Mr David E. Vokes
FRACS
Consultant Otolaryngologist, Head & Neck Surgeon, Auckland City & North Shore Hospitals, Auckland, NZ
After completing ORL-HNS training in New Zealand, David spent two years in the USA to pursue Fellowship training in Head & Neck Surgery and in Laryngology. David is the first Otolaryngologist in New Zealand to complete subspecialty training in Laryngology.  David has Consultant appointments at Auckland City Hospital and North Shore Hospital, and serves on the Training Committee of the NZ Society of ORL-HNS. David’s clinical interests include voice disorders, dysphagia, airway stenosis and H&N cancer.

Vocal Fold Medialization - Challenging Cases: Persistent dysphonia in patients treated with Vox Injection Laryngoplasty

Vocal fold medicalization (VFM) is an effective treatment for glottic insufficiency caused by vocal fold paralysis, paresis, and atrophy. The two most common surgical treatments for VFM are injection laryngoplasty (IL) and laryngeal framework surgery (LFS). A number of injectables have been described for IL, including Vox (polydimethylsiloxane), that is classified as a permanent implant. A case series of 5 patients with persistent dysphonia after treatment with Vox injection laryngoplasty (VIL) is presented to highlight the potential risks of using this laryngeal injectable for permanent vocal fold medicalization technique. Granuloma formation, a complication not previously reported with Vox, was diagnosed on histological examination in three cases. The techniques used for voice and airway rehabilitation included removal of the Vox, and revision surgery with LFS.