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VOCAL CYSTS - Clinical and surgical aspects

VOCAL CYSTS - Clinical and surgical aspects
24 Aug, 2017

VOCAL CYSTS

Vocal cysts are benign lesions of the vocal cord and can affect both children and adult. They can be unilateral bilateral and can be easily confused with vocal nodule. They can be classified broadly into two subtypes- Epidermic and Mucous retention cyst.

CAUSE

Epidermic cysts may be secondary to vocal abuse or due to entrapped epithelium inside lamina propria and appears pearl like with caseous content.

Mucous retention cysts are due to obstruction of the glandular ducts consequent to vocal abuse, laryngitis, upper airway infection or laryngo pharyngeal reflux.

INVESTIGATION

Video-laryngo stroboscopy is quite helpful in the diagnosis of the vocal cysts which are otherwise easily mistaken as vocal nodules, especially in bilateral lesions and lesions which are symmetrical on stroboscopy. Cysts have a typically reduced or absent mucosal wave due to increased bulk of the cord. There can be a phonatory gap associated with the cyst and also decreased amplitude.

Incidence

These lesions are more common in adult female patients, especially those associated with professional voice use.

Vocal cysts are also frequently seen in paediatric population and can be congenital in some cases resulting in early vocal symptoms. Vocal abuse is also very common in children, thereby resulting in the development of cysts. Children below 5 years of age, the incidence of vocal cysts is higher among males.

Vocal cysts may develop in association with other minor structural lesions in- the larynx such as sulcus vocalis, micro- web and vascular dysgenics.

 

TREATMENT

The treatment of choice for vocal cysts is Micro laryngeal surgery. The surgical approach demands minimal manipulation to avoid scaring. Medial micro flap technique is performed by carefully raising the flap, avoiding damage to the lamina propria. The cyst is carefully dissected and the micro flap is repositioned. Vocal rehabilitation is important complementary treatment to obtain adequate results.

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