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Clinical Problem Solving: Pathology
June 01, 2008

Pathology Quiz Case: Diagnosis

Author Affiliations
 

JULIA C.IEZZONIMD

Arch Otolaryngol Head Neck Surg. 2008;134(6):670. doi:10.1001/archotol.134.6.670

Diagnosis: Teflon granuloma of the larynx

Teflon (polytef) was introduced in 1962 to augment the true vocal cord in cases of dysphonia or aspiration. It was the mainstay for treatment of this problem for more than 25 years. However, according to the literature, many problems have developed after the injection of Teflon. Most of the problems appear to result from overinjection, from misplaced injections, or from an overexuberant tissue response by the patient's immune system. Such complications often lead to Teflon granuloma of the larynx, which can cause symptoms ranging from dysphonia to airway obstruction. The possibility of granuloma formation, in addition to the introduction of alternative materials for injection, has led to a decrease in the use of Teflon. However, Teflon injections are still being administered, especially in terminal cases, in which the long-term concern for granuloma formation is diminished. While many other materials have been used for injection laryngoplasty, including bovine collagen, absorbable gelatin sponge (Gelfoam), fat, and hydroxylapatite, each carries its own problems, including hypersensitivity for bovine collagen and minimal duration for the absorbable gelatin sponge. Currently, banked cadaveric tissues, including acellular dermis (AlloDerm; LifeCell Corp, Branchburg, New Jersey) and a micronized formulation (Cymetra; LifeCell Corp), are often used for the correction of unilateral vocal cord paralysis.

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