Long-Term Outcomes of In-Office Laser-Assisted Marsupialization of Vocal Fold Mucous Retention Cysts

Vocal fold cysts have been traditionally treated with microsurgical excision under general anesthesia. Awake in-office laser-assisted drainage and marsupialization are an alternative treatment approach to address vocal fold mucous retention cysts in select patients to avoid the risks of general anesthesia.¹ While short-term efficacy of the approach has been described, longer-term voice outcomes and rates of recurrence are unknown.

A multi-institutional retrospective chart review was conducted of patients with vocal fold mucous retention cysts treated with in-office laser-assisted marsupialization and had follow-up data beyond 6 months. Data abstracted included demographics, pre- and postprocedural Voice Handicap Index (VHI)-10 scores, cyst recurrence, and videostroboscopic findings.

Six patients (mean age 70.7 years, 50% male) with unilateral vocal fold mucous retention cysts were included. Mean VHI-10 scores improved from 21 to 5.5. Follow-up ranged from 9 months to 33 months (mean 19 months). Mucosal pliability was completely preserved in four patients. Two patients demonstrated a very mild reduction in mucosal pliability on laryngeal stroboscopy but reported overall favorable postprocedural voice quality. One patient recurred at 14 months and required microlaryngeal surgery for excision of the cyst.

In-office awake laser-assisted drainage and marsupialization of vocal fold mucous retention cysts can be an effective treatment paradigm in select patients, with favorable and durable long-term outcomes. However, small risks of postoperative scarring and cyst recurrence need to be balanced against benefits such as avoiding general anesthesia.