VOCAL FOLD SUBMUCOSAL INFUSION TECHNIQUE IN PHONOMICROSURGERY

Phonomicrosurgery is optimized by maximally preserving the vocal fold' s layered microstructure (laminae propriae). The technique of submucos al infusion of saline and epinephrine into the superficial lamina prop ria (SLP) was examined to delineate how, when, and why it was helpful toward this surgical goal. A retrospective review revealed that the su bmucosal infusion technique was used to enhance the surgery in 75 of 1 52 vocal fold procedures that were performed over the last 2 years. Th e vocal fold epithelium was noted to be adherent to the vocal ligament in 29 of the 75 cases: 19 from previous surgical scarring, 4 from can cer, 3 from sulcus vocalis, 2 from chronic hemorrhage, and 1 from radi otherapy. The submucosal infusion technique was most helpful when the vocal fold epithelium required resection and/or when extensive dissect ion in the SLP was necessary. The infusion enhanced the surgery by vas oconstriction of the microvasculature in the SLP, which improved visua lization during cold-instrument tangential dissection. Improved visual ization facilitated maximal preservation of the SLP, which is necessar y for optimal pliability of the overlying epithelium. The infusion als o improved the placement of incisions at the perimeter of benign, prem alignant, and malignant lesions, and thereby helped preserve epitheliu m uninvolved by the disorder.