Office‐Based Resection of Large Vocal Process Granulomas

Abstract

Objectives: (1) Describe techniques to appropriately anesthetize the larynx to facilitate complete resection of large granulomas in an unsedated patient. (2) Implement transnasal and transoral techniques to resect granulomas in conjunction with fiber-guided lasers. Methods: This is a retrospective review of patients undergoing resection of large symptomatic vocal process granulomas in the office environment. Three patients were treated with resection of granulomas with primarily transoral excision, with transnasal resection and laser ablation utilized as adjunct techniques. Botox injections were also used in a subset of patients to optimize healing. All procedures were documented with video. All patients received only topical anesthesia with no periprocedural sedation. Results: All patients had resolution of their granulomas or self-reported their vocal function to have returned to baseline after healing. Conclusions: Large vocal process granulomas can be treated in a single session in the laryngology procedure suite on the unsedated patient. An excellent outcome can be attained with readily available technology to include rigid endoscopy, flexible tranasal laser laryngoscopy, and Botox injections. Consideration should be given to treating these bulky granulomas in the office-based environment.