Intracordal Cysts Research Articles

Investigation of the effect of endolaryngeal vocal cord surgery on voice level and life quality of patients

Objectives: The study aimed to investigate the efficiency of the performed surgery for patients with vocal cord polyps or intracordal cysts according to their own evaluations and to analyze the effects of surgery to patients’ life quality. Patients and Methods: This retrospective study was performed with 56 patients (32 males, 24 females; mean age: 35.2±15.95 years; range, 19 to 61 years), of whom 35 had vocal cord polyps and 21 had intracordal cysts, between March 2015 and January 2018. Improvements in voice level and life quality were preoperatively and postoperatively investigated by the life quality index and other subjective evaluations. Results: After the surgery, patients’ own evaluation for their voice quality from 0-10 points increased from 4.8 to 8.3, and the change was statistically significant (p<0.05). Improvements were determined in subparameters other than pain, vitality, physical function, and physical role difficulty according to the life quality scale (p<0.05). Conclusion: Although pathologies that cause dysphonia are mostly not life threatening, they functionally or psychosocially effect patients’ life quality. It is possible to increase life quality in benign pathologies by surgical treatment.

Development and validation of a 3D laryngeal model in surgical skills training

ObjectiveTo present and validate a new simulation model for endoscopic phonomicrosurgery training as an improved teaching method. MethodsA low-cost artificial model was assembled using 3D printing, silicone, and gelatin. The study was designed to test the model's ability to carry out training and teaching of endoscopic phonomicrosurgery. The synthetic model was built to simulate normal and pathological vocal folds such as polyps, intracordal cysts and keratoses, made of silicone and gelatin and embedded in a larynx framework made by 3D printing. Simulations of endoscopic surgical procedures were performed and documented through photographs and videos and the images were submitted to the evaluation of a group of 17 otorhinolaryngologists who used a Likert scale questionnaire. The responses were submitted to an agreement analysis using the sum of the scores obtained for the responses as an appropriate level of validation. Cronbach's alpha index was calculated to measure the degree of the questionnaire internal consistency. ResultThe evaluations indicated maximum approval for the model adequacy for use in practical classes and for the teaching of the procedures, as well as in the overall satisfaction with the model in the use of surgical training. ConclusionThe present proposal for training laryngeal endoscopic surgery in a 3D synthetic model is a viable option according to the validation methodology used in the present study.

Squamous Cell Carcinoma of the Larynx Arising in the Intracordal Cyst

Squamous Cell Carcinoma of the Larynx Arising in the Intracordal Cyst

Cotton Ball Self-Retraction Technique: A Novel Surgical Method Used During Microflap Dissection.

Microsurgical removal with a microflap technique via direct laryngoscopy is considered the primary treatment option for vocal cysts. However, the microflap technique is technically difficult and challenging. Therefore, we developed the "cotton ball self-retraction" technique to aid in vocal cyst surgery and reduce the cyst rupture incidence. This study aimed to evaluate the efficacy of this technique in microflap dissection for vocal cysts by comparing its treatment outcomes with those of the conventional technique as well as investigate the rate of recurrence using a retrospective chart review. A retrospective review. We reviewed the medical records of 169 patients who underwent surgery with the microflap technique for vocal cysts from December 2006 to December 2017. The patients were divided into two groups: 78 patients underwent laryngomicrosurgery using the conventional microflap technique (group A), whereas the remaining 91 patients underwent surgery with the microflap technique with cotton ball self-retraction (group B). The voice outcomes and operative data of the two groups were retrospectively reviewed and compared. The cyst ruptured intraoperatively in 42 of 78 (53.8%) patients in group A and 17 of 91 (18.6%) patients in group B. Recurrence during the follow-up period was detected in 9 of 78 (11.5%) patients in group A and 2 of 91 (2.19%) patients in group B. The degrees of improvement in assessed voice parameters were not significantly different between the groups. The cotton ball technique allows accurate and effective dissection during microflap surgery for intracordal cysts. 3 Laryngoscope, 131:E2553-E2557, 2021.

Videolaryngoscopy Quality with Protective Cover of Intraoral Odontologic Camera Evaluation in Vocal Fold Coverage Lesions

The examination of the larynx with indirect visualization is one of a series of steps in otorhinolaryngological evaluation. In the past this exam was performed more commonly with mirrors and headlights, but for at least the last four decades physicians have resorted to assessing the laryngopharynx with both rigid and fiberoptic instruments. The rigid 70° laryngoscope is the most used in our practice, its main drawback being the time-consuming resterilization process needed between scope usages in different patients. Recently we have been using a disposable protective cover over the rigid scope to obviate instrument contamination and thus the office time delays. To investigate the maintenance of image quality in videolaryngoscopy (VDL), with and without a protective cover of intraoral odontologic camera (PCIOC), in patients with benign lesions of the vocal fold. Quantitative and accurate cross-sectional study of VDL images with and without PCIOC. The images were captured by videolaringoscope of digital camera chip-on-the-tip type in an otorhinolaryngological care center. We studied patients presenting with vocal fold nodules, intracordal cysts, polyps, and Reinke's edema. All judges evaluating the images were otorhinolaryngologists. The exams with and without PCIOC were presented in a randomized form. The data of professionals' answers were analyzed by means of descriptive statistics and application of variables association tests. Thirty professionals participated in the study. There was no statistically significant difference between the probability of success in exams performed with or without PCIOC, nor between the perception of image quality and the number of correct answers in the diagnosis. In the polyp lesion without PCIOC there was a statistically significant difference between the confidence level of the diagnosis (and the number of correct answers (P=0.037). There is no difference between VDL diagnoses of vocal fold coverage lesions with and without PCIOC, maintaining image quality in both VDL exams.

후두 미세 수술 후 발생한 경부 피하기종 1예

Laryngomicrosurgery (LMS) has been commonly used for benign laryngeal lesion, especially in phonosurgery. LMS has relatively low incidence of complications. Some complications are related to the process of approaching laryngeal lesion, referred to as mechanical complication. Among these mechanical complications, cervical subcutaneous emphysema occurs rarely. Subcutaneous emphysema is the state of existence of gas or air in the layer under the skin. In most cases, it is self-limited, but it may sometimes extend to mediastinum and axilla. We present a case of cervical subcutaneous emphysema following laryngomicrosurgery in a 61-year old male who have the intracordal cyst. The day after surgery, we found right side cervical subcutaneous emphysema, and did conservative management. Two days after surgery, the symptom resolved and the patient was discharged from the hospital. We report this case regarding the diagnosis and treatment with review of literatures. (J Clinical Otolaryngol 2018;29:109-113)

Stroboscopy: an evolving tool for voice analysis in vocal cord pathologies

<p class="abstract"><strong>Background:</strong> Benign vocal fold disease, such as vocal polyp, vocal nodule, intracordal cyst or Reinke’s edema is one of the most common causes which deteriorate the voice. Since 1854 when Manuel Garcia first observed the movement of his own vocal cords using a laryngeal mirror and sunlight as the light source, a number of techniques for demonstrating laryngeal anatomy have evolved. Preoperative evaluation of these lesions initially by indirect laryngoscopy or direct rigid laryngoscopy, gave way to the use of transnasal flexible fibreoptic endoscopy in the eighties. The introduction of the video stroboscope into Otorhinolaryngology practice has revolutionized the assessment of vocal cord pathology.</p><p class="abstract"><strong>Methods:</strong> The present study includes a 50 cases of subjects with complain of change of voice coming at department of E.N.T and Head and Neck surgery, at our hospital. A detailed history was taken following which a thorough examination of larynx using appropriate techniques were carried out. Further investigations were done as and when required. </p><p class="abstract"><strong>Results:</strong> On stroboscopic examination patients were analyzed on four parameters like, symmetry, amplitude, periodicity and mucosal wave. Observations of periodicity and mucosal wave were significantly different in preoperative and post-operative analysis. Stroboscopic evaluation suggested that preoperatively 50% of the patient were having asymmetricity, decreased amplitude, aperiodicity and absent mucosal wave. On postoperative follow-up at 15 days and 2 months interval almost all the patients got all the parameters near normal.</p><p><strong>Conclusions:</strong> It was observed that statistical significant difference in pre and postoperative findings of different parameters of voice evaluated using it. We can draw the probable conclusion that video stroboscope proved to be useful and reliable tool for evaluation of the patients with benign vocal cord pathologies as it reflects the change in the all the parameters of voice postoperatively most accurately and promptly. </p>

The Effects of Intralaryngeal Needle Technique in Intracordal Cyst

Background and Objectives Surgery is considered the primary treatment for intracordal cyst. However, patients who had undergone surgery are still subject to recurrence and continued voice changes. Intracordal cysts naturally disappear in some patient population. Cyst does not always recur in patients who had received partial surgical removal, too. Contradicting results raises a question whether complete surgical removal of intracordal cyst is necessary and demonstrate need for better treatment. Herein, the author proposes novel surgical method technique intralaryngeal needle technique (INT), a technique using surgical needle for not only injection but also for aspiration and excision of cyst. This study aims to examine the potential of intralaryngeal needle technique in treating intracordal cysts. Materials and Methods Surgical procedures were done on in-patients diagnosed with intracordal cyst. 23 patients received follow-up screening after the surgery for one year. Patients’ subjective satisfaction levels, acoustic measures, aerodynamic measures, laryngeal stroboscopic results were compared before and after the treatment. Results Overall patients were satisfied with novel surgical excision method. In terms of aerodynamic measures, maximum phonation time, mean air flow rate improved after the surgery. In terms of acoustic measures, Jitter, Shimmer, NHR, and voice pitch changes after the treatment showed statistically significant differences. Laryngeal stroboscopy results showed significant decreases in cyst sizes. Post-surgery patients had improved mucosal waves and amplitudes values. Conclusion The results show the validity of intralaryngeal needle technique in reducing intracordal cyst size by excision, aspiration, and injection. The author believes this novel technique can be used as an alternative surgical method for intracordal cysts. Key words: Intracordal cyst ㆍ Intralaryngeal needle technique 핵심용어: ì„±ëŒ€ë‚´ë‚­ì¢ ã† 성대내바늘기법

Microsurgical Extirpation of Intracordal Cyst with a Microflap Technique

Microsurgical Extirpation of Intracordal Cyst with a Microflap Technique

Anatomical study of minor alterations in neonate vocal folds

IntroductionMinor structural alterations of the vocal fold cover are frequent causes of voice abnormalities. They may be difficult to diagnose, and are expressed in different manners. Cases of intracordal cysts, sulcus vocalis, mucosal bridge, and laryngeal micro-diaphragm form the group of minor structural alterations of the vocal fold cover investigated in the present study. The etiopathogenesis and epidemiology of these alterations are poorly known. ObjectiveTo evaluate the existence and anatomical characterization of minor structural alterations in the vocal folds of newborns. Methods56 larynxes excised from neonates of both genders were studied. They were examined fresh, or defrosted after conservation via freezing, under a microscope at magnifications of 25× and 40×. The vocal folds were inspected and palpated by two examiners, with the aim of finding minor structural alterations similar to those described classically, and other undetermined minor structural alterations. Larynges presenting abnormalities were submitted to histological examination. ResultsSix cases of abnormalities were found in different larynges: one (1.79%) compatible with a sulcus vocalis and five (8.93%) compatible with a laryngeal micro-diaphragm. No cases of cysts or mucosal bridges were found. The observed abnormalities had characteristics similar to those described in other age groups. ConclusionAbnormalities similar to sulcus vocalis or micro-diaphragm may be present at birth.

Improvement of Vocal Pathologies Diagnosis Using High-Speed Videolaryngoscopy

Introduction The study of the dynamic properties of vocal fold vibration is important for understanding the vocal production mechanism and the impact of organic and functional changes. The advent of high-speed videolaryngoscopy (HSV) has provided the possibility of seeing the real cycle of vocal fold vibration in detail through high sampling rate of successive frames and adequate spatial resolution. Objective To describe the technique, advantages, and limitations of using HSV and digital videokymography in the diagnosis of vocal pathologies. Methods We used HSV and digital videokymography to evaluate one normophonic individual and four patients with vocal fold pathologies (nodules, unilateral paralysis of the left vocal fold, intracordal cyst, and adductor spasmodic dysphonia). The vocal fold vibration parameters (glottic closure, vibrational symmetry, periodicity, mucosal wave, amplitude, and glottal cycle phases) were assessed. Results Differences in the vocal vibration parameters were observed and correlated with the pathophysiology. Conclusion HSV is the latest diagnostic tool in visual examination of vocal behavior and has considerable potential to refine our knowledge regarding the vocal fold vibration and voice production, as well as regarding the impact of pathologic conditions have on the mechanism of phonation.

Proposed computerized protocol for epidemiological study of patients undergoing microsurgery of the larynx.

Summary Introduction: The merging of medicine with information technology facilitates the retrieval of stored data, aiding the conduct of research with greater scientific rigor. Studies in the field of otorhinolaryngology, specifically in the area of laryngology and voice, are of fundamental importance, since 70% of the economically active need their voice to work. Objective: To create a computerized protocol of the diseases of the larynx, apply and validate it, and use it to evaluate patients undergoing laryngoscopic microsurgery of the larynx. Method: We created a database of ENT diseases through a literature review of textbooks and scientific articles. Next, we computerized the data and incorporated it into the SINPE©, creating a master protocol (ENT diseases) and a specific protocol (laryngeal diseases). Data were collected prospectively from patients undergoing laryngeal microsurgery in the ENT Hospital of Paraná. The collected data were analyzed with graphs through the SINPE© Analyzer module. Results: We evaluated 245 patients aged 9–79 years, and determined that 36.61% (93 patients) underwent surgery for the presence of polyps on the vocal folds, 12.6% (32) underwent surgery for papillomatosis, and 11.83% (29) underwent surgery for intracordal cysts. Conclusions: The creation of an electronic database of clinical ENT diseases was feasible. We were also able to implement and validate the protocol. The database may be released to physicians involved in clinical data collection and retrieval of information to conduct scientific research in an organized manner. The most common laryngeal disorders identified were polyps, papilloma, and intracordal cysts.

Benign Mucosal Fold Lesion as a Cause of Hoarseness of Voice - A Clinical Study

Hoarseness of voice is a common disorder seen in day to day practice of Otorhinolaryngologist. Although, occasionally it can be a symptom of underlying malignancy, there are a variety of benign lesions causing the same. We analyzed a total number of 100 patients with history of hoarseness of voice for at least six months in whom the cause of hoarseness was the presence of a benign vocal fold lesion. Malignancies, vocal cord paralysis and Neurological lesions were excluded from the study. We found that vocal nodules were the commonest benign mucosal vocal fold lesion, (37% patients); followed by vocal polyps in 26%, LPR 23%, Reinke’s edema in 4%, intracordal cyst in 4%, contact ulcer in 3%, saccular cyst in 2% and papillomatosis in 1% of the patients.

Videographic Documentation of an Open Cyst Converting Into a Sulcus Vocalis

Case study. The origin of sulcus vocalis is debatable, it may arise from a congenital or acquired cyst that ruptures leaving a sulcus attached to the deep layer of the lamina propria. This has been hypothesized but never shown before. In this article, we present the first videographic documentation of an intracordal cyst that over time may have become a sulcus vocalis.

Reply to the letter to the editor by FG Dikkers: Laser-assisted microsurgery for intracordal cysts decreases cost-effectiveness, Eur Arch Otorhinolaryngol 2011, published online

First of all, we would like to thank Frederik Dikkers for his interest in our article: Matar N, Amoussa K, Verduyckt I, Nollevaux MC, Jamart J, Lawson G, Remacle M. CO2 laser-assisted microsurgery for intracordal cysts: technique and results of 49 patients. Eur Arch Otorhinolaryngol 267:1905–1909, as well as for his comments published recently [1]. Dr Dikkers is kind enough to recognize our expertise in laser technology and its application in microsurgery. We fully agree that the CO2 laser scanning technology is not the single best technique for treating intracordal cysts or any other benign vocal fold lesions. However, what we wanted to demonstrate is that lesions affecting the deep part of the lamina propria can be operated by CO2 laser without any injury the vocal ligament, provided that the parameters are strictly respected. That was considered impossible by many surgeons just some years ago. We have showed in a previous paper [2] that the coagulation along the incision line is 15 lm for ultra-pulse (median values) allowing sharp and precise section. Therefore, we agree that the functional results are similar for cold-steel or CO2-laser scanning, but we find presently the procedure easier to perform by CO2 laser. According to our biostatistician and co-author Jacques Jamart, calculation of medians is a popular technique in summary statistics and summarizing statistical data, because it is simple to understand and easy to calculate, while also giving a measure that is more robust in the presence of outlier values than is the mean [3]. With regard to the voice tone, we do not think that many readers of this journal are familiar with semitones and many instruments are calibrated in Hertz (Hz) [4]. Moreover, from what we know and contrary to what Dr Dikkers says, the frequency scale (Hz) by itself is not logarithmic, only the intensity scale is (in decibel or dB) [5]. This is true, however, that the pitch, a perceptual attribute of sound does not have a linear relationship with the fundamental frequency. The auditory system is more sensitive to some frequency changes than to others. In particular, the average listener is more sensitive to changes at lower frequencies. The semitone scale reflects actually this situation by an exponential growth function [6]. As we were dealing in our paper, not with the perception of the voice range, but with the improvement of the voice range itself, we found that expressing our results in hertz was more significant. We agree with Dr Dikkers that buying such an equipment only for phonosurgery would not be cost-efficient, but the versatility of this device is so extended: from cancer surgery to benign lesions of the vocal fold, from larynx and pharynx to middle ear and nose, from dermatology and gynecology to oto-rhino-laryngology.... With so many possible applications that cannot be performed by coldsteel surgery, spending money in laser technology makes a lot of sense for an institution or a group of practitioners.

Laser-assisted microsurgery for intracordal cysts decreases cost-effectiveness

Sir, Matar et al. [1] nicely presented their results after CO2 laser-assisted microsurgery for intracordal cysts. The use of the laser in their clinic is widely acknowledged, recognized and respected. However, caution should be taken as one might think that laser-assisted microsurgery is the single best technique in treating intracordal cysts. As no comparison is made with the standard cold steel microsurgery, this is a question that remains unanswered. We have published VHI results of patients with benign voice disorders [2], including cold steel microsurgery of intracordal cysts. Interestingly enough, the subjective functional results are very comparable. In our series of 68 patients, 8 were treated for intracordal cysts, 2 males and 6 females. Their VHI changed from 44/120 preoperatively to 25/120 3 months postoperatively, where Matar et al. describe 51/120 and 28/120, respectively. Some comments should be made. Results are presented quite roughly: the change in median G in the GRBAS has been presented without mentioning the mean G. Improvement and trends were mentioned in changes of R, S, and B scale without offering exact data. Change in mean frequency range was presented in Hz, while dealing with a population of a combination of males and females. As the Hz scale is a logarithmic one, it would have been better to present the change in frequency range in semitones, thereby abolishing gender differences. The authors should be congratulated with the nice description of the surgical technique. However, laser-assisted microsurgery is more expensive [3]. Laser-assisted microsurgery for intracordal cysts offers no clinical advantages. Comparable functional results can be obtained using cold steel instruments. In conclusion, laser-assisted microsurgery for intracordal cysts decreases cost-effectiveness.

CO2 laser-assisted microsurgery for intracordal cysts: technique and results of 49 patients

Microsurgery for intracordal cysts is a challenging procedure, because cysts are close to the vocal ligament and the risk of inducing a scar is high. In this retrospective study, our experience with the CO(2)-laser scanning system (Acublade(®)) is reported on 49 patients. There were 41% epidermoid cysts and 59% mucous retention cysts. A quarter of the patients presented with bilateral cystic lesions and 59% had a contralateral lesion other than a cyst. The cyst was removed after a minimicroflap. It was dissected away from the lamina propria and the epithelium. Collagen was injected intraoperatively if the glottal gap was considered important. The epithelium was redraped using Tissucol (Baxter, Vienna, Austria). The mean follow-up time was 160 days. We noted a statistically significant improvement in the grade of the dysphonia according to Hirano's perceptual scale (G pre = 2, G post = 1, p = 0.002); the Vocal Handicap Index (VHI pre = 51, VHI post = 28, p = 0.001) and the maximal phonation time in milliseconds (MPT pre = 11, 1 MPT post = 12.7, p = 0.033) in all the patients. In the professional voice subgroup (20/49 patients), there was a significant improvement in the frequency range (FR pre = 310 Hz, FR post = 434 Hz, p = 0.001). The CO(2)-laser scanning system is reliable in the treatment of intracordal cysts.

Phonomicrosurgical treatment of intracordal vocal‐fold cysts in singers

Phonomicrosurgical treatment of intracordal vocal‐fold cysts in singers

Foreign body aspiration masquerading as difficult asthma

It is important to assess patients of difficult/therapy resistant asthma carefully in order to identify whether there are any correctable factors that may contribute to their poor control. It is critical to make a diagnosis of asthma and to exclude other airway diseases. A 65-years-old lady presented with repeated acute episodes of dyspnoea and wheezing. She was on regular medication for bronchial asthma for 18 years. There was no history of foreign body aspiration or loss of consciousness. Her chest radiograph was normal. She showed poor response to corticosteroids and bronchodilators. Fibreoptic bronchoscopy (FOB) showed intracordal cyst of the left vocal cord and 1cm size irregular piece of betel nut in right main bronchus, which was removed endoscopically with the help of dormia basket, following which her condition improved and asthma was controlled on inhaled bronchodilators.

Intracordal injection of autologous fat in patients with unilateral laryngeal nerve paralysis: long-term results from the patient's perspective.

Based on 80 patients with a previously nonsurgically treated unilateral laryngeal nerve paralysis (ULNP) and according to the patient's self-assessment, the authors document the long-term results achieved with the intracordal injection of autologous fat. Retrospective series, inception cohort. Kaplan-Meier actuarial life table method and univariate analysis. None of the 80 patients died in the immediate postoperative period. Morbidity included hematoma at the donor site (in three patients), development of an intracordal cyst at the injection site (in three patients), fat extrusion at the injection site (in one patient), and temporary tracheotomy (in one patient). The initial and ultimate overall success rates were 96.2% and 77.2%, respectively. In univariate analysis, none of the variables under analysis (gender, age, associated neurological lesions, associated pneumonectomy, associated neoplasia, cause of the ULNP, side of the ULNP, nerve involved, delay between the onset of the ULNP and the intracordal injection, severity of the symptoms, mode of harvesting the autologous fat, and surgeon who performed the injection) was statistically related to the ultimate outcome after the intracordal injection of autologous fat. Among the group of 45 patients in whom the intracordal injection was initially considered to be successful with no further recovery of motion of the true vocal cord and a minimum survival of 12 months, the ultimate overall success rate was 62.2%, and the 3-month, 6-month, and 12-month Kaplan-Meier actuarial estimates for success were 91.1%, 72.8%, and 63.1%, respectively. In the present study, data confirm that the intracordal injection of autologous fat is a useful and safe procedure in patients with ULNP. However, the impossibility of exactly predicting the amount of resorption of the injected fat and the lack of predictability of the duration of the results, together with the good and stable results achieved at the authors' department with the medialization thyroplasty led the authors to reduce its current use.