[Phonosurgical treatment of benign lesions of the vocal cords (10 years' experience)].

UNLABELLED

The aim of phonosurgery is to improve the state of voice and speech, while surgical treatment of benign vocal fold lesions belongs to the category of extirpation phonosurgery. Excellent functional results can be achieved with the aid of modern light sources and monitoring systems [8-19]. The aim of this study was to stress the advantages and shortcomings of direct suspension microlaryngoscopy, indirect microstroboscopy and indirect videostroboscopy, as well as indications for their use.

METHOD

Over a 10-year period 1550 patients with benign lesions of the vocal folds were operated by direct microlaryngoscopy, indirect microstroboscopy and indirect videostroboscopy. Basic parameters which influence the selection of a particular surgical method were established, while a comparison was made among these various surgical techniques.

RESULTS

Our surgical experience led us to conclusion that indirect procedures should be used in the majority of functional benign lesions of the vocal fold (Table 1). Selection of a particular surgical technique depends on several parameters (Table 2). Indirect procedures are indicated for small lesions with narrow base and with a distinct demarcation to the vocal tissue. Other cases are better approached by direct microlaryngoscopy, which is also indicated for submucosal lesions, sulcus vocalis etc., when bimanual instrumentation is required. Unfavourable local anatomy and "difficult" localization of a lesion (anterior commissure and posterior glottis) are better approached by indirect videostroboscopy. Indirect surgery is also required for cases when direct microlaryngoscopy is contraindicated and vice versa (contraindication for general anaesthesia or insufficient effect of epimucous anaesthesia). The patient should be allowed to express his preference for a particular surgical technique.

DISCUSSION

Binocular vision and bimanual procedure are significant advantages of direct microlaryngoscopy, related to indirect procedures. However, some inadequacies of this technique and advantages of indirect procedures with modern light sources, magnification and videostroboscopic control make, in our experience, indirect videostroboscopy a procedure of choice for about two thirds of functional benign lesions of the vocal fold. Indirect videostroboscopy is technically simpler in relation to indirect microstroboscopic surgery, while indications for direct microlaryngoscopic and indirect videostroboscopic surgery are complementary. Laser surgery should be avoided in functional benign lesions of the vocal fold for its inferior functional results [25, 26].