Concomitant bilateral vocal cord cysts in a 12-year-old patient treated by one-stage mini-microflap CO2 laser microsurgery: case report and review of the literature

Abstract

Introduction: Dysphonia in the pediatric population has effects on school, family and social activity. Among the benign pathologies causing dysphonia in children, concomitant bilateral vocal cord cysts are quite uncommon. Vocal cord cysts can be congenital or acquired. The diagnosis is not always straight, but when defined the only treatment is surgery.

Objective: The authors reported a pediatric case of chronic dysphonia due to bilateral vocal cord retention cysts and discuss the etiopathogenetic hypothesis and surgical treatment with the CO₂ laser mini-microflap technique. A review of the literature was also performed.

Case report: A 12-year-old patient was admitted at the Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Italy for chronic dysphonia lasting from one year: Grade Roughness Breathiness Asthenia Strain scale was 3 in every specific area, and Pediatric Voice Handicap Index score was 48. Laryngoscopy showed a bilateral vocal cord swelling at the middle third of both vocal cords suspect for cystic lesions. The patient underwent microlaryngoscopy under general anesthetic and CO₂ laser microsurgical excision with the mini-microflap technique. The procedure was performed with the aid of an UltraPulse® Duo (Lumenis®, Tel Aviv, Israel) CO₂ laser (10 W, CW, UP, AB 2 mm and 1 mm) with an AcuBlade™ focusing system by Lumenis® (Tel Aviv, Israel). Histology confirmed the diagnosis of bilateral vocal fold epidermoid cyst. One month after surgery, indirect laryngoscopy showed complete healing of both vocal cords with an adequate vibratory pattern. Dysphonia recovered completely.

Conclusion: CO₂ laser microsurgery can be safely and effectively performed even in the pediatric population.