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.