Granuloma of the Membranous Vocal Fold: An Unusual Complication of Microlaryngoscopic Surgery

Abstract

Granuloma should be suspected when a mass lesion appears at the surgical site early in the postoperative course. Surgical excision is generally not necessary and may provoke further growth of granulation tissue.

Vocal Process Granulomas

“…Details of previous treatment in refractory studies are outlined in Table 1. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] The 3 most common treatment options are antireflux therapy, mostly proton pump inhibitors (PPIs), speech and language therapy (SALT), and steroids. Surgical excision is usually reserved for refractory or recurrent cases.…”

“…There have been several studies citing Botulinum A toxin injection as a useful adjunct for the treatment of VPGs and is usually given for refractory VPGs. 11,14,15,19,20,23 The aim of BOTOX is to induce a chemical paralysis reducing the adduction trauma and allowing the mucosa of the vocal fold to regenerate. Unfortunately injecting the vocal cords results in hoarseness or breathiness or both until the toxin degrades, which must be weighed against benefits of the procedure.…”

Granulomas of the membranous vocal fold after intubation and other airway instrumentation

“…Rare granuloma cases have been reported along the membranous portion of the vocal fold following surgical manipulation of the mucosa or idiopathic ulcerative laryngitis. 5,6 In both of these circumstances, granuloma formation is exceptional and unexpected, as the membranous vocal fold has none of the anatomic disadvantages of the posterior glottis. Depth of injury and extent of de-epithelialization have been proposed as an explanation for the unusual development of granulation tissue in this location.…”

Fill Volume as an Indicator of Surface Heterogeneity in Glass Vials for Parenteral Packaging

“…Typical features include prolonged course of ulcer resolution (>6 weeks) and lack of response to pharmacologic management 3. In contrast, granuloma of the membranous VF has been reported to occur rarely following microlaryngoscopy, presumably secondary to surgical violation of deep tissue planes 4. We report a novel case of noniatrogenic membranous VF granulation developing in a patient with IUL.…”