Microflap dissection with a cotton ball self‐retraction technique in treating vocal cysts

Efficacy of KTP Laser-Assisted Marsupialization in the Treatment of Vocal Cysts

OBJECTIVES

Vocal cysts, common benign laryngeal lesions, often lead to voice disturbances. Total surgical enucleation presents challenges due to the delicate nature of vocal tissues. Conventional surgery carries risks of recurrence and decreased voice quality due to incomplete removal and potential vocal fold damage. This study investigates the efficacy of Potassium-Titanyl-Phosphate (KTP) laser-assisted marsupialization for the treatment of vocal cysts.

SUBJECTS AND METHODS

We retrospectively analyzed 78 patients who underwent either conventional surgery or KTP laser-assisted marsupialization to compare the voice outcomes and recurrence rates of the two groups.

RESULTS

KTP laser-assisted group (B) demonstrated significantly higher recurrence rates (18.4%) compared to conventional surgery group (5%). The mean time to cyst recurrence were 12.4months in group A and 10.9months in group B. The degree of postoperative improvement in all voice parameters was not significantly different between the two groups.

CONCLUSIONS

While KTP laser-assisted marsupialization may offer some advantages such as reduced vocal fold damage and ease technique, the higher recurrence rates observed in this study suggest that this technique may not achieve cure rates comparable to conventional surgery. Therefore, careful consideration is necessary when selecting patients for this procedure, and further research is needed to refine the technique and evaluate its long-term efficacy.

LEVEL OF EVIDENCE

Level III.

Cotton Ball Self-Retraction Technique: A Novel Surgical Method Used During Microflap Dissection

OBJECTIVES/HYPOTHESIS

Microsurgical removal with a microflap technique via direct laryngoscopy is considered the primary treatment option for vocal cysts. However, the microflap technique is technically difficult and challenging. Therefore, we developed the "cotton ball self-retraction" technique to aid in vocal cyst surgery and reduce the cyst rupture incidence. This study aimed to evaluate the efficacy of this technique in microflap dissection for vocal cysts by comparing its treatment outcomes with those of the conventional technique as well as investigate the rate of recurrence using a retrospective chart review.

STUDY DESIGN

A retrospective review.

METHODS

We reviewed the medical records of 169 patients who underwent surgery with the microflap technique for vocal cysts from December 2006 to December 2017. The patients were divided into two groups: 78 patients underwent laryngomicrosurgery using the conventional microflap technique (group A), whereas the remaining 91 patients underwent surgery with the microflap technique with cotton ball self-retraction (group B). The voice outcomes and operative data of the two groups were retrospectively reviewed and compared.

RESULTS

The cyst ruptured intraoperatively in 42 of 78 (53.8%) patients in group A and 17 of 91 (18.6%) patients in group B. Recurrence during the follow-up period was detected in 9 of 78 (11.5%) patients in group A and 2 of 91 (2.19%) patients in group B. The degrees of improvement in assessed voice parameters were not significantly different between the groups.

CONCLUSION

The cotton ball technique allows accurate and effective dissection during microflap surgery for intracordal cysts.

LEVEL OF EVIDENCE

3 Laryngoscope, 131:E2553-E2557, 2021.