Microflap excision is an advanced surgical procedure to effectively removes cysts and lesions from the vocal folds (cords) while leaving surrounding healthy tissue intact. This technique results in faster healing and more improvement in voice quality than traditional laryngeal surgery. Cysts and precancerous lesions of the vocal cords, can cause speaking or breathing difficulties and put patients at risk for cancer. Although nodules and polyps may respond to conservative treatment, vocal cysts typically do not. Treatment of vocal fold lesions almost always requires surgical removal. During micro flap excision surgery, the overlying epithelial cover is lifted up to remove the abnormal tissue and then put back into place, eliminating the need for reconstructive treatment and allowing patients to heal more quickly.
The Microflap Excision Procedure
Before the procedure, a diagnostic microlaryngoscopy or videostroboscopy is usually administered to confirm the diagnosis. All known sources of vocal trauma are treated prior to surgical therapy, often with voice therapy, to maximize improvement and prevent postoperative recurrence of the problem.
During the microflap excision procedure, the doctor inserts a laryngoscope through the nose and down into the larynx, which will provide a full view of the vocal folds and make them accessible. The laryngoscope is fitted with microscopic tools. Once the surgeon can reach the affected site, a tiny incision is made in the side or center of the vocal folds, near the targeted lesion. After delicately lifting up the cut membrane of the vocal fold, the surgeon precisely separates the cyst from the neighboring tissue, removing it.
One of the benefits of microflap excision is that once the abnormal growth is removed, and the flap is restored to its original position, no sutures are necessary. The incision is allowed to heal on its own, a process that minimizes scarring. A solution of triamcinolone acetate may also be injected into the flap to minimize scar formation. In vocal fold surgery, it is especially important to minimize scarring since scar tissue is thicker than normal tissue and does not vibrate as well.
After the microflap excision, the patient must be on strict voice rest for 2 weeks in order to promote healing. It is important for patients to understand that speaking and singing engagements must be postponed for at least 3 months after the operation. Antibiotics and corticosteroids may be prescribed to prevent infection and help manage pain. Frequently, acid reflux medication is also prescribed to prevent stomach acid from damaging the vocal folds as they heal.
After the procedure, patients may experience tongue or throat pain from the laryngoscope. Patients may also experience temporary loss of taste from the anesthesia. While recovery from the surgical procedure is usually complete after 2 to 3 weeks, these postoperative symptoms may persist for up to 3 months.
Complications Of Microflap Excision Surgery
While microflap excision is generally a safe procedure, there are risks inherent in any surgery. If the cyst is excised extends into the vocal ligament, recovery may be slower and prolonged hoarseness can be expected. If a cyst ruptures during surgery, scarring may occur, complicating vocal improvement. In such cases, intensive voice therapy and a higher dosage of corticosteroids may be required after the procedure. The pressure exerted during the procedure may result in tongue numbness, altered taste, hoarseness, injuries to the mouth or throat, or, in rare cases, coughing, or difficulty swallowing. The risk of these complications is, however, greatly diminished by the use of the microflap excision technique.
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