Vocal fold masses removal: The sub epithelial micro flap technique

Abstract

Vocal fold mass removal techniques were significantly modified back in 1970s by Hirano's laminar vocal structure and physiology of phonation works, as well as Titze's vibratory vocal cycle works. New methods were to come. Removing the lession by maximum preservation of vocal laminar microstructure (lamina propria and epithelium) and minimal damage of surrounding normal vocal tissue, was pointed out. Microflap technique is based on presenting the superficial layer of lamina propria with the lesion and removing the lession without damage of the mucosa. Preserving of the mucosal layer provides the shield for vibratory substructures. There are two elementary approaches for microflap: lateral and medial. Lateral microflap technique enables better identification of vocal ligament and lowers the risk of it's injury, particulary when scars and tightly adherent lessions are present. This technique has been used in case of big or diffuse lesions, such as vocal oedema or vocal lygament identification difficulties (e.g. vocal scarification). Medial microflap technique seems to be appropriate in removing smaller, localised lessions, such as cysts and vocal polyps. Our 45 patients experience is presented in this article, in 30 patients lessions were removed by lateral microflap technique (46 vocal cords in total), while 15 patients were treated by medial microflap technique. The outcome was assumed by endovideolaryngostroboscopic analysis of glottal occlussion and mucosal wave prior and following to the procedure. Reinke oedema management results were analysed separately.

Vocal Cysts: Clinical, Endoscopic, and Surgical Aspects

“…The surgical approaches are based on a minimal manipulation of the adjacent tissues to avoid fibrotic scars. 26,27 In this study, the surgery technique used in 46 patients was the confection of medial microflap followed by a careful dissection of the cystic lesion. The results of this technique were satisfactory in all cases.…”

Are Vocal Alterations Caused by Smoking in Reinke's Edema in Women Entirely Reversible After Microsurgery and Smoking Cessation?

“…13 Considerable voice improvement is observed after surgery for Reinke's edema, as published by us and by other authors. [4][5][6][7][8] However, there is evidence that surgery cannot eliminate all structural alterations present in the vocal folds, justifying the remaining symptoms and the vocal characteristics of those with Reinke's edema, which differ from those of the voices of control patients, nonsmokers, as evidenced in this study. One explanation could be the persistence of structural changes in the lamina propria caused by Reinke's edema; understanding them further is key for the treatment of these abnormalities.…”

“…The surgical procedure may be conducted by several techniques, all following the same principle of removing the mucus content deposited in Reinke's space, and excising the redundant mucosa, with maximum preservation of the structure of the vocal folds, including epithelium, lamina propria, and vocal ligament. [4][5][6]12 Recently, Young et al 13 described the benefits of the titanyl phosphate laser to the surgery of the Reinke's edema. The authors reviewed nine patients submitted to potassium-titanyl-phosphate laser treatment for Reinke's edema and observed decrease of voice handicap index (VHI; 10 by 8.23) without other complications.…”

“…The treatment of choice in Reinke's edema, especially for types 2 and 3, is microsurgery, which can be performed by various techniques, among them microdebrider, decortication, laser, and microflap. [4][5][6][7] Nevertheless, postoperative voice restoration is slow and depends on several factors, especially the success of the surgical removal of the lesion and smoking cessation.…”

Phonomicrosurgery for Benign Vocal Fold Lesions Using Medial-Microflap Technique With Cold Instruments in a Teaching Hospital of India

“…Thus the concept of lateral (larger lesions like reinke's edema) and medial microflap technique developed. 11,12,13 In India, Phaneendra Kumar and Nerukar have popularized the phonosurgery [14,15] . Nerukar has also popularized the microflap technique in India by using hydro-dissection with cold instruments [14] .…”