Teflon Granuloma

Injection of Teflon paste (polytetrafluoroethylene) into the lateral thyreoarytenoid muscle has been used in patients with unilateral paralysis of the vocal cord, with the aim of augmenting and medialising the paralysed hemilarynx. The increased bulk of the vocal cord could, therefore, contribute to a more complete glottic closure, prevent aspiration, and improve a poor-quality voice caused by impaired breathing. The most common cause of vocal cord paralysis is surgical trauma of the laryngeal recurrent nerve and/or malignant tumours [31, 370, 385]. In general, Teflon injection has been well tolerated, and after a short-lived inflammatory reaction, it becomes stable and walled-off by surrounding fibrosis

[31, 210]. Technical errors during injections, such as over injection or misplaced injection of Teflon may, however, cause dysphonia and airway obstruction, as well as the presence of a neck mass, resembling a neoplasm, in the case of an escape of Teflon via the cricothyroid membrane [264, 370].

Teflon granulomas (TGs) are submucosal polypoid lesions of the vocal cord. Histologically, they are composed of a foreign body giant cell reaction with extension to the underlying muscle and cartilage. Teflon is present in foreign body giant cells, and also extracellu-larly, as glassy crystalline deposits that are characteristically birefringent under polarised light. A dense fibrot-ic tissue is evident over time, while the surrounding inflammatory infiltrate is not present [385]. TG is treated by conservative surgery, although the results are unpredictable [31]. There have been no reports of cancer development in TG [385]. With the introduction of laryngeal framework surgery and medialisation laryngoplas-ty, fewer centres nowadays additionally advocate Teflon injection [370].

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