Vascular abnormalities involving the vibratory margin of the vocal fold.

A 38-year-old premier Broadway soprano came to the office for evaluation of a sudden voice change that began after she had screamed at a friend. She had persistent hoarseness, breathiness, and decreased control. Voice rest had not helped. She reported that the only other voice problem she had experienced occurred approximately 6 weeks earlier when she had had an upper respiratory infection.

Strobovideolaryngoscopy revealed the presence of a large varicosity on the superior surface of her left vocal fold and a varicosity on the superior surface of her right fold; the latter turned medially toward the vibratory margin and entered a vascular mass (figure). Surrounding this mass was a broad-based pseudocyst.

Following a brief course of voice therapy, the patient underwent resection of the right vascular mass and both varicosities. The right varicosity was resected rather than vaporized because its close proximity to the vibratory margin would have made laser therapy less safe. The pseudocyst was evacuated. The left varicosity was cauterized with a laser. The right vocal fold healed perfectly, and the patient was able to return to the Broadway stage 8 weeks following surgery. The left varicosity recanalized and persisted as a smaller varicosity, but it did not cause any symptoms.

This operation was performed in 1995, and this woman was the first patient to undergo the new technique of varicosity resection with cold instruments. Since then, this technique has become the senior author's (R.T.S.) standard approach.