In most cases of vocal fold polyp, surgery is reserved for patients with unacceptable voice impairment that persists despite conservative management. However, two situations override that rule and make surgical excision the appropriate immediate step.
This protocol applies when a vocal fold lesion is affecting the patency of the airway — posing a mechanical risk — or when the clinical picture raises concern for malignancy and tissue diagnosis is required. In either circumstance, the usual threshold of failed voice therapy and medical management does not apply.
The intervention is phonosurgical excision of the polyp. The preferred technique, when anatomically feasible, involves a specific microflap approach designed to preserve the underlying tissue architecture. Alternative methods exist and may be selected based on lesion characteristics and available expertise.
Complete technique selection criteria, procedural details, and post-operative considerations are in the full protocol.As previously noted, with the exception of lesions affecting the patency of the airway or those in which the diagnosis of malignancy is entertained, the indication for surgical therapy is the presence of unacceptable vocal impairment despite compliance with medical treatment and appropriate voice therapy.
The author's technique of choice is the subepithelial microflap, when feasible.
A simple superficial excision, sparing the underlying uninvolved LP and minimizing the epithelial loss, is generally sufficient.
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