Phonomicrosurgical management of vocal fold polyps: The subepithelial microflap resection technique

Vocal fold polyps are typically caused by acute and chronic trauma to the m icrovasculature of the superficial lamina propria (SLP). Shearing stresses that are induced by hyperfunctional glottal sound production lead to bleedi ng into the SLP and malformed neo-vascularized masses. Because the primary process does not involve the epithelium, the authors designed a technique t o resect hemorrhagic polyps by epithelial cordotomy with partial or complet e preservation of the vocal fold epithelium. This approach is different fro m the traditional microsurgical resection of hemorrhagic polyps by amputati on with or without the carbon dioxide laser. Forty patients who underwent m icrolaryngoscopic resection of hemorrhagic polyps from 1996 through 1998 we re reviewed retrospectively. Thirty-six of the 40 procedures were by epithe lial cordotomy and subepithelial removal of the polyp contents. Sixteen of 36 were assisted by a subepithelial infusion of saline and epinephrine, and all were 3 mm to 6 mm. Four of 40 polyps were amputated; all of these were less than 3 mm and were pedicled on a narrow base. Cold instruments were u sed exclusively in all 40 patients. Postoperative laryngeal stroboscopy wit hin 2 weeks revealed improved mucosal wave propagation and improved glottal closure in all 33 patients in whom postoperative strobovideolaryngoscopy w as available. The epithelial cordotomy technique was introduced to minimize disturbance of normal SLP and epithelium. Despite the hemorrhagic nature o f these lesions, cold instruments could be used exclusively with facility d ue to careful microdissection between the polyp and the residual normal SLP and the enhanced hemostasis provided by the subepithelial infusion of sali ne and epinephrine. The rapid return to improved glottal function is the re sult of this ultra tissue-sparing technique.