Endoscopic microsuture repair of vocal fold defects

The presence of a nonvibratory segment of vocal folds after microlaryngeal surgery is often a cause of poor voice result. The etiology of a nonvibratory segment is due to full thickness epithelial defect followed by secondary wound closure and scar contracture. To reduce scar contracture and nonvibratory segment of the vocal folds, primary repair with a 6-0 chromic endo-knot suture technique was used to close defects and approximate microflaps of the vocal folds. This was done in 18 patients with epithelial defects after resection of benign vocal fold lesions. The pathologic findings included severe polypoid degeneration (n = 7), fusiform laryngeal polyps (n = 5), sulcus vocalis (n = 2), cyst (n = 2), and keratosis (n = 2). Voice was improved in all patients after surgery. Comparison of vocal fold vibration before and after surgery showed improvements in configuration, amplitude, and mucosal wave. Vocal folds that were sutured all had good vibratory characteristics; none had a nonvibrating segment at the site of suture placement. Voice and healing after microsuture technique were near normal by Day 10 and return of mucosal wave was often complete by Day 14. Endoscopic microsuture closure of microflaps of the vocal folds edge is safe and affords the surgeon an opportunity for primary repair with improved functional result.