The Evaluation of Benign Glottic Lesions: Rigid Telescopic Stroboscopy Versus Suspension Microlaryngoscopy

Department of Surgery, University of Wisconsin School of Medicine, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin 53792, USA.
Journal of Voice (Impact Factor: 1.24). 02/2007; 21(1):112-8. DOI: 10.1016/j.jvoice.2005.09.006
Source: PubMed


Rigid telescopic strobo-video-laryngoscopy (RTS) is a primary clinical assessment methodology in the office evaluation of benign glottic lesions. However, diagnostic observations can be made only at the time of suspension microlaryngoscopy (SML). The records of 100 consecutive patients undergoing microlaryngoscopy for benign glottic lesions were retrospectively reviewed. Nine of 100 patients were found to have additional glottic lesions during SML. Sixteen additional lesions were noted in these nine patients. Fifteen of 16 lesions were sulci and/or mucosal bridges. Forty-five percent (4/9) of the patients with additional lesions underwent a management change intraoperatively. Three patients underwent additional surgical dissection, and one underwent less dissection than was planned. The discrepancy in diagnosis between rigid telescopic strobo-video-laryngoscopy and suspension microlaryngoscopy highlights certain key points: (1) During office endoscopy, tangential views of the medial surface of the glottis limit the diagnostic sensitivity. (2) Sulci and mucosal bridges are most subject to this limitation. (3) Informed consent should address the potential need for a change in intraoperative management. It is advisable to discuss the possibility for dissection in both vocal folds, even if a unilateral lesion is observed in the office. (4) Microlaryngoscopy is the final diagnostic step in the evaluation of glottic pathology. Meticulous inspection and palpation of the glottis are recommended during SML.

1 Follower
18 Reads
  • Source
    • "If voice analysis points to an organ pathology and stroboscopy shows no direct evidence of functional dysphonia, we therefore recommend microlaryngoscopy to exclude pathology such as scars and mucosal bridges, hidden from stroboscopic view (Figure 11 (Fig. 11)). Microlaryngoscopy reduces the risk of missing small scars and arriving at an incorrect diagnosis such as a functional problem or an aging voice [128], [129], [130], [131]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: More than half of patients who present with the symptom of hoarseness show benign vocal fold changes. The clinician should be familiar with modern diagnostic and therapeutic possibilities of benign vocal fold changes in order to ensure an optimal and individualized attention to voice patients. Basic knowledge of the etiology are provided for targeted phonosurgical or conservative therapy. This review article focuses on the diagnostic and therapeutic limitations and difficulties of treatment of benign vocal fold tumors, the management and prophylaxis of scarred vocal fold changes and the issue of unilateral vocal fold paralysis.
    Full-text · Article · Apr 2013 · Laryngo-Rhino-Otologie
  • Source
    • "As lesões ambulatoriais mais freqüentes foram pólipo vocal (40%) e cisto epidermóide (29,4%). Excluindo-se nódulo vocal, os resultados foram semelhantes aos achados de Dailey et al., em 2007, Poels et al., em 2003 e Colton et al., em 1995. 11,12,17 Durante a realização da microcirurgia foram descritas 124 lesões nos 79 pacientes. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Proper diagnosis of laryngeal benign lesions still brings doubts among experienced laryngologists, despite current diagnostic progress. The goal of this study was to compare telelaryngoscopy (preoperative) with suspension laryngoscopy (intraoperative) on the diagnosis of vocal fold benign lesions. We carried out a restrospective study analyzing 79 charts from patients followed up in a University Hospital. In all the charts there was at least diagnostic hypothesis suggested by telelaryngoscopy, which was later on compared to intraoperative findings of suspension laryngoscopy. Almost two-thirds of the patients were females, with ages varying between 12 and 66 years (mean of 37 years). Of the 79 patients studied, we diagnosed 95 lesions with telelaryngoscopy and 124 with suspension laryngoscopy. The most frequently found benign lesion was the vocal polyp in both methods. In 64.5% of the cases the diagnosis of the lesions in the outpatient ward was the same as those in the surgical findings. Laryngologists must be prepared to alter their surgical planning and treatment approaches because of diagnostic changes that may happen during surgery.
    Full-text · Article · Dec 2008 · Brazilian journal of otorhinolaryngology
  • [Show abstract] [Hide abstract]
    ABSTRACT: This article provides a practical guide with which surgeons and nonsurgeons can highlight key areas of concern for optimal outcomes in phonomicrosurgery. Factors such as thorough diagnostics, patient history and physical examination, office endoscopy with stroboscopy, and operative examination are essential to avoiding pitfalls and enhancing results. The timing and preparation for surgery and managing expectations allow for mature decision-making by the surgeon and patient. Considerations specific to surgical technique must include anesthesia, intubation, exposure of the glottis, lighting, magnification, hemostasis, instrumentation, flap design, and tissue handling. Practical and technologic solutions are offered throughout the text, pointing out future directions for this commonly performed operation.
    No preview · Article · Feb 2006 · Otolaryngologic Clinics of North America
Show more