Intracordal epithelial cyst with secondary contact trauma to the opposite vocal fold.

We evaluated a 13-year-old boy who reported that he had been hoarse throughout his life. He said that people often asked him to repeat himself or asked him if he was ill.

Strobovideolaryngoscopy detected a large mass on the left vocal fold that extended from the vibratory margin to deep in the vocal ligament (figure). The white contents of this intracordal cyst were easily seen. Also noted were erythema and edema of the epithelium, a vascular blush, and a feeding vessel on the superior surface of the fold. Deep to the cyst was fibrosis, which probably had been caused by the repeated striking of the cyst against the vocal ligament during phonation. The cyst had also caused considerable trauma to the opposite vocal fold, where most of the vibratory margin consisted of thick, rough epithelium indicative of fibrotic change or scar tissue; a transition to more normal epithelium was evident just anterior to the vocal process.

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On the basis of these findings, we advised the parents that removal of the cyst would result in the patient's voice being improved but not normal. The boy was scheduled for surgery.

In order to optimize the postoperative healing environment, the patient was treated for reflux despite the lack of definite physical findings of extraesophageal acid exposure. The patient also underwent a few sessions of preoperative voice therapy to prepare him for speaking after the cyst was removed. The cyst was removed via a mini-microflap procedure with the patient under general anesthesia.

Because the trauma to the right vocal fold was secondary and the changes were soft to palpation, it was not resected but was just injected with a steroid; otherwise, it was left undisturbed and allowed to heal. Two months postoperatively, examination revealed near-complete resolution of the hoarseness.

Pathology demonstrated the presence of keratin debris, which helped establish the final diagnosis: an epithelial cyst. These cysts are usually congenital, which helps explain the patient's life-long dysphonia.

Robert Eller, MD; Mary Hawkshaw, BSN, RN, CORLN; Robert T. Sataloff, MD, DMA

From the American Institute for Voice and Ear Research (Dr. Eller and Ms. Hawkshaw); and the Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine and Graduate Hospital (Dr. Sataloff), Philadelphia.