Chapter 75 - Benign VC lesions/Microsurgery Flashcards
should you always try non-surgical management of benign VC lesions prior to microsurgery?
yes, unless a very large lesion
ideal depth of dissection for microsurgery
SLP
Not going any deeper than this lends to best voice outcome
Vocal ligament is dense, appears pearly white
Layers of VC
Stratified Squamous BM SLP Intermed/Deep LP (ligament) vocalis muscle
What is in the lamina propria?
Fibroblasts, glycosaminoglycans, proteoglycans, water, loose collagen/elastin. Gelatinous
Is SLP a potential space?
No, it is 0.5mm thick, is a distinct anatomical structure
What makes up the vocal ligament?
elastin, collagen
denser collagen in deep comp to intermediate
Which layers move like a wave and form the “cover” of the “body” of the VC
Epithelium, SLP
Body is vocal ligament, vocalis
Strobe findings with VC nodules
minimal alteration in vibration
Are polyps/cysts always unilateral?
No, can present bilaterally
How do polyps affect strobe? How is treatment different than with nodules?
Like nodule, minimal effect on vibration
Unlike nodule, unlikely to respond completely to voice therapy
Two types of vocal fold cysts…how cysts are treated
Subepithelial- mucous gland obstructed, mild vibratory changes
Intraligamentous- may cause significant VC vibration change
Cysts usually do not respond to voice therapy and need surgery eventually
how can glottic insufficiency lead to benign VC lesions?
Can cause pt to develop inefficient phonation –> excessive collision/trauma
Reinke edema (polypoid corditis)
Uni or bilateral
More VC mass –> lower pitch, harsh voice
Greater reduction in mucosal wave –> greater depth of edema
Tobacco use
sulcus vocalis
irreversible loss of viscoelasticity to SLP
Voice abuse
May lead to GI
Tx- augment VC
How to treat cancerous VC lesions that extend to vocal ligament
Cannot use phonomicrosurgery if into ligament
Can use CO2 laser or radiation
