Vocal fold polyps: Assessing the vertical dimension.

A nonsmoking 37-year-old woman came to the office with a 2-month history of hoarseness and an inability to project her voice. Her hoarseness started suddenly and was without any identifiable antecedent event. She denied upper respiratory infection, voice abuse, and allergies. She also denied using aspirin or other medications that affect coagulation, and she did not recall being premenstrual at onset.

Strobovideolaryngoscopy revealed a hemorrhagic polyp involving the left vibratory margin, based near the middle of the musculomembranous portion (striking zone). There were also somewhat enlarged, irregular vessels on the superior surface of both vocal folds. An intraoperative photograph taken through a Storz 10-mm 0[degrees] rod showed a polyp and a small (asymptomatic) anterior microweb (figure 1). A photograph taken through a 4-mm 70[degrees] rod showed the vertical extent of the mass along the contact surface of the left vibratory margin, as well as the mass's vasculature and the anatomy of its attachment to the vocal fold (figure 2). Such accurate endoscopic mapping of the lesion assisted in limiting surgery to the area of the abnormality and leaving normal tissue undisturbed.

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