
• Language: English
• Published: United States 01-06-1993
• Subjects: Adult; Aged; Female; Granuloma, Foreign-Body - etiology; Granuloma, Foreign-Body - surgery; Humans; Laryngoscopy; Laser Therapy; Male; Middle Aged; Polytetrafluoroethylene - adverse effects; Polytetrafluoroethylene - therapeutic use; Prostheses and Implants - adverse effects; Tracheotomy; Vocal Cord Paralysis - therapy; Vocal Cords - surgery
• ISSN: 0003-4894
• DOI: 10.1177/000348949310200601

The difficulties in treating granulomas resulting from Teflon injection into the vocal fold are underreported in the literature. We have reviewed our experience with nine patients undergoing 27 procedures for Teflon granuloma. Two patients required tracheotomy before undergoing endoscopic granuloma removal because of airway compromise, and a third required urgent tracheotomy following endoscopy. One of the patients requiring elective tracheotomy had a granuloma that extended across the midline to the contralateral arytenoid, causing its fixation. Arytenoidectomy was required for decannulation in this patient. In all but one patient the granuloma nearly completely replaced the thyroarytenoid muscle. This extensive involvement often precludes the adequate excision of the granuloma in a single procedure; however, the microflap technique allows mucosal preservation to facilitate future procedures. In some cases the granuloma destroys large amounts of mucosa, and a microflap cannot be elevated and saved. The difficulties of excision are related to the near-total replacement of the thyroarytenoid muscle by granuloma. This paper will help the otolaryngologist--head and neck surgeon understand this destructive process and the resulting difficulties in surgical rehabilitation.