Vocal fold masses removal--the sub epithelial micro flap technique.

Area of Science:

• Otolaryngology
• Phonosurgery
• Vocal Fold Pathology

Background:

• Vocal fold mass removal techniques evolved significantly since the 1970s, influenced by Hirano's and Titze's work on vocal structure and phonation.
• Emphasis shifted towards preserving the laminar microstructure (lamina propria, epithelium) and minimizing damage to surrounding tissues.

Purpose of the Study:

• To present the authors' experience with microflap techniques for vocal fold mass removal.
• To compare the outcomes of lateral and medial microflap techniques in a patient cohort.

Main Methods:

• The microflap technique involves elevating the superficial layer of the lamina propria to access and remove lesions while preserving the mucosal layer.
• Two approaches were utilized: lateral microflap (for larger, diffuse lesions, or when vocal ligament identification is challenging) and medial microflap (for smaller, localized lesions).
• A cohort of 45 patients (30 with lateral, 15 with medial microflap) underwent the procedures, with outcomes assessed via endovideolaryngostroboscopy.

Main Results:

• The study details the application of lateral and medial microflap techniques in 45 patients.
• Outcomes were evaluated by assessing glottal occlusion and mucosal wave pre- and post-operatively.
• Results for Reinke's edema management were analyzed separately.

Conclusions:

• Microflap techniques, by preserving vocal fold microstructure, represent an advancement in phonosurgery.
• The choice between lateral and medial microflap techniques should be guided by lesion characteristics and anatomical considerations.
• Further analysis of Reinke's edema outcomes is presented separately.