Vocal Cord Microsurgery — Procedure Guide, Recovery & Risks | MyMedicPlus

Vocal cord microsurgery (microlaryngoscopy) uses a rigid laryngoscope and operating microscope to excise or ablate benign or malignant lesions of the vocal folds under high magnification. It provides precise access to the vocal folds while preserving the delicate vibrating mucosal layers.

Indicated for vocal cord polyps, cysts, nodules persisting despite 3–6 months of voice therapy, Reinke's oedema, recurrent respiratory papillomata (RRP), carcinoma in situ (CIS), and early-stage glottic carcinoma (T1a–T1b) amenable to CO2 laser excision.

Under general anaesthesia using jet ventilation or a microlaryngoscopy tube, the laryngoscope is suspended to expose the glottis. The operating microscope provides magnification. The microflap technique elevates the epithelium to excise the lesion while meticulously preserving the superficial lamina propria to maintain vocal fold vibration.

Strict voice rest — no speaking or whispering — for 5–7 days is critical for optimal healing. Adequate hydration and steam inhalations reduce mucosal dryness. Voice therapy resumes at 2 weeks with a speech and language therapist. Full vocal recovery takes 4–8 weeks; professional voice users may require longer.

Risks include vocal fold scar formation (the most consequential complication, causing a hoarse or strained voice), tooth or lip injury from rigid laryngoscope placement, posterior glottic stenosis, anterior webbing from bilateral anterior lesions, and aspiration during the early post-operative period.

Resolution rates exceed 90% for polyps and cysts after a single procedure with the microflap technique. Nodules may recur if vocal misuse is not corrected through voice therapy. Early glottic carcinoma (T1a) achieves 90–95% local control with CO2 laser excision, comparable to radiotherapy.