Direct Laryngoscopy and Vocal Injection


Sigma ENT was founded by Dr. Christian Conderman and Dr. Kanwar Kelley and has expanded to include a world class collection of physicians and advanced practice providers.

Office Hours

(individual locations vary)

Emergency Cases

(925) 254-6710

Working Hours

Monday – Friday
09:00 – 04:00

Telephone support and scheduling. Clinic times vary.

A direct laryngoscopy allows a clear visualization of the larynx. It is used during general anesthesia, surgeries concerning the larynx, and resuscitation. A vocal cord injection with fat is implemented to bulk and enlarge the vocal cord in cases where a vocal cord is static, damaged, or frail. The goal of the surgery is to improve overall voice.

By visualizing the larynx, endotracheal intubation can be performed easily. This is a vital step for many patients who are incapable to secure their own airway such as those with altered mental status and those who are undertaking a surgical procedure. One must be well acquainted with the anatomy, indications, contraindications, equipment, and personnel for successful use of direct laryngoscopy so always consult with your doctor before proceeding.

Surgery is performed in the operating room while you are induced to a sleep. Fat is removed from the belly or side of the leg through a liposuction. A hollow metal tube is then placed in the mouth to view the vocal cord. After placement, the fat is then injected through into the vocal cord. Fat lasts within the vocal for approximately 6 months. A fat injection is not permanent and may need to be repeated in the future if necessary. More permanent procedures exist and may be performed depending on the patient’s case.

With all surgeries, there are risks. These include but are not limited to:

  • Hoarseness – changes in the voice may be temporary or permanent
  • Teeth damage such as loose, chipped and even broken teeth
  • Change in taste – this occurs due to pressure on the nerve of taste is usually temporary
  • Pain – soreness in the mouth, jaw join, throat and even the ear are normal and usually temporary
  • Bleeding – the chance of bleeding is rare, and bleeding typically stops on its own
  • Problem breathing – this can occur due to swelling and may require immediate attention
  • Bruising or infection of the abdomen or leg
  • Rare risks of anesthesia – stroke, blood clots, heart attack, and death

Instructions after the procedure:

Voice rest for the first three days after surgery which includes the day of surgery, avoid using your voice. This means no talking, whispering, laughing, and coughing. Have other means of communicating like writing on paper, texting, or emailing to address your needs.

Once the patient has been monitored, the patient must be pre-oxygenated. If a patient had a difficult intubation or at risk for rapidly desaturating, one can pre-oxygenate by using apneic oxygenation. Apneic oxygenation, the passive flow of oxygen into the alveoli during apnea, is achieved by using passive oxygen insufflation via nasal cannula at 15 liters per minute. Keep a functioning suction device and bag-valve mask nearby to be prepared for emergencies. Monitoring devices such as blood pressure, pulse oximetry, continuous cardiac monitoring, and capnography should always be connected to the patient during the procedure. Next, intravenous access should be established. Lastly for the final arrangements, always ensure that induction agents, adjunctive medications, neuromuscular blocking agents, and emergency medications are ready.

Dr. Kanwar Kelley is located at Orinda California and if you need Direct Laryngoscopy and Vocal Injection, don’t hesitate to make an appointment (925) 254-6710. He is an experienced physician in many illnesses who can guide your health in the right direction.

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