表面不整なポリープ様声帯

Abstract

The polypoid vocal fold is a relatively common lesion in the field of laryngology. It affects mostly forties, fifties and sixties with a habit of heavy smoking. The membranous part of the vocal fold is intensively edematous and under the epitherium, abnormal substance, fluid and/or mucoid is contained. At first, we stripped the edematous part of the vocal fold entirely and payed a painstaking effort only to normalize the vocal fold shape. Such a technique is called “decortication”. Among the cases treated with such a technique, we had some cases with postoperative voice which was much worse than preoperative one. The stroboscopic examination revealed that there was no wave motion on the surface of the vocal fold. We thought that this result should be caused by scar formation after “decortication”. Therefore, we have newly designed a surgical technique for the polypoid vocal fold. Instead of stripping the whole membrane for normalization of the vocal fold shape, we only suck the abnormal substance under the membrane while maintaining the membrane itself. In addition, several sophisticated techniques like squeezing and pinching have been developed, resulting in excellent postoperative voice. For the polypoid vocal fold with uneven surface, we applied snare method to remove excessive amount of membrane, and to preserve the membrane especially at the free edge.After resection of a part of membrane, we suck with a suction tube or pinch with forceps localized abnormal substance while observing severely the membrane at the lower surface of the vocal fold in order to avoid undesirable injury to the free edge membrane.In this paper, a history of development of surgical techniques for the polypoid vocal fold was described. And we introduce a snare method especially for uneven polypoid vocal fold.