A 10‐year study of the etiopathogenesis of cysts with a study of seromucinous glands in vocal folds

Abstract

Objective An increasing number of vocal fold cysts excised, as compared to polyps, over the last decade led us to review these cases. We found a statistically significant increase in cysts excised as compared to polyps, over the latter 5‐year period (2013–2017). This prompted us to analyze possible factors responsible for this increase. We also performed a histological study of the normative distribution pattern of seromucinous glands in the apparently normal vocal folds. Methods A retrospective review of all cysts and polyps excised over a 10‐year period was performed. Patient demographics, air‐pollution levels, videostroboscopic findings and histologic analysis of pathology were reviewed. Findings were compared between the initial and latter 5‐year period of all cysts excised. The second part of the study entailed a histological study of the presence and distribution pattern of seromucinous glands in 40 apparently normal fresh frozen cadaver vocal folds. Results There was a statistically significant (P = .035) increase of mucous retention cysts excised as compared to polyps over the latter 5‐year period. Decreased laryngeal hydration was a significant associated finding in cysts excised over the decade as compared to polyps. Striking zone lesions, suggestive of vocal abuse, were seen in a majority of patients of both polyps and cysts excised over the decade. Air pollution had significantly increased in India over the latter 5‐year period. Vocal fold histology in cadavers revealed a presence of seromucinous glands in 32.50% (13/40) with 25.00% (10/40) present in the Superficial Lamina Propria (SLP). Conclusion Decreased laryngeal hydration, vocal abuse and mucous glands present in the SLP may be predisposing factors towards mucous retention cyst formation. An increase in number of these cysts excised over the latter 5‐year period was seen as was increased air pollution. Level of Evidence 3b for the first part of study and NA for the second part of the study Laryngoscope, 130:986–991, 2020

Vocal Fold Cyst Formation after Photoangiolytic KTP Laser Treatment of Early Glottic Cancer

“…In that study, while 77% of seromucinous glands identified were located in the superficial lamina propria, the remainder were located within the thyroarytenoid muscle. 12 While we did not find statistical significance in the relationship between tumor surface geography (or depth) to POGC genesis, this may be an artifact of the somewhat crude nature of T stage as an approximation of glottic surface area involved by the cancer and / or limited sample size.…”

“…More importantly, a recent histological study of the presence and distribution pattern of seromucinous glands within the glottis found that only 32.5% of visibly normal fresh frozen cadaveric vocal folds even contained glands. 12 If considering only patients with histologically identifiable glands within their true vocal folds, the percentage of this patient subset who developed POGC’s would be much higher than 25%.…”

Phonotraumatic Lesions

“…Inadequate laryngeal hydration may affect the stiffness and viscosity of the lamina propria, predisposing to the formation of thick secretions, which may plug the mucous gland duct, forming a mucous retention cyst. 34 A mucous retention cyst is usually lined by a thin capsule formed by respiratory epithelium (cuboidal or columnar) and typically contains clear or yellow colored fluid. They may vary in their sizes and can wax and vane over a period of time.…”

In Reference to A 10‐Year Study of the Etiopathogenesis of Cysts With a Study of Seromucinous Glands in Vocal Folds

“…In their study, Nerurkar et al concluded that decreased laryngeal hydration and vocal abuse may be predisposing factors for VFRC formation. 1 First, the daily consumption of ≤4 glasses of water/ beverages was used to define VF dehydration, without consideration of many factors influencing the VF hydration assessment including medication, daily activity, environmental humidity, and the reflux that leads to pathophysiological mechanisms of mucus dehydration. 2,3 The authors used the reflux finding score (RFS) for the reflux diagnosis, but the RFS-reported findings are nonspecific and encountered in healthy subjects 4 or in patients with vocal abuse.…”