Teflon vocal fold augmentation: failures and management in 28 cases.

Although vocal fold augmentation by Teflon injection has been the mainstay of treatment for glottic insufficiency for three decades, the success and safety of this treatment have been overstated. Twenty-eight patients who manifested poor or complicated Teflon results between 1984 and 1991 were evaluated using acoustic, aerodynamic, videostroboscopic, perceptual, and subjective patient self-evaluation of voice, both before and after our management of these complications. Most of these had Teflon granulomas; subglottic overfilling was the most common condition. In most instances such management included microsurgical removal of the Teflon granuloma. Voice measures that were abnormal before correction tended to improve and move into the normal range, although the resultant voices were not totally normal. Degree of improvement varied depending on the Teflon-induced tissue changes and the methods of correction subsequently used. The worst results were in patients with scarring, atrophy, and bilaterally mobile vocal folds, for whom Teflon should never have been injected. Teflon injection should be reserved for those instances in which it is clearly indicated and the surgeon is skilled in the technique of intrafold injection.