eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Laryngology

Vocal Fold Cysts: Follow-up

Author: John Schweinfurth, MD, Associate Professor, Department of Otolaryngology, University of Mississippi Medical Center
Coauthor(s): Robert Ossoff, DMD, MD, MS, Chair, Professor, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center
Contributor Information and Disclosures

Updated: Sep 8, 2008

Outcome and Prognosis

Using the microflap technique described above, Courey et al found that 85% of patients with an absent wave preoperatively regained their mucosal wave, while 97% percent of patients with an intact preoperative wave retained this important parameter.1 Blinded comparison of preoperative and postoperative voice samples from this series showed that the postoperative voice was rated as better in 100% (48 of 48) of patients. Although long-term results in these patients remain excellent, continued emphasis should be placed on the prevention of pathology (eg, voice training, good vocal hygiene, maintenance of systemic health).

Future and Controversies

Some authors have expressed concern that elevating a microflap may lead to disruption of the attachment of the basement membrane to the superficial layer of the lamina propria through interlinked collagen loops. The mini-microflap was described to minimize tissue manipulation and prevent possible basement membrane injury. The plane of the microflap is in the superficial layer of the lamina propria deep to the basement membrane and likely leaves these attachments untouched. This is demonstrated by the observation of blood vessels within the flap, which clearly reside deep to the basement membrane. Other authors have proposed entering the vocal fold through an anterior, submucosal approach through the thyroid cartilage that obviates the need for an incision in the epithelium. Endoscopes placed into the Reinke space in cadavers allowed for surgery of lesions of the lamina propria.2 This approach could potentially minimize vocal scarring associated with mucosal incisions and raising subepithelial flaps.
 
Determining whether the traditional or newer mini-microflap procedures damage or protect the basement membrane or whether basement membrane injury hampers voice is difficult. Results with the microflap have been excellent, with return of good-to-excellent voice and mucosal wave in most patients. Use of the laser in the surgical treatment of benign nodules, polyps, or cysts to minimize scar formation is minimal.

 


More on Vocal Fold Cysts

Overview: Vocal Fold Cysts
Workup: Vocal Fold Cysts
Treatment: Vocal Fold Cysts
Follow-up: Vocal Fold Cysts
Multimedia: Vocal Fold Cysts
References
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References

  1. Courey MS, Gardner GM, Stone RE, et al. Endoscopic vocal fold microflap: a three-year experience. Ann Otol Rhinol Laryngol. Apr 1995;104(4 Pt 1):267-73. [Medline].

  2. Hoffman HT, Bock JM, Karnell LH, et al. Microendoscopy of Reinke's space. Ann Otol Rhinol Laryngol. Jul 2008;117(7):510-4; discussion 515-6. [Medline].

  3. Courey MS, Garrett CG, Ossoff RH. Medial microflap for excision of benign vocal fold lesions. Laryngoscope. Mar 1997;107(3):340-4. [Medline].

  4. Courey MS, Shohet JA, Scott MA, et al. Immunohistochemical characterization of benign laryngeal lesions. Ann Otol Rhinol Laryngol. Jul 1996;105(7):525-31. [Medline].

  5. Gray S. Basement membrane zone injury in vocal nodules. In: Gauffin J, Hammarberg B, eds. Vocal Fold Physiology. San Diego: Singular Press; 1991.

  6. Gray SD, Hammond E, Hanson DF. Benign pathologic responses of the larynx. Ann Otol Rhinol Laryngol. Jan 1995;104(1):13-8. [Medline].

  7. Gray SD, Hirano M, Sato K. Molecular and cellular structure of vocal fold tissue. In: Gauffin J, Hammarberg B, eds. Vocal Fold Physiology. San Diego: Singular Press; 1991:1-35.

  8. Hirano M. Surgical anatomy and physiology of the vocal folds. In: Voice Surgery. St. Louis: Mosby-Year Book; 1993:125-58.

  9. Hirano M, Yoshida T, Hirade Y, et al. Improved surgical technique for epidermoid cysts of the vocal fold. Ann Otol Rhinol Laryngol. Oct 1989;98(10):791-5. [Medline].

  10. Rubin JS, Lee S, McGuinness J, et al. The potential role of ultrasound in differentiating solid and cystic swellings of the true vocal fold. J Voice. Jun 2004;18(2):231-5. [Medline].

  11. Sataloff RT. The professional voice. In: Cummings CW, Fredrickson JM, Haker LA, et al, eds. Otolaryngology: Head and Neck Surgery. Vol. 3. St. Louis: Mosby; 1986:2029-56.

  12. Sataloff RT, Spiegel JR, Heuer RJ, et al. Laryngeal mini-microflap: a new technique and reassessment of the microflap saga. J Voice. Jun 1995;9(2):198-204. [Medline].

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Further Reading

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Keywords

vocal fold cysts, vocal cord, cysts, epidermoid cysts, mucus retention cysts, benign vocal lesions, benign vocal disorders, intracordal cysts, dysphonia, aphonia, diplophonia, Reinke space, vocal fold

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Contributor Information and Disclosures

Author

John Schweinfurth, MD, Associate Professor, Department of Otolaryngology, University of Mississippi Medical Center
John Schweinfurth, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Robert Ossoff, DMD, MD, MS, Chair, Professor, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center
Robert Ossoff, DMD, MD, MS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Bronchoesophagological Association, American College of Chest Physicians, American College of Surgeons, American Laryngological Association, American Laryngological Rhinological and Otological Society, American Medical Association, American Rhinologic Society, American Society for Head and Neck Surgery, American Society for Laser Medicine and Surgery, Sigma Xi, and Southeastern Surgical Congress
Disclosure: Nothing to disclose.

Medical Editor

Clark A Rosen, MD, Director, University of Pittsburgh Voice Center; Associate Professor, Department of Otolaryngology and Communication Science and Disorders, University of Pittsburgh School of Medicine
Clark A Rosen, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Robert M Kellman, MD, Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York, Upstate Medical University
Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Medical Society of the State of New York
Disclosure: GE Healthcare Honoraria Review panel membership

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
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