Laryngology Surgery & Voice Care

Right vocal cord cyst (arrow) causing phase asymmetry and abnormal mucosal waves in in laryngeal videostroboscopy examination.

Right vocal cord cyst (arrow) causing phase asymmetry and abnormal mucosal waves in in laryngeal videostroboscopy examination.

Flexible nasolaryngoscopy showing an extensive papillomas involving epiglottis, false vocal cords and true vocal cords. The latter resulted in progressive worsening of voice needing surgical intervention. Florid and further growth of these papillomas can result in airway obstruction and difficulty in breathing. These lesions can be ablated or removed using CO2 laser, pulse dye laser and microdebrider. The lesions are known to be recurrent and can involve lower airway passage in long-standing cases.

Established pedunculated benign granuloma complicating endotracheal intubation injury. The patient presented with hoarseness and episodic dyspnea. No stridor present. The lesions developed at its typical site - posterior glottis corresponding to the medial surface of the arytenoid cartilage. [1 - granuloma of right side, 2 - granuloma of left side, arrow - the stalk/pedicle, t - true vocal fold, f - false vocal fold, e - epiglottis]

Removal of benign vocal fold polyp using CO2 laser is shown. The polyp had caused hoarse voice and was successfully restored after this microlaryngeal surgery.

PPW - posterior pharyngeal wall, A - arytenoid complex, E - epiglottis, PC - posterior commissure, arrow - left vocal fold polyp

Voice rest is indicated during acute laryngitis. This would minimize the injury of over the vibrating segments of the vocal folds which already made inflamed by the inflammation caused by the infection. The maximal point of contact is at the anterior half of the vocal folds, The voice become hoarse with pitch breaks and at its extreme to aphonia (voiceless) - if more areas involved. Endoscopic laryngeal examination shows the above changes over few days of the onset of laryngitis if voice overused continued. Fibrin exudates formed - the white segment of the anterior vocal folds (dotted round rectangles]. TVF - true vocal fold, FVF - false vocal fold. arrow - towards anterior.

Despite having intact vocal folds function and anatomy, this patient was unable to vocalized due to complete upper upper tracheal obstruction - no air pass up and beyond true vocal folds to generate mucosal waves although the vocal cords meeting each other nicely. Tracheostomy was performed to bypass the obstructive segment earlier to allow respiration. The obstruction was related to motor vehicles accident with severe intracranial injury and prolonged endotracheal intubation. Tracheal resection and reanastomosis was scheduled.

Prolonged and repetitive voice over-used or abuse have detrimental effect on vocal folds especially when voice projection is needed in a very noisy background. In this video, left vocal fold polyp has formed (white arrow) with opposite vocal fold thickening seen and evidence of recent bleeding into superficial vocal fold layer (green arrow with yellowish tinge underneath the vocal folds lining on both sides). The mucosa of arytenoids and posterior commissure appeared swollen, reddish and oedematous due to coexisting untreated reflux laryngitis (blue interrupted line)