DISCUSSION
Based on the clinical morphological and pathological characteristics of
vocal cord polyps, we divided sessile vocal cord polyps into four
different histological types: edematous, gelatinous, vascular, and
fibrous types. The edematous and gelatinous types of polyps are usually
display with translucent and gelatinous in clinical morphology, the
vascular type presents as opaque hemangioma, and the fibrous type shows
gray-white and dull fibrous. The edematous, gelatinous and vascular
types of polyps are soft, brittle and elastic. They are edema-like,
translucent and pale red color tissues, which are easy to remove. The
fibrous type of polyps is hard and less elastic. It’s a grayish or dark
red color tissue, which is hard to remove. The representative images are
shown in Figure 1 (A – D). Meanwhile, we assessed the pathological
features of these 4 different types of vocal cord polyps by IHC. We
observed a loose, myxoid, vascularized stroma with pale gray or pink
color in edematous type and gelatinous type of polyps (Figure 1, a and
b). The vascular type contained many dilated vessels with occasional
granulation tissue and hemorrhage (Figure 1, c). In the fibrous type,
the fibrin-like substances were distributed around the vascular space
and the spindle cells can be seem in a dense fibrous matrix (Figure 1,
d).6,17
Vocal cord polyps are classified based on their morphological
manifestations and pathological characteristics. The clinical
manifestations of different types of vocal cord polyps influence their
surgical treatments and outcomes. To verify this clinical observation,
we retrospectively compared the surgical outcomes of TVFP with those of
MLS for these types of vocal cord polyps. Through the retrospective
analysis, we found that the edematous, gelatinous, and vascular types of
polyps were technically easier to remove due to their sparse texture and
edema-like structure. Therefore, the surgical operation time was
shorter. The surgical outcome is as well as MLS treatment. For the
fibrous type of polyps, the operation time is longer due to the dense
texture which is relatively difficult to remove. Compared with the MLS
treatment, TVFP treatment has a significant worse surgical outcome.
Electronic flexible laryngoscope has the characteristics of high
resolution imaging, flexible and less irritation. A simultaneous imaging
operation can be performed with specific flexible forceps through the
operative channel.18 Nowadays, it has been commonly
used in the otolaryngology clinic and become an indispensable diagnostic
and therapeutic tool for ENT (Ear
Nose and Throat) doctors. When patients require a quick and lost-cost
surgical treatment, with the help of electronic flexible laryngoscope,
we can perform a surgery under local anesthesia in an outpatient setting
at the same day without hospitalization. It also can be an alternative
surgical option for patients who are not suitable for general anesthesia
or laryngeal suspension. When we performed the surgery, the patient was
placed in a supine position and the anti-bending tube with camera at the
front end was inserted through the contralateral side of nose.
Meanwhile, the flexible forceps within laryngoscope can be easily
operated with bending and less stimulating. The curved channel fits the
natural orifice perfectly, so the patient’s month dose not remain
rigidly open. The whole procedure enhances the patients comfort and
significantly reduces the complications such as surrounding soft tissues
damage caused by large tension producing from inserting and suspending
the direct laryngoscope through the mouth.
CONCLUSION
The therapeutic effects of both TVFP and MLS on the treatment of
broad-based sessile vocal cord polyps are related to their clinical
characteristics and histological types. Satisfactory outcomes are
achieved in edematous, gelatinous, and vascular types of vocal cord
polyps after either surgical procedure. The surgical treatment of
broad-based sessile vocal cord polyps by office-based TVFP is a
practical surgical operation with minimal trauma and complications
compare with MLS. This surgical procedure also saves patients’ time and
money. Therefore, TVFP can be a preferred option for the patients who
require fast and low-cost surgical treatment in outpatient setting. The
TVFP also can be an alternative surgical treatment for the patients who
could not tolerate general anesthesia or laryngeal suspension. In
contrast, MLS has proven to be particularly advantageous in patients who
have fibrous type of vocal cord polyps.