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Subepithelial hydrodissection improves voice outcome of microflap surgery for vocal cord cyst



The aim was to evaluate voice outcomes of microflap surgery with subepithelial infiltration for vocal fold cysts and to compare voice outcomes of microsurgery with and without subepithelial infiltration for vocal fold cysts.

Patients and Methods

This study was conducted on patients with vocal folds cysts. Patients who met selection criteria were divided into two groups: group A was operated by microflap surgery with subepithelial infiltration, and group B was operated by microflap surgery without subepithelial infiltration.


Within the included 24 patients (12 in each group), a significant improvement of average fundamental frequency/fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, maximal phonation time (MPT), and dysphonia was detected postoperatively in group A (with subepithelial infiltration), with 58.3% of patients resorted to grade 0 dysphonia. Statistically significant improvement of MPT and dysphonia was registered after intervention in group B (without hydrodissection). However, average fundamental frequency/fundamental frequency, jitter, shimmer, and harmonic to noise ratio (HNR) showed nonsignificant improvement after intervention. It was clear that dysphonia improved significantly more in hydrodissection group than nonhydrodissection group (P=0.0063). However, there was no significant difference in postoperative MPT (P=0.3138).


Subepithelial infiltration is beneficial during microflap surgery for vocal fold cysts, with statistically significant better voice results. Therefore, we recommend using this technique during microflap surgery to enhance vocal outcomes; however, further studies are needed on a large number of patients and for a prolonged period of follow-up.


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Corresponding author

Correspondence to Mohammad W. El-Anwar MD.

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Merwad, E.A., AbdElftah, M.M., Abdelmonem, S. et al. Subepithelial hydrodissection improves voice outcome of microflap surgery for vocal cord cyst. Egypt J Otolaryngol 35, 51–55 (2019).

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  • cyst recurrence
  • dysphonia
  • hydrodissection
  • microflap dissection
  • subepithelial infiltration
  • vocal fold cyst
  • voice