Vocal fold cyst and contralateral occult sulcus mucosal bridge.

A 27-year-old woman, a pharmaceutical sales representative, came to the office with progressive hoarseness over a period of 6 months. She denied any previous voice problems, respiratory infections, or pain in the area. She experienced occasional heartburn, which she self-treated with antacids. The woman was not a singer or avocational voice user, but she was talkative. She had been a cheerleader in high school.

At her initial visit, her voice was rough, breathy, and diplophonic. Her speaking technique was characterized by a habitual low pitch and frequent hard glottal attacks during speech. She was otherwise healthy.

Strobovideolaryngoscopy revealed a mass at the midmembranous left vocal fold. The left vocal fold featured diminished vibratory properties, and the lesion appeared to be a subepithelial cyst. Her right vocal fold had a prominent vessel (figure 1).

The patient was prescribed preoperative voice therapy, which was followed by phonomicrosurgery. Intraoperatively, she was found to have a left vocal fold cyst, an occult mucosal bridge, and sulcus vocalis in the contralateral fold (figure 2).

We performed a mini-microflap procedure and excised the cyst on the left. We also excised the mucosal bridge on the right and injected a steroid. The abnormal vasculature was treated with bipolar cauterization. The patient received postoperative voice therapy and experienced significant vocal improvement, including return to fulltime sales activities.

From the Department of Otolaryngology--Head and Neck Surgery, University of Pittsburgh School of Medicine, and the University of Pittsburgh Voice Center.