Histological basis for indirect videostroboscopic phonosurgery - a scanning electron microscopic study

Indications for indirect videostroboscopic surgery are well established for small, benign functional lesions of the vocal folds. Epithelial cells of the vocal folds are spindle-shaped and by their long axies run parallel to the free edge of the vocal fold. This occurrence is used clinically by surgeons to obtain an even operative defect when using a cup forceps during single-handed manipulations. Nevertheless, there are still some doubts about single-handed procedures, so that many surgeons prefer the convenience of bimanual manipulation offered by direct (suspension) microlaryngoscopic surgery. The aim of this study was to demonstrate that single-handed manipulation during indirect videostroboscopic surgery permitted obtaining regular edges of an operative defect during laryngeal surgery. A scanning electron microscopic study was conducted on five cadaver larynges following indirect videoscopic excisions at the vocal fold's free edge and ten controls. Results demonstrated a clearly regular edge of the operative defects in cases when a posterior traction surgical procedure was followed. These findings reaffirm the value of indirect videostroboscopic surgery for small, benign functional lesions of the vocal folds.