INTRODUCTION
LCG, is a kind of benign lesion that occurs around the vocal fold mucosa and presents ulcer and granulation tissue hyperplasia, which is easy to relapse and difficult to cure radically. After standardized treatment for more than 3 months, those who still have no improvement or disease recurrence are called refractory contact granuloma1. LCG usually associated with several etiological factors such as laryngopharyngeal reflux, habitual throat clearing and improper use of voice. Thought the disease is not completely clear, it is usually considered that mucosal inflammation and ulceration that occur the posteromedial aspect of the vocal cords followed by granulation tissue hyperplasia2.Intubation granuloma is self-limited, caused by endotracheal intubation, and totally different from laryngeal contact granuloma. Very few of the intubation granuloma could not heal spontaneously, and surgery may resolve it well with low recurrence rate.
Conservative treatment and surgical treatment have been widely used in contact granuloma, but almost both treatments cannot form consensus to overcome the persistence and recurrence contact granuloma. Granulomas cause psychological trauma and anxiety in patients, leading to loss of interest in peripheral events3.In this article advanced surgical methods with mucosal-flap and botulinum toxin A injection are applied in the treatment of refractory LCG, with significant efficacy and extremely low recurrence rate.