Clinical Characteristics And Voice Outcomes After Laryngeal Microsurgery For Vocal Fold Epidermoid Cysts Coexisting With Sulcus Vocalis

Objective:To investigate the clinical characteristics and voice outcomes after laryngeal microsurgery for vocal fold epidermoid cysts coexisting with sulcus vocalis.Methods:The clinical data of 115 vocal fold epidermoid cysts coexisting with sulcus vocalis patients were retrospectively analyzed.All patients underwent surgery through suspension laryngoscope and microscope under general anesthesia.Patients were treated with microflap excision of sulcus vocalis,cyst wall,and contents,and patients that occult with mucosal bridges were applied mucosal bridges resection or mucosal bridges reconstruction respectively.Videolaryngoscopy and subjective and objective voice evaluation were performed before and after surgery.The preoperative acoustic parameters of patients with vocal fold epidermoid cysts coexisting with sulcus vocalis were compared with those of vocal fold mucus retention cysts and simple vocal fold epidermoid cysts underwent surgery during the same period.SPSS version 26.0 software was used for the statistical analysis of the data,and a value of P<0.05 was considered a statistically significant difference.Results:A total of 115 patients were diagnosed by surgical microscope with postoperative pathology,of which 21 cysts combined with mucosal bridges,including 49 males and 66 females.The mean age was 43 years.Significant reduction or lack of mucosal waves were showed via videolaryngostroboscopy in all 115 cases,in addition,vascular changes including dilation,tortuousness,increased branches,and abrupt direction change were showed on the cystic area.Shimmer percent of epidermoid cyst coexisting with sulcus vocalis was significantly higher than that of mucous retention cysts(P<0.05),and was significantly lower than that of simple epidermoid cyst(P<0.05).94 patients were treated with microflap excision of sulcus vocalis,cyst wall,and contents,and 21 patients that occult with mucosal bridges were applied mucosal bridges resection(2 cases)and mucosal bridges reconstruction(19 cases)respectively.The intraoperative microscopic examination revealed a focal pouch-like deficit plunging into the vocal ligament or muscle.Histopathology demonstrated a cystic cavity structure lined with squamous epithelium and caseous keratin desquamation inside the cystic cavity.4 of 115 patients were lost at follow-up and excluded from the analysis of voice outcomes after surgery.Except for the fundamental frequency and noise harmonic ratio,all other voice parameters showed a significant improvement 3 months after surgery(P<0.05).Then mucosal waves and the voice quality were gradually improved and became steady in 6 months after surgery.The subjective and objective voice parameters,except for the fundamental frequency,were all significantly improved(P<0.05).Steady function with no complications was observed during the 12 months(up to 3 years in 34 patients)follow-up period.Conclusion:Ruptured vocal fold epidermoid cysts could result in sulcus vocalis and mucosal bridges.Characteristics changes in preoperative videolaryngoscopy and acoustic parameter were effective diagnostic tools.Accurate diagnosis and microlaryngeal surgery can lead to satisfactory long-term effects.