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Cymetra® Micronized AlloDerm® Tissue—The Ideal Alternative for Injection Laryngoplasty
Procedure for Injection Laryngoplasty with Cymetra® Micronized Tissue
- Explicit rehydration instructions accompany each syringe of Cymetra® Micronized Tissue. All components required for rehydration (except for the normal saline or selected diluent) are provided by Lifecell.
Injection Methods and techniques
- Recommended needle size: 18-23 gauge. The particle size is the limiting factor for needle size. Smaller needles may become clogged. (Do not dilute Cymetra® Micronized Tissue in order to use a smaller needle—dilution may cause leaking from the injection site.)
- Position of injections: Cymetra® Micronized Tissue is injected at the anterior third and the posterior third of the vocal cord—toward the vocal process. Immediate phonation following injection will help distribute the Cymetra® Micronized Tissue evenly across the vocal cord.
Technical Considerations
Transoral- Place the needle transorally into the anterior third of the vocal cord and inject approximately 0.5-0.8cc (or until the Cymetra® Micronized Tissue is visible at the injection site). Withdraw and repeat the injection in the posterior third, near the vocal process. (To avoid losing Cymetra® Micronized Tissue from the needle, pressure on the syringe plunger should be released prior to withdrawing the needle.)
Transcutaneous- Infuse the skin at the treatment line with about 2cc lidocaine (with 1:100,000 epinepherine) and allow time for induction of local anesthesia. If patient is sensitive to either, substitute the proper local anesthetic.
- Locate the midline of the thyroid lamina with an index finger. Approaching from the side to be treated, penetrate the skin with a 1-inch needle (18-23 gauge) attached to the Cymetra® Micronized Tissue syringe about 1mm inferior to the midline of the thyroid lamina and anterior. Pass the needle through the thyroid lamina with a twisting motion, and advance the needle while visualizing the vocal cord through a laryngoscope. Once a bulge can be visualized, withdraw the needle slightly and inject approximately 0.5 - 0.8cc of Cymetra® Micronized Tissue. (To avoid losing Cymetra® Micronized Tissue from the vocal fold, do not allow the needle to penetrate into the airway.)
Reposition the needle more posterior toward the vocal process and repeat injection.
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