Microsurgical Extirpation of Intracordal Cyst with a Microflap Technique

BACKGROUND AND OBJECTIVES: Microsurgical resection of intracordal cysts is technically difficult and challenging because the wall of cysts may be tightly attached to underlying vocal ligament and/or overlying epithelium, and therefore their thin wall will easily rupture during surgical dissection. We aimed to evaluate the voice outcomes of standard microflap subepithelial resection and the recurrence rate depending on the intraoperative rupturing of the cyst. MATERIALS AND METHODS: Medical records of Samsung Medical Center, Seoul, Korea, were reviewed for sixty-four consecutive patients who received surgical resection of vocal cyst using microflap subepithelial dissection technique between the year 2004 and 2013. Meticulous dissection was performed to completely remove the cyst wall while preserving the mucosa and the lamina propria as much as possible. Voice outcomes and recurrence rates were compared according to the type, size and the intraoperative rupture of cyst. RESULTS: Presence or absence of cyst rupture was clearly described in the operation records of 41 patients. Intraoperative rupture of the cyst occurred in 32 of 41 (78%) patients. The recurrence was detected in 5 of 64 (7.8%) total cases and 4 of 32 (12.5%) cases of ruptured cyst, but not in 9 cases of intact extirpation. Rupture was more common in case of mucous retention cyst compared with epidermoid cyst (p=0.036). Subjective and objective voice parameters were measured at before and 3 months after surgery, which improved regardless of the cyst rupture. CONCLUSION: Although complete microsurgical extirpation of intracordal cyst while keeping the cyst wall intact is technically difficult, meticulous dissection with maximal preservation of surrounding tissue may warrant the improvement of voice outcomes.

A Case of Primary Laryngeal Aspergillosis Confused with Vocal Cyst / 대한이비인후과학회지

With a surge in the population of immunocompromised patients, the incidence of laryngeal fungal infection has also been increased. Infection by aspergillus, which is a kind of mold, or a filamentous fungus, occurs rarely in larynx. Furthermore, most aspergillosis of the upper airway is an extension of the pulmonary or systemic aspergillosis in the immunocompromised host. So, the primary laryngeal aspergillosis that occurrs as an isolated laryngeal infection of aspergillus without other aerodigestive tract extension is very rarely encountered. We present a case of primary laryngeal aspergillosis misconceived as a vocal cord cyst in a 24-year-old female who had no past history of immune deficiency, voice abuse or steroid use.

The Efficacy of Voice and Stroboscopic Analysis in Diagnosis of Vocal Cyst / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study is to describe the objective features of vocal cysts and to assess the ability to differentiate vocal cysts from other vocal cord lesions on the basis of voice and stroboscopic analyses. We hope that present study will contribute toward improving the preoperative diagnosis rate. MATERIALS AND METHOD: The voice analysis was pre-and post-operatively in 12 vocal cyst patients, and the resulting data was compared with those of 12 vocal polyp patients, RESULTS: In pre-operative voice analyses, fundamental frequency, jitter, shimmer, noise to harmonic ratio were significantly decreased. In stroboscopic findings, mucosal waves were absent or diminished 100% in the vocal cyst patients. Acoustic parameters of vocal cyst patients, however, were not significantly different from those of vocal polyp patients. Post- operative voice analyses and all acoustic parameters were improved. Pre-operative diagnosis rate was 75.0% when voice and stroboscopic examinations were performed, but 42.9% when voice and stroboscopic examinations were not performed. CONCLUSION: Vocal cysts show absent ordecreased mucosal waves, but show similar acoustic values to other vocal cord lesions. This study finds that voice analysis and stroboscopic examinations are valuable tools in the diagnosis of vocal cord cysts.

Electronic laryngoscopic diagnosis and therapy for laryngeal diseases / 第二军医大学学报

Objective: To study the diagnostic and therapeutic effects of electronic laryngoscope in treating laryngeal diseases and discuss some problems concerned. Methods: Follow up studies were conducted in 846 patients with laryngeal diseases who were treated electronic laryngoscopically in our department and sex, site of lesion and therapeutic effect were analyzed. Results: The incidence of vocal polyp and nodules in female was significantly higher than that in male, and vise versa in vocal cyst and leukoplakia. Vocal nodules could be located bilaterally, while vocal cyst unilaterally. The operative style applied showed good therapeutic effect. The effective rate for vocal polyp, nodule, and cyst was 99.84%~100%, and that for vocal leukoplakia, 66.67%. Conclusion: Operation under electronic laryngoscope has advantages of rapid performance, small dead angle, high accuracy, few complications, clear image, and little pain, and is beneficial to early diagnosis and treatment of laryngeal diseases. So it is worthy of wide application. [