Elsevier

Journal of Voice

Volume 36, Issue 4, July 2022, Pages 570-573
Journal of Voice

A Novel Approach to Vocal Fold Mucous Retention Cysts: Awake KTP Laser-Assisted Marsupialization

https://doi.org/10.1016/j.jvoice.2020.07.028Get rights and content

SUMMARY

Vocal fold mucous retention cysts are an important etiology of dysphonia and have classically been treated via microsurgical excision under general anesthesia. We present four cases that were treated with a novel technique of awake potassium-titanyl-phosphate laser-assisted marsupialization under local anesthesia. Reasons for in-office treatment included older age, medical comorbidities, and desire to avoid surgery/general anesthesia. No recurrences were observed and all patients had improved vocal quality, with a mean reduction in Voice Handicap Index-10 of 12.5. Hence, awake potassium-titanyl-phosphate laser treatment exhibits potential as a modality for addressing vocal fold mucous retention cysts in select patients with favorable outcomes.

Section snippets

INTRODUCTION

Vocal fold cysts fall within the family of benign laryngeal lesions, and represent an important potential etiology of dysphonia. While felt to be less common, cysts still comprised 13.6% of the benign lesions treated with microsurgery in a cohort of 1283 patients reported by Bouchayer and Cornut.1 Histologically, vocal fold cysts are categorized into two subtypes: epidermoid cysts and mucous retention cysts. Epidermoid cysts are thought to arise from invagination of squamous epithelium, either

MATERIALS AND METHODS

Three laryngologists (L.S.R., M.A., M.M.J.) identified four relevant cases of patients with dysphonia related to vocal fold mucous retention cysts that were treated awake in the office with the KTP laser. The electronic medical record was reviewed to collect the clinical history, patient reported outcome measures, images from videostroboscopic exam, and details/images of procedural treatment.

Procedural Technique

All patients were treated with a similar technique. Nasal anesthesia and decongestion is first achieved, followed by administration of topical laryngotracheal anesthetic (4% lidocaine). A KTP laser was used with the respective settings shown in Table 1 for each of the cases. A channeled laryngoscope is used with the KTP laser fiber in the working channel. The laryngoscope is introduced through the nasal cavity and advanced to the larynx. The fiber is positioned with the tip abutting the apex of

DISCUSSION

Vocal fold cysts have classically been treated with microsurgical excision.6 Marsupialization is also a promising alternative operative technique.10,11 We describe a novel approach utilizing the KTP laser that has been used successfully to treat four patients with mucous retention cysts in the office setting under local anesthesia. As illustrated by our cases, clinical scenarios that may warrant consideration of this treatment option involve patients who either wish to avoid surgery/general

CONCLUSION

Awake KTP laser treatment of vocal fold mucous retention cysts can be utilized successfully in select patients with favorable outcomes. This approach may be considered in those who wish to avoid or are at high risk for surgery under general anesthesia. Ultimately, the decision to choose this modality of treatment must appropriately weigh the benefits against the risks of adverse scarring and cyst recurrence.

REFERENCES (11)

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The authors have no funding, financial relationships, or conflicts of interest to disclose.

Presented at the Combined Otolaryngology Spring Meetings in conjunction with the American Laryngological Association, Austin, Texas, USA, May 1-3, 2019 and at The Fall Voice Conference, Dallas, Texas, USA, Oct 18-19, 2019.

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