Efficacy of Fiberoptic Laryngeal Surgery in Benign VocalCord Lesions in Comparision with Microlaryngeal Surgery.

Abstract

The use of operating microscope and rigid telescope in laryngeal surgery represents one of the most exciting advances. Both systems provide good illumination, magnification and relative ease of operation. Microlaryngeal surgery (MLS) with suspension laryngoscope is currently considered the gold standard for surgical approach to the larynx for excision of benign lesions of vocal folds. The limitation of this technique is intubation, general anesthesia (GA) related and in difficult exposure of larynx. The development of ideal anesthetic system has not been successful in satisfying both the surgeon and the anesthesiologist. Fiberoptic Laryngeal Surgery (FLS) is convenient as it avoids GA, is an outpatient procedure with less morbidity and reduced costs. FLS is preferable for the patients who have medical contraindications for general GA. To compare the efficacy of MLS and FLS surgical procedures in terms of functional outcome. This is a comparative clinical study done on 42 patients who were diagnosed to have benign vocal fold pathology. Pre and post-operative speech evaluation was done for all the patients by the same examiner, which included GRABS scale, Maximum Phonation Time, voiced consonants, voiceless consonants, s/z ratio along with stroboscopy. In Group A, MLS was the treatment modality, done under GA, while in Group B, FLS was the treatment modality done under Local Anesthesia (LA). After one-month, post-operative evaluation of voice was done. When the Maximum Phonation Time, S/Z ratio and stroboscopic parameters (mucosal wave) were compared between the two study groups there appeared no statistically significant difference between the two groups. Our study shows that when benign vocal cord pathologies were treated by MLS or FLS the voice Quality improvement remains the same. FLS is the procedure of choice when MLS under general anesthesia is contraindicated.