Use of a microdebrider for subepithelial excision of benign vocal fold lesions

We present a series of patients who underwent excision of subepithelial lesions using a laryngeal microdebrider.

A retrospective review was carried out of all patients who between June 2005 and April 2009 underwent microlaryngoscopy and excision of vocal fold lesions by the senior author using a microdebrider. The patients' demographics,past medical history, preoperative and postoperative videostroboscopy findings,and surgical pathology findings were reviewed.

Eight patients were identified. All were female and had a mean age of 44 years (range, 21 to 54 years). Four patients had a unilateral pseudocyst, 2 patients had bilateral pseudocysts, 1 patient had bilateral Reinke's edema, and 1 patient had unilateral Reinke's edema. Through an incision made just lateral to the lesion on the superior surface, a small microdebrider blade was inserted and run at 800 to 1,000 revolutions per minute in oscillation mode with low wall suction until the lesion was completely excised, and the overlying epithelium was left intact. Postoperative videostroboscopic examination of the larynx revealed an absence of lesions and near-complete glottal closure in all patients. Seven of the 8 patients reported an improvement in voice.

Microdebrider excision of subepithelial vocal fold lesions is feasible. The patients with Reinke's edema had slightly more residual edema, a decreased epithelial wave, and less improvement in voice as compared to the patients with pseudocysts. Meticulous technique, low oscillation speeds, and low wall suction are necessary to avoid injury to the overlying epithelium.