Farzad Izadi - Department of Otorhinolaryngology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
Hadi Ghanbari - Department of Otorhinolaryngology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
Sahar Zahedi - Department of Otorhinolaryngology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
Behzad Pousti - Department of Otorhinolaryngology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
Mojtaba Maleki Delarestaghi - Department of Otorhinolaryngology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
Abolfazl Salehi - Department of Speech Therapy, University of Social welfare and rehabilitation Sciences, Tehran, Iran.

Introduction: Mucous retention cysts are a subtype of intracordal vocal cysts that may occur spontaneously or may be associated with poor vocal hygiene, and which require optimal treatment. The objective of this study was to present a new laser-assisted microsurgery technique for treating intracordal mucous retention cysts and to describe the final outcomes.   Materials and Methods: In this prospective study, we assessed the pre-operative and post-operative acoustic analysis, maximum phonation time (MPT), and voice handicap index (VHI) of four patients with a diagnosis of mucous retention cyst. The island flap technique was applied to all patients without any complications. In this procedure, we favored the super-pulse mode using a ۲-W power CO۲ laser to remove the medial wall of the cyst, before clearing away the lateral wall margins of the cyst using repeat-pulse mode and a ۲-W power CO۲ laser. Indeed, we maintained the underlying epithelium and lamina propria, including the island flap attached to the vocal ligament.   Results: There was a statistically significant improvement in the MPT (pre-op,۱۱.۰۵ s; post-op,۱۵.۸۵ s; P=۰.۰۰۲) and the VHI (pre-operative, ۷۲/۱۲۰; post-operative,۲۷/۱۲۰; P=۰.۰۰۱) in all patients. Moreover, jitter and shimmer were refined after surgery, but there was no statistically significant relationship between pre-operative and post-operative data (P=۰.۰۷۱) (P=۰.۶۲۲). In the follow-up period (median, ۱۵۰ days), there was no report of recurrence or mucosal stiffness.   Conclusion:  The island flap procedure in association with CO۲ laser microsurgery appears to be a safe and effective treatment option for intracordal mucous retention cysts, but needs further investigation to allow comparison with other methods.

CO۲ laser, Island flap, Mucous Retention Cyst, Voice analysis