![]() ![]() Vocal fold granuloma is inflammatory tissue arising from the perichondrium near the arytenoid cartilage (Fig. 1, 4, 5, 10, 11, and 12 for further information.ġ9.2 Disease Characteristics and Differential Diagnosis ■ It is critical that some gelatinous material in the SLP should be left behind to reconstitute Reinke’s space and preserve vibratory characteristics. #Surpac foldbacks must be removed manual■ Removal of the polypoid material may require a high-vacuum suction device and/or manual extraction of loculated portions of the disease. Alternatively, it is acceptable to operate unilaterally and stage the second procedure. ■ Microflap surgery can be performed bilaterally, but incisions should not extend to the anterior vocal fold to avoid web formation. ■ Surgical indications for polypoid corditis include symptomatic dysphonia despite medical management, airway encroachment/partial obstruction, or concern of malignancy. ■ Polypoid corditis is a bilateral process characterized by expansion of Reinke’s space with gelatinous inflammatory material throughout the entire vocal fold, and is seen almost exclusively in smokers. The result is stiffness/loss of vibratory properties with rough, breathy dysphonia, vocal fatigue, and lack of projection. A risk factor for unfavorable scarring is the removal of excessive amounts of the SLP/gelatinous material. ■ Scarring of the vocal folds can also occur. The best way to avoid this complication is to make the incisions on the lateral aspect of the vocal fold, and not to extend the incisions to the anterior most aspect of both vocal folds. #Surpac foldbacks must be removed freeThe most serious complication is anterior glottic web, which can occur when raw surfaces are left at the anterior free edge of both vocal folds. ■ Complications are generally related to technical errors in the surgical procedure. In general, recovery and stabilization of voice takes longer than with most other benign lesions, typically 6–8 weeks. In addition, the pitch of the voice will be significantly higher due to the loss of mass after the surgery. ■ The patient will experience a breathy voice postoperatively, primarily due to the preoperative high subglottal pressures that are used to drive the vibration of the polypoid material. ![]() Smoking should be discontinued or significantly reduced in the postoperative period. Postoperative care should include PPIs, pain medicine, and voice rest for 5–7 days. The incised edges of the flap should coapt closely, without a significant mucosal dehiscence (Fig. Long cuts across the mucosa are preferable to short cuts, and these tend to give a jagged contour to the cut edge. Frequently, there are loculations of more fibrous material mixed in with One must allow a few seconds for the maximum pressure to be achieved after placing the suction into the polypoid material. Care is taken to retract the flap so it is not caught in the suction. In general, a 5- or 7-French microsuction with closed thumb port is used (Fig. The larger suction tubing used in the units can be adapted to the smaller suction tubing using a “Christmas tree” adaptor. Routine operating room suction units are frequently inadequate, and the liposuction units are generally employed. Much of the polypoid tissue can be removed with suction however, suction with a strong negative pressure is essential. It should be noted that some mild-to- moderate cases of polypoid corditis might not require much flap elevation (as described in this and step 4) in these cases, the material may aspirate more readily without the need for extensive flap elevation. Once the material has been freed, it is ready for removal. 18.5)Īgain, using a 30° flap elevator, the vocal ligament is identified at the superior/lateral aspect of the vocal fold, and a plane is developed between the vocal ligament and the diseased polypoid tissue. Raise a plane between the vocal ligament and the overlying polypoid material (Fig. In some cases, an extensive flap is required, extending well into the infraglottis, and from “stem-to-stern” of the entire membranous vocal fold.ĥ. As the dissection extends inferiorly, it is necessary to put lateral pressure on the flap elevator to get adequate visualization of the flap. Using a 30° flap elevator, the epithelium is separated from the underlying polypoid tissue, taking great care not to perforate the epithelial flap, which can be quite thin. Raise the microflap between the epithelium and the polypoid material (Fig. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |