From the Research
Injections of corticosteroids like Kenalog (triamcinolone) and dexamethasone in the larynx should be administered into the Reinke's space (superficial lamina propria) for conditions like vocal fold nodules, polyps, or Reinke's edema, as supported by the most recent study 1. The safest approach is to inject laterally into the membranous portion of the vocal folds, avoiding the anterior commissure, posterior third of the vocal folds, and vocal processes to prevent scarring and voice complications. Some key points to consider when performing these injections include:
- Typical dosing includes Kenalog at 10-40 mg/mL or dexamethasone at 4-10 mg/mL, with volumes ranging from 0.1-0.5 mL per vocal fold.
- These injections should be performed by experienced laryngologists using either indirect laryngoscopy with local anesthesia or direct microlaryngoscopy under general anesthesia.
- The procedure works by reducing inflammation and edema in vocal fold lesions, potentially avoiding more invasive surgical interventions.
- Patients should be monitored for potential complications including vocal fold atrophy, scarring, or systemic steroid effects, particularly with repeated injections, as noted in studies such as 2 and 3. It's also important to consider the specific technique used for the injection, such as the transnasal endoscopic approach described in 3, which can be a practical and effective alternative treatment for benign vocal fold disorders. Overall, the goal of these injections is to improve voice quality and reduce the need for more invasive surgical procedures, while minimizing the risk of complications and promoting the best possible outcomes in terms of morbidity, mortality, and quality of life.