Dense vocal fold scar.A 39-year-old pharmaceutical representative and aerobics instructor presented to us with voice complaints. Two months earlier, she had had a left vocal fold cyst Vocal fold cysts are collections of fluid in sac-like formations on the vocal folds. Cysts can deteriorate the quality of human speech production, causing diplophonia, a condition where the vocal cords produce multiple tones at the same time, or dysphonia, an impaired removed by another otolaryngologist. She had been informed postoperatively that the cyst cyst, abnormal sac in the body, filled with a fluid or semisolid and enclosed in a membrane. Cysts can be congenital but are usually acquired, the most common locations being the skin and the ovaries. was deep and that she had hemorrhaged into the vocal fold. She had been placed on 1 week of voice rest after surgery. She returned to work 3 weeks after surgery, but she became progressively more hoarse. One month postoperatively, she was reevaluated by her otolaryngologist and informed that another mass had arisen on the left vocal fold. She came to us for a second opinion. The patient's medical history was otherwise unremarkable. She was taking esomeprazole twice daily and rofecoxib. On examination, her voice was severely hoarse. Flexible laryngoscopy and rigid stroboscopy demonstrated several masses on both vocal folds. On the left fold, two large fibrotic masses were present in the striking zone, and several varicose varicose /var·i·cose/ (var´i-kos) variceal or variciform; of the nature of or pertaining to a varix; unnaturally and permanently distended. var·i·cose adj. vessels were visible on the superior surface (figure). A submucosal submucosal /sub·mu·co·sal/ (-mu-ko´sal) 1. pertaining to the submucosa. 2. beneath a mucous membrane. mass was seen on the superior aspect of the right vocal fold with a vessel leading into it. Vessels extended into both masses. In addition, a large area of scar extended laterally from these masses. On the right fold, several smaller masses were seen in the striking zone, including two with punctate punctate /punc·tate/ (punk´tat) spotted; marked with points or punctures. punc·tate adj. Having tiny spots, points, or depressions. ectasias on them. [FIGURE OMITTED] The patient was started on voice therapy and prepared for microdirect laryngoscopy with excision of the masses and the scar. She was counseled that there was a significant chance that her voice might worsen with surgery. Intraoperative rigid endoscopy endoscopy Examination of the body's interior through an instrument inserted into a natural opening or an incision, usually as an outpatient procedure. Endoscopes include the upper gastrointestinal endoscope (for the esophagus, stomach, and duodenum), the colonoscope (for the confirmed the earlier findings on flexible laryngoscopy and rigid stroboscopy. Both dilated vessels on the left vocal fold were removed with a vessel knife. The entire lamina propria within the striking zone of the left fold had been replaced by a dense, irregular scar. There was no discernible vocal ligament. This area of scar was excised. On the right vocal fold, the patient had a submucosal cyst, which was removed using a minimicroflap. Two small masses and ectasias in the middle of the right striking zone also were excised. Dexamethasone dexamethasone /dex·a·meth·a·sone/ (dek?sah-meth´ah-son) a synthetic glucocorticoid used primarily as an antiinflammatory in various conditions, including collagen diseases and allergic states; it is the basis of a screening test in the was injected bilaterally. Postoperatively, her voice was substantially better but not normal. From the Department of Otolaryngology--Head and Neck Surgery, Thomas Jefferson University It began as Jefferson Medical College in 1824. On July 1, 1969 the institution officially became Thomas Jefferson University. The university is made up of three colleges:
|
|
||||||||||||||||||||
Printer friendly
Cite/link
Email
Feedback
Reader Opinion