Bipedicled Vocal Fold Mucosal Flap Use in Phonomicrosurgery: Case Series

J Voice. 2020 Apr 20;S0892-1997(19)30431-X. doi: 10.1016/j.jvoice.2020.01.009. Online ahead of print.


Objectives: The objective of this study was to present a novel surgical technique involving the use of a "bipedicled vocal fold mucosal flap" to repair a mucosal defect and to evaluate the outcomes of patients in whom it was used.

Material and methods: This was a retrospective study of 6 clinical cases. All patients underwent surgery between November 2000 and July 2018, and all procedures were performed by the same surgeon. For the auditory-perceptual assessment, the Grade-Roughness-Breathiness-Asthenia-Strain hoarseness scale was used. We based the stroboscopic evaluation on the European Laryngological Society protocol, analyzing the parameters glottal closure, mucosal wave, and phase symmetry.

Results: Ages at the time of surgery ranged from 10 to 52 years, and all of the patients were male. Preexisting vocal fold lesions included polyps, cysts, a sulcus, and mucosal bridges. Among the stroboscopic parameters, only the mucosal wave differed significantly between the preoperative and postoperative periods (P = 0.046). There were also significant postoperative improvements in the overall grade of dysphonia (P = 0.025) and in the degree of breathiness (P = 0.025).

Conclusions: The use of a bipedicled vocal fold mucosal flap appears to promote significant improvements in the mucosal wave and in voice quality. In the patients evaluated here, the technique was used without preoperative planning. However, it proved to be a safe and appropriate means of repairing mucosal defects in the vocal folds, with the potential to preserve rheological properties and promote healing with less chance of fibrosis.

Keywords: Bipedicled mucosal flap; Dysphonia; Phonomicrosurgery; Surgery technique; Surgical flap.