In-Office Laryngeal Suture Removal

A 55-year-old woman with a history of left vocal fold avulsion due to traumatic intubation 5 months prior to our visit complained of dysphonia, throat pain, and coughing. Evaluation revealed glottic insufficiency, reflux laryngitis, Reinke’s edema, vocal process avulsion, and thyroarytenoid muscle laxity.

The left vocal fold avulsion was repaired surgically with chromic suture. Botox (5 mouse units) was injected into the thyroarytenoid muscle for chemical tenotomy. During examination 30 days after surgery, the patient complained of coughing and a tickling sensation on the left side of her throat. Flexible laryngoscopy revealed the chromic suture (Figure 1). It was removed using indirect laryngeal forceps (Figure 2). No bleeding occurred, and her symptoms resolved (Figure 3). Thyroarytenoid muscle tension and voice and vocal process position despite the Box injection were improved compared to her preoperative evaluation.

Figure 1.

Suture protruding from the left vocal fold.

Figure 2.

The partially dissolved suture was removed easily with a right cupped forceps.

Figure 3.

Appearance of the vocal fold immediately following suture removal.

Vocal fold avulsion results from laryngeal trauma (internal or external) that separates the vocal process of the arytenoid cartilage from the body and results in laxity of the vocal fold. ^1,2 Repair using figure-of-eight chromic suture has produced good results. ¹ Chromic sutures typically are tolerated well and absorb in less than 7 days. ³ If sutures are not absorbed and cause symptoms, they can be removed in the office in many patients.