Subepithelial vocal fold cyst (SEVFC) is an epithelium lined sac within the lamina propria. These cysts are of two histologic types: Mucous retention cyst and epidermoid cyst. Rupture of the cyst during surgical excision and incomplete cyst wall removal with consequent recurrence of the cyst is not an infrequent problem. While performing cold-steel blunt microflap surgery for SEVFC, the first author observed thick fibrotic bands at the 12 and 6 o'clock position in all the cases, giving the appearance of a ‘pearl (cyst) on a string (fibrotic bands)’. In most cases of cyst rupture, it took place during dissection of these bands. The aim of our study was to see if there was any significant difference in rupture and recurrence rate by sharp versus blunt dissection of these fibrotic bands.

Retrospective nonrandomized cohort comparison.

Fifty-nine subepithelial cysts were operated by microflap technique. The first 26 cysts were taken in alternation for blunt vs sharp dissection of the fibrotic bands. As the results of sharp dissection were better, the subsequent 33 cysts were operated with sharp dissection of the anterior and posterior bands.

Sharp dissection of the anterior and posterior bands during microflap dissection reduced the incidence of cyst rupture (p = 0.006) and recurrence (p = 0.007) of cyst formation.

SEVFC are anchored by thick fibrotic bands at the 12 and 6 o'clock position giving it the appearance of a ‘pearl (cyst) on a string (fibrotic bands)’. Sharp dissection of these bands during microflap dissection reduces the incidence of cyst rupture and recurrence.

Nerurkar NK, Shukla SC. Subepithelial Vocal Fold Cyst: A Pearl on a String? Int J Phonosurg and Laryngol 2012;2(2):53-56.

Primary lymphomas amount to less than 1% of the primary laryngeal tumors. It is the second most common primary hematologic tumor of the larynx after plasmacytoma. Although squamous cell carcinoma amounts to 90% of the laryngeal tumors, diagnosis of laryngeal lymphoma is very important as nonsurgical management is indicated in all stages of this disease.

A case of 10-year-old boy with hoarseness of voice with direct laryngoscopic biopsy reported as diffuse B-cell lymphoma. The sections were positive for epithelial membrane antigen (EMA), LCA, CD138, CD4 and Mum1 and ALK. He was managed under MCP 842 protocol. He had complete response after the treatment and was symptom free after 13 months of therapy.

Primary laryngeal lymphoma is a rare entity and should be managed with current chemotherapeutic protocol. Differentiating it between squamous cell carcinoma is important as management protocol in lymphoma is nonsurgical. Aid of immunohistochemistry helps in early diagnosis and management of these cases.

Naik SM, Nanjundappa A, Halkud R, Premlatha CS, Ramarao C, Appaji L, Gupta S. Anaplastic Lymphoma Kinase-positive Primary Diffuse Large B-cell Lymphoma of the Larynx: A Rare Clinical Entity. Int J Phonosurg Laryngol 2012;2(2):57-61.

Malignant lesions of the larynx are very rare in pediatric population as it accounts for less than 0.1% of all head and neck malignancies in childhood. Apart from human papilloma virus infection, adult risk factors like laryngeal papilloma, gastroesophageal reflux, human immunodeficiency virus (HIV) infection, immunosuppressive therapy, smoking, alcohol abuse, poor oral hygiene and a family history of cancer also play a role in pediatric laryngeal cancers.

A 14-year-old boy presented to us with hoarseness of voice since 8 months. He was treated for laryngitis and subacute bacterial laryngitis and later referred to us. He complained of mild dysphagia and the hoarseness of voice. An ulceroproliferative lesion in the left arytenoids and aryepiglottic fold was seen with retroarytenoid extension in the left arytenoids and the left hemilarynx was fixed. The left level II node was enlarged 2 × 2 cm and a staged as carcinoma supraglottis T3/ 4N1Mx. The node aspiration biopsy revealed metastatic squamous cell carcinoma.

The case was posted for wide field laryngectomy, under ASA grade II. The direct laryngoscopic examination revealed the extent of the tumor, and the frozen sections of biopsy revealed squamous cell carcinoma of the larynx. The surgery was done with the classical Gluck Sorenson incision and the patient was given postoperative radiotherapy.

Pediatric laryngeal cancers are very rare and studies about the etiology, biology of the tumor, diagnostic and management protocols are not standardized. Formulating a protocol for childhood laryngeal cancers management which includes early diagnosis and accurate treatment is essential.

Naik SM, Nanjundappa A, Srihariprasad H, Halkud R, Chavan P, Gupta S. Pediatric Laryngeal Malignancies: Current Management Protocols and Review of Literature. Int J Phonosurg Laryngol 2012;2(2):62-65.

Jain AK, Jain S, Katarkar A, Alam N, Lakum N, Shah P, Modh D. A Rare Case of Sessile Polypoidal Xanthoma of Vocal Cord. Int J Phonosurg Laryngol 2012;2(2): 66-68.

Laryngeal paragangliomas are benign slow growing tumors with symptoms resembling squamous cell carcinoma. Hoarseness or dysphasia is the commonest presenting symptom and usually it presents as a submucosal mass on laryngoscopy. A total of 90% of these tumors occur in the supraglottic larynx and the rest in the glottis and the subglottic region. Functional activity is seen in a few (2.9%), none are associated with paraneoplastic syndromes.

Department of Head and Neck Oncosurgery, Kidwai Memorial Institute of Oncology, Bengaluru.

A 35-year-old male presented to us with hoarseness of voice since 4 months duration. Contrast arteriography demonstrated that the left superior thyroid artery supplied greater than 80% of the blood supply to the laryngeal mass. Superselective embolization was done from the right femoral under local anesthesia and sedation which was uneventful.

The tumor was excised from lateral pharyngotomy approach with an elective tracheostomy. Microscopy suggested it to be paraganglioma and immunohistochemistry confirmed it.

Complete surgical resection or partial laryngectomy with meticulous dissection of surrounding tissues and preservation of neurovascular structures give an excellent prognosis as far as oncological clearance is concerned. Malignant paragangliomas of the larynx are rare and a major meta-analysis is necessary to provide a true biological behavior of this tumor.

Naik SM. Supraglottic Laryngeal Paraganglioma: A Rare Clinical Entity managed by Lateral Pharyngotomy Approach. Int J Phonosurg Laryngol 2012;2(2): 69-73.

To describe a novel method of examination of neonatal larynx, using a 70° rigid 4 mm fiber optic endoscope in OPD as a screening procedure for evaluation of neonatal stridor/hoarse cry.

Examination technique and safety profile of a novel method of examination of neonatal larynx in OPD using widely available 70° rigid 4 mm endoscope.

Ten neonates, underwent laryngoscopy as described below, whose age and weight in kilograms were recorded. The pulse rate, O₂ saturation levels and mean arterial pressure were recorded during the procedure to know the effect of the procedure on hemodynamics and respiration of the neonates. Time taken for the procedure for satisfactory view of larynx is also recorded and tabulated.

The novel method of examination of neonatal larynx using 70° 4 mm rigid endoscope in OPD/ward is a safe procedure and gives excellent view/recording of neonatal larynx in its native anatomical and functional status.

Pingili HCR, Kumar SR. Rigid Endoscopic Examination of Neonatal Larynx in OPD as a Screening Procedure. Int J Phonosurg Laryngol 2012;2(2): 74-76.

Varghese BT. Near Total Laryngectomy and Laryngopharyngectomy. Int J Phonosurg Laryngol 2012;2(2):77-78.

Megalamani SB, Gadag R, Raza A, Satish A. Lipomas of Larynx: The Rare Entities. Int J Phonosurg Laryngol 2012;2(2):79-81.

Implants like silastic, titanium, Gore-Tex and autologous cartilage have been used for type I laryngoplasty. Though rare, implant extrusion or migration, wound infection and airway compromise are some of the complications of medialization laryngoplasty surgery irrespective of the implant used. We document a rare case of bilateral implant migration in a patient who had undergone bilateral medialization laryngoplasty 5 years ago. Gore-Tex extrusion resulted in stridor 5 years after the initial surgery. Endoscopic removal of the extruded implant is advised, if feasible, without the need for tracheostomy or transcervical approach. An update on current knowledge and management of implant extrusion or migration is discussed. How to cite this article: Nerurkar NK, Shukla SC. Stridor due to Bilateral Implant Migration 5 Years after Bilateral Medialization Laryngoplasty. Int J Phonosurg and Laryngol 2012;2(2):82-84.

Shetty S, Anusha RL, Thomas PS, Babu SG. Hypoglossia with Mandibular and Palatal Abnormalities. Int J Phonosurg and Laryngol 2012;2(2):85-87.

We report a case of granulomatous lesion infiltrating the recurrent laryngeal nerve to produce vocal cord palsy, the diagnostic dilemma posed by it and its management.

Clinical documentation of a 52-yearold man who presented with hoarseness of 3 months duration is presented. The clinical examination revealed immobile left vocal cord and a bulky (Lt) ventricular band with a suspicious ulcer on its posterior aspect. A computed tomographic (CT) scan of the neck and chest revealed a 1 × 1 cm nodular lesion in the tracheoesophageal groove.

Causes for vocal cord palsies are wide ranging and predominantly include malignant infiltration of the vagus or the recurrent laryngeal nerve. The anatomical site of involvement can be clinically and radiologically assessed with ease. Vocal cord palsy due to recurrent laryngeal nerve involvement by a granulomatous lesion is an unreported phenomenon and we believe that this is the first case to be reported in literature.

An unusual case of recurrent laryngeal nerve granuloma is reported with the diagnostic dilemma that it presented. This was successfully managed by surgical excision and postoperative antituberculosis treatment.

Varghese BT, Sebastian P, Divya GM. An Unusual cause for Vocal Cord Palsy: Case Record. Int J Phonosurg Laryngol 2012;2(2):88-90.