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Vocal fold submucosal infusion technique in phonomicrosurgery
E S Kass1, R E Hillman, S M Zeitels
1Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
Summary
Submucosal infusion of saline and epinephrine optimizes phonomicrosurgery by improving visualization and preserving vocal fold microstructure. This technique is particularly beneficial when vocal fold epithelium requires resection or extensive dissection in the superficial lamina propria.
Area of Science:
- Otolaryngology
- Surgical Innovation
- Vocal Fold Physiology
Background:
- Phonomicrosurgery aims to preserve vocal fold layered microstructure (laminae propriae).
- The superficial lamina propria (SLP) is critical for vocal fold pliability.
- Adherence of vocal fold epithelium to the vocal ligament complicates surgical dissection.
Purpose of the Study:
- To evaluate the utility of submucosal infusion of saline and epinephrine into the SLP during phonomicrosurgery.
- To determine the specific conditions and reasons for the helpfulness of this infusion technique.
Main Methods:
- Retrospective review of 75 phonomicrosurgery procedures utilizing submucosal infusion over 2 years.
- Analysis of cases where vocal fold epithelium was adherent to the vocal ligament.
- Assessment of the infusion's impact on visualization and dissection during cold-instrument tangential dissection.
Main Results:
- Submucosal infusion was used in 75 of 152 vocal fold procedures.
- The technique was most beneficial for cases requiring epithelium resection or extensive SLP dissection.
- Infusion improved visualization via vasoconstriction, facilitating SLP preservation and precise lesion margin incision.
Conclusions:
- Submucosal infusion of saline and epinephrine is a valuable adjunct in phonomicrosurgery.
- The technique enhances surgical precision, preserves vocal fold microstructure, and aids in oncologic resections.
- Optimal preservation of the SLP ensures better vocal fold pliability post-surgery.