Use of injectable hydroxyapatite in the secondary setting to restore glottic competence after partial laryngectomy with arytenoidectomy

Hydroxyapatite cement is a calcium phosphate putty, approved by the US Food and Drug Administration, that solidifies in 20 minutes and gains bone-like stability after 4 to 6 hours. It has been used for craniofacial reconstruction, spinal stabilization, and ossicular reconstruction. This is the first report of use of injectable hydroxyapatite to rebuild soft and hard tissue defects of the larynx after partial laryngeal surgery. Hydroxyapatite was injected in 4 patients to address glottic incompetence after partial laryngectomy. The patients were dependent on tracheotomy and/or gastrostomy tubes. Some had failed prior corrective surgeries. All of the operations were performed endoscopically and gave immediate improvement of glottic incompetence. All 4 patients reported improved symptoms. Three were able to have gastrostomy tubes removed, 1 was decannulated, and 1 had improved voice. In conclusion, hydroxyapatite injection is a technically simple procedure to restore glottic competence that may obviate the need for an open procedure.