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.

Gore-Tex Medialisation Thyroplasty for Unilateral Vocal Cord Palsy: A Tertiary Centre 7 Years Experience

The resultant dysphonia and aspiration in unilateral vocal cord palsy can be overcome with medialisation thyroplasty. With this background, we aim to determine the aetiology of the unilateral vocal cord palsy and effectiveness of the phonosurgical procedure with Gore-Tex as a sole treatment. Methods: Within a seven year period, 37 Gore-Tex medialisation thyroplasty were performed for unilateral vocal cord palsy at our institution and medical records were retrospectively reviewed. Results: There were 18 males and 19 females with mean age of 48.7 years (range 19–81 years). The predominant aetiology was thyroidectomy (43.2%) with benign thyroid disease predominates (n=13) over thyroid malignancy (n=3). Voice outcome was evaluated subjectively using visual analogue scoring system, results indicating that Gore-Tex medialisation thyroplasty was effective in addressing dysphonia in 62.5% (n=15) patients. However it alone cannot address aspiration seen in those with high vagal nerve lesion. Airway compromise occurred in two cases postoperatively (5.4%) presenting as acute stridor. Conclusion: In unilateral vocal cord palsy, Gore-Tex medialisation thyroplasty can effectively improve the resultant dysphonia and often accompanying aspiration which would otherwise be disabling for the patients.