Patient Cohort and Procedure
Patients with broad-based sessile vocal polyps who were treated in our hospital from January 2016 to December 2019 were retrospectively selected. Our hospital offered patients alternative surgery options (TVFP and MLS) and the attending physicians described the advantages and disadvantages of both procedures to them (e.g. local versus general anesthesia, length of hospital stay, cost, surgical risks, complications, and perioperative discomfort). The patients made decisions independently after careful evaluation.
The patients with sensitive and strong pharyngeal reflex might choose MLS under general anesthesia, whereas the patients who were unwilling to accept general anesthesia might choose outpatient TVFP under local anesthesia. According to our past experience, either surgical method could be considered for vocal cord polys with a diameter of 3-6 mm. For those vocal cord polys which were larger than 6 mm, we would suggest patients to choose MLS. For some special cases, the patients who were not suitable for general anesthesia or laryngeal suspension such as cardiovascular disease, cervical spine disease, oropharyngeal stenosis, and high laryngeal body due to obesity, we would recommend them to choose TVFP under local anesthesia.
The broad-based sessile vocal cord polyps were defined according to their appearances. They appeared on the free edge of the vocal folds and generally larger than those with peduncles. The large enough polyps result in dysphonia by interrupting vocal fold closure. In our study, the broad-based vocal cord polyps developed in the anterior and middle margin of the vocal cords and more than 3 mm long along the edge of the vocal cords. The polyps with an inactive broad base with a fusiform or semicircular shape, protruding from the edge of the vocal cords were included. Meanwhile, the polyps with a diameter greater than 3 mm but length less than 3 mm at the base were excluded.
All clinical diagnosis and different types of pathological tissue were determined by the pathological examination. According to the morphology of electronic laryngoscope and pathological features, we classified vocal cord polyps into four different histological types: edematous, gelatinous, vascular, and fibrous type (Figure 1). The patients were subsequently divided into corresponding group depending on the histological characteristics of their tissues. Each group was divided into two subgroups upon their surgical treatment: TVFP under local anesthesia and MLS under general anesthesia. The surgical effects and complications of each group were compared and analyzed.