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.