OtoRhinoLaryngology Portal

The Leading Online Gallery of Otolaryngology and Head & Neck Surgery Specialty

OtoRhinoLaryngology Portal Video Collections @

YouTube & MEDtube

Vocal Fold Nodules

 

 

Vocal fold nodules are symmetrical free edge swelling typically located at the junction between anterior 1/3rd to posterior 2/3rd of the vocal fold.  It is associated with phonotrauma caused by voice misuse, overuse, or abuse.  Speech therapy is the preferred management for early/soft nodules with microlaryngeal surgery reserved for more mature/fibrous nodules.  In some,early surgical intervention is justified.

 

Hourglass appearance of glottic aperture upon phonation in vocal fold nodules.

 

Watch video of vocal fold nodules @ YouTube

 

 

 

Vocal Fold Nodules: Intraoperative

Before Surgery                                      After Surgery

 

Image on the left also shows evidence of subcordal oedema which is one

of the finding strongly suggestive of laryngopharyngeal reflux disease.

 

Watch video on microlaryngeal surgery of vocal fold nodules @ YouTube

Phonotrauma with Fibrin Formation

 

  It is important to address on voice rest during acute laryngitis.  Additional phonotrauma may end-up with the risk of scar formation and further worsens the voice quality.  Strict voice rest is advocated initially and later to limited usage.

 

Watch video of vocal folds fibrin formation complicating voice overused @ YouTube

Phononotrauma with Thickened Vocal Folds Free Border

Chronic Phonotrauma Resulting in Irregular Excrescence of Vocal Folds Free Edge

                        At rest                                              During phonation

 

Vascular Ectasia (Including KTP Laser Treatment)

Anterior Commissure Scar & Variceal Lesion

Arrow - anterior commissure scar, rounded rectangle - variceal lesion, LVF - left vocal fold, RVF right vocal fold.  Flexometallic endotracheal tube is seen centrally. 

Arrow - anterior commissure scar, rounded rectangle - variceal lesion, RVF - right vocal fold, LVF - left vocal fold.  Flexometallic endotracheal tube is seen centrally.
Arrow - anterior commissure scar, rounded rectangle - variceal lesion, RVF - right vocal fold, LVF - left vocal fold.  Flexometallic endotracheal tube is seen ce

Vascular Lakes with Ectasia and Vocal Fold Nodules

Dotted circle -vascular lakes with ectasia, arrows - nodules 

Vocal Fold Subepithelial Haemorrhage

      

 Subepithelial haemorrhage secondary to phonotrauma.  Patient was advised for complete voice rest initially for 3-5 days followed by limited and gradual voice use to normal.  No other significant vocal fold pathology. 

Evidence of LPR noted over arytenoid mucosa and interarytenoid area.

 

Watch video of acute vocal fold haemorrhage @ YouTube

Video 1                         Video 2

Vascular Ectasia: Bipolar Cautery

Abnormal capillaries predispose to vocal fold haemorrhage and may result in benign vocal fold lesions and scar formation.  KTP and pulse-dye laser would

be ideal for the management of these lesions. However, bipolar diathermy at

low power setting is a good alternative if laser is not available.

 

Watch video on telangiectasia of true vocal folds @ YouTube

Vocal Fold Polyp

Vocal fold polyp is a unilateral mass lesion usually arising near its free edge.  It can be sessile or pedunculated.  There might be contralateral vocal fold reactions usually a thickened epithelium which resolves spontaneously upon microsurgical excision of the primary lesion. 

Figure on the left shows a small vocal fold polyp with a thin pedicle

while on the right a multilobular type with a thick and broad pedicle.

 

Watch video on intraoperative vocal fold polyp assessment @ YouTube

           Large right vocal fold polyp                    Anterior commissure polyp.

     with a thin broad-based attachment.

 

Right vocal fold polyp with recent subepithelial hemorrhage

secondary to voice overuse.

The view of the same lesion as above during phonation.

 

 

 

 

 

 

Video clip showing a small sessile right vocal fold polyp.

 

     

Video clip showing a large right vocal fold polyp with a broad-based pedicle.

 

 

Video clip of right vocal fold polyp excision by using cold instruments.

 

Watch video on avulsion of vocal fold polyp @ YouTube

Phonotrauma with Reflux Laryngitis

 

Prolonged and repetitive voice over-used or abuse have detrimental effect on vocal folds especially when voice projection is needed in a very noisy background.  In this video, left vocal fold polyp has formed (white arrow) with opposite vocal fold thickening seen and evidence of recent bleeding into superficial vocal fold layer (green arrow with yellowish tinge underneath the vocal folds lining on both sides).  The mucosa of arytenoids and posterior commissure appeared swollen, reddish and oedematous due to coexisting untreated reflux laryngitis (blue interrupted line).

Huge Vocal Fold Polyp Before & After Laser Surgery

 

 

In this video, a huge a obstucting vocal fold polyp is seen between the vocal folds.  It was successfully excised by using carbon dioxide (CO2) laser and his laryngeal symtoms (hoarse voice, difficulty in breathing, and throat irritations) recovered to normal.

Excision of Laryngeal Polyp

Reinke's Oedema

Reinke's oedema of polypoid corditis is a generalised oedema of the

subepithelial space with cumulation of gelatinous/myxomatous material. 

It can occur unilaterally or bilaterally.  Treament is by microsurgical

aspiration and alleviating the predisposing factor- usually smoking. 

Still image on fiberoptic laryngoscopy.

 

 Severe Reinke's oedema as seen during direct laryngoscopy.

Vascularity pattern in Reinke's oedema.

 

Video of Reinke's oedema on rigid laryngoscopy.

 

Watch video of Reinke's oedema intraoperative assessment @ YouTube

Reinke's Oedema: Intraoperative

           Gel-like substance (arrows)                         Lateral cordotomy       

       Suctioning  of excess material                 View at completion of surgery

 

Video of Reinke's oedema on examination under general anaesthesia.

 

Watch video of Reinke's oedema microlaryngeal surgery @ YouTube.

Subepithelial Vocal Fold Cyst

Cyst is fluid filled swelling lined by mucosal lining. 

It needs to be excised completely by using microsurgical technique.

 

          Video of left vocal fold cyst on videostroboscopy.

 

Watch video of vocal fold cyst with 'Cup & Saucer' effect @ YouTube

Intracordal Vocal Fold Cyst: A Fusiform Smooth Swelling

Intracordal Vocal Fold Cyst & Vascular Ectasia

 

This image shows a swollen left true vocal fold due to an intracordal cyst. 

There is an abnormal capillary on the opposite vocal fold (blue arrow)

which needs to be treated as well.  This vessels predispose to vocal fold haemorrhage with subsequent development of benign vocal lesions and scarring.

 Close-up view of the same lesion showing an obviously abnormal subepithelial vessels of right true vocal fold. (R - right, L - left) 

Infected  Vocal Fold Cyst

Intraoperative view of left vocal fold cyst.

Thick mucopus seen emanating from the cyst  upon infiltration  of adrenaline-mixed saling (the needle tip had gone into the cyst causing its content to leak)

The Medial Flap

 Endoscopic view of left subepithelial vocal fold cyst.

 Close-up view of the cyst. 

                  Flap raised after                          Cyst exposed after further

        medial cordotomy performed.                 dissection while care taken

                                                      to avoid rupture.

 

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