Surgery for Vocal Cord Masses
There are in essence three different types of surgical approaches to remove vocal cord masses. Regardless of type, there are some common elements:
- Patients almost always require some amount of voice therapy both before and after surgery. Why? Mainly in order to allow for proper healing as it is imperative that patients learn to talk in a manner that won't cause further damage to the surgical site.
- Strict voice rest for a period of time after surgery followed by a slow increase in voice use (as directed by a voice therapist).
- Restricted voice use for up to 3-6 months (ie, no yelling, screaming, whispering, etc).
- General anesthesia with intubation is required for the first 2 types. The 3rd type requires only local anesthesia and is done in the office.
- Surgery is performed through the mouth under a microscope using micro-instruments.
What the surgeon does under the microscope is where the variation occurs.
Type 1: Micro-Direct Laryngoscopy with Mass Excision
This procedure is performed when the mass is found on the mucosa (or lining) of the vocal cord. Such "mucosal" masses include nodules, polyps, leukoplakia, papillomas, etc. The skin equivalent would be a callous or blister. For such masses, the general principle of the surgery is to grab it, and sharply excise it completely. After excision, the wound is kept open and not sutured closed. Why? It is felt that suturing increases risk of scarring which would adversely affect the vocal quality (causing a raspy voice).
But, because the wound is left open, that's why strict voice rest is required after surgery. Talking would cause the vocal cords to come together and bang right on the surgical wound area. To use an analogy, talking is like walking after getting surgery on your heel. Not good.
Type 2: Micro-Direct Laryngoscopy with Micro-Flap Mass Excision
This procedure is performed when the mass is found UNDER the mucosa (or lining) of the vocal cord. Such "sub-mucosal" masses include cysts, large blood vessels, etc. The skin equivalent would be a sub-dermal cyst. For such sub-mucosal masses, the general principle of the surgery is to make an incision on the vocal cord and through this incision, carefully dissect free and remove the mass. The incision is than brought together.
But, just as for the first case, because the wound is left open without suturing, that's why strict voice rest is again required after surgery. Talking would cause the vocal cords to come together and bang right on the surgical wound area and prevent the incision from properly healing closed.
Type 3: Lasers
The third and final type of vocal cord surgery is the use of lasers. The predominant laser used for vocal cord surgery is PDL/KTP laser. Read more about this type of vocal cord surgery here.
CO2 laser is also used, but is going out of favor.
Video is courtesy of Dr. Chandra Marie Ivey.
Note that vocal cord stripping is not mentioned here. That's because this type of surgery is no longer performed. Vocal cord stripping is an imprecise surgical technique where the lesion/mass is simply grabbed and torn away. Imagine if a dermatologist just grabbed a mole on your skin and just yanked it off your skin by pulling with a pair of pliers. That's what vocal cord stripping is like.
Once it is determined that a mass is not cancerous, injections can be performed to the mass under endoscopic guidance without any sedation as shown in the video below.
If vocal cord surgery is something you are considering, please contact our office for an appointment.
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