Use of Co2 Laser versus conventional microlaryngeal surgery in treatment of vocal fold benign lesions

Background Benign superficial lesions of vocal fold (nodule, polyp, cyst and Reinke's edema) arise from the epithelium and the lamina propria. Vocal abuse and misuse presumably lead to excessive mechanical stress and trauma in the membranous portion of vocal fold, resulting in wound formation. Wound healing leads to remodeling of the superficial layer of the lamina propria. This tissue remodeling leads to formation of benign vocal fold lesions. These lesions are classically treated by conventional microsurgery and recently by CO2 laser. The use of the CO2 laser for the surgical treatment of Minor Associated Pathological Lesions (MAPL's) is still controversial. Some preferred cold instruments, whereas others appreciate CO2 laser as a novel alternative to conventional microsurgery for benign vocal fold lesions. To summarize the reviewed literature the issue of CO2 laser versus cold instruments is still controversial and the stage is open for more studies. Aim The aim of this study is to investigate the effect of Co2 Laser versus cold instruments in the treatment of benign lesions of the vocal folds regarding voice outcome & vocal fold function. Methodology A meta-analysis study is done to assess the use of Co2 Laser versus conventional microlaryngeal surgery in treatment of vocal fold benign lesions. Results This study does not reveal any detectable differences in clinical outcomes in patients with nodules, polyps and cysts who underwent excision via CO2 laser or cold instruments. Conclusion There is no sufficient evidence to determine if conventional surgery or CO2 assisted surgery is better.

Two cases of microlaryngeal surgery in highly obese elite vocal performers

We describe two cases of microlaryngeal surgery under general anesthesia in severe obese elite vocal performers. Microlaryngeal surgery under general anesthesia is feasible in patients with severe obesity, provided that the anesthesiologist and nurse work together to perform preoperative simulations and take into consideration the position and anesthesia.

Laryngeal lipoma: case series- successful microlaryngeal surgery

<p class="abstract">Lipoma of the larynx is a very rare entity. In this study, we report two cases of lipoma of the larynx. The first case presented to us with hoarseness of voice and choking sensation and was diagnosed using a flexible fibreoptic video laryngoscopy and a computerised tomography (CT) of the neck. The lesion was excised surgically using microlaryngoscopic method. The diagnosis was confirmed histopathologically. Follow-up after 2 years showed no residual or recurrent lesions. The second case was a middle aged man with change in voice, burning sensation and foreign body sensation in throat. Flexible fibreoptic videolryngoscopy showed a small ventricular swelling on the right side in the anterior part. We considered the provisional diagnosis of a benign tumor and proceeded with microlaryngoscopic excision without any radiological investigation. Diagnosis of Lipoma was revealed after the histopathologic examination. We are reporting this case to highlight the rare location of the lesions and the successful use of microlaryngoscopic surgery.</p>

Comparative study on surgical outcome for benign vocal cord lesions by conventional method versus coblation

<p><strong>Background: </strong>Benign<strong> </strong>vocal cord lesions are common laryngeal pathology found in routine clinical practice.microlaryngeal surgery is useful in excision for pathology. Coblation assisted microlaryngeal surgery is a new technique for the vocal cord lesions</p><p><strong>Methods:</strong> Current study was conducted in Government Kilpauk medical college hospital and Government Royapettah hospital from the period of 2018 to 2019 in 40 patients with benign vocal cord lesion. The objectives of current study were to assess the voice handicap Index before and after surgery, to assess the surgical benefits and ease in doing the procedure intraoperatively and to assess the postoperative recovery in conventional micro laryngeal procedure.</p><p><strong>Results:</strong> The overall analysis shows coblation being an evolving technique has advantages over the conventional cold knife method. Blood loss and the surgery duration was less in coblation. But the assessment tools of both voice handicap index, voice analysisand GRBASscore favours conventional micro laryngeal surgery with reduced scores and improvement in performance with statistically significant values probably due to minimal tissue handling and decrease in post op scarring in conventional micro laryngeal surgery.</p><p class="abstract"><strong>Conclusions: </strong>The overall voice handicap index and voice analysis showed improvement post operatively in both the groups with more favoring response to conventional method with statistically significant values. In the same away the GRBAS score also favors the conventional method. Coblation being a newer technique can be employed for surgical treatment for micro-laryngeal surgery considering its advantages and less time consumption. Stroboscopy and other acoustic analysis along with long term follow up is needed.</p>