After its introduction in 1962, Teflon became popular for injection augmentation of the paralyzed vocal cord. Unfortunately, such injections have many drawbacks, including (a) “Teflon granuloma” formation (sometimes with airway obstruction); (b) Scarring of the vocal cord; and (c) when removal is attempted, complete removal is often not possible.
Some clinicians believe all patients with Teflon injections will develop Teflon granulomas eventually. In addition, most laryngologists agree that Teflon should never be injected into a mobile vocal cord; that is, Teflon injection augmentation should not be considered a treatment for bowing or paresis of the vocal cords. When Teflon is injected into a mobile cord, it appears to diffuse throughout all layers and produce a stony hard vocal cord with gradual, progressive worsening of the voice over time. Though surgical options exist for removing Teflon, these procedures are technically difficult, and may or may not lead to significant improvement in voice outcome.
Classically, an endoscopic approach to the removal of Teflon granulomas was used in order to simply develop a straight edge. Since a great deal of Teflon usually remained after the endoscopic procedure, recurrence of granuloma formation was quite common. Recently a new approach has been advocated and has been highly successful in the hand of numerous surgeons. This involves an external approach. This method allows a complete removal of Teflon as well as reconstruction of the vocal cord. The results of this vocal rehabilitative procedure have often been outstanding.
At present, the authors recommend Teflon injection only for patients with limited life expectancy, such as those with terminal cancer. Generally, medialization laryngoplasty or injection augmentation with another substance should be considered preferred treatments for vocal cord paralysis or paresis.
