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Cyst

Cyst

What is a cyst?

A cyst is a mass made up of a collection of material, usually mucus, that is surrounded by a membrane. It is found underneath the mucosa , within the superficial lamina propria, the layer that is important for normal voice function. It is not entirely clear how cysts form, but many believe that they result from mucous glands that have become blocked. Sometimes, this happens spontaneously, but it seems likely that glands are more prone to become clogged when the vocal folds are irritated. Many cysts occur at the midpoint of the vocal fold, which suggests that phonotrauma, the physical stress resulting from voice use, may contribute to their formation.

Cysts are not precancerous or cancerous lesions. They are important purely because of their effect on the voice.

CYST Figure 1

Figure 1: An ovoid cyst is visible underneath the covering (“epithelium” of the vocal fold).

cyst-fig2

Figure 2: A large mid-vocal fold cyst interferes with vocal fold closure and vibration during voicing.

What are the symptoms of a cyst?

Cysts generally cause painless hoarseness. The hoarseness results from irregularities in vocal fold closure as well as irregularities in vibration, both the result of the bulk and location of the cyst. In some cases, the voice change may be accompanied by a sensation of a foreign body at the level of the vocal folds, or a feeling of wanting to clear the throat or cough.

What does a cyst look like?

A cyst is usually a spherical white or translucent mass located underneath the mucosa of the vocal fold. Because the mucosa drapes over it, it may look like a mound within the fold. For this reason, very small cysts may be indistinct. Examination by stroboscopy and under magnification is very helpful in clarifying the diagnosis.

CYST-Figure-leftandright

Figure 3: These images show the appearance of the vocal folds before (left) and 10 days after (right) surgical removal of a vocal fold cyst. Removal of the cyst has restored the normal contour and function of the vocal fold.

Usually, cysts occur singly. Although they may appear anywhere along the length of the vocal fold, a mid-fold location is most common.

How is a cyst treated?

Voice rest, often prescribed in cases of hoarseness, may improve the voice somewhat, but is not likely to make a cyst go away. Voice rest serves to soften and dissolve associated swelling, but the cyst itself will not usually shrink.

Very rarely, a cyst may resolve on its own. Probably the blockage that led to the accumulation of fluid resolves and the cyst drains. This generally happens only when a cyst has been present for a short while, and even under these circumstances, it is unusual.

Most commonly, a cyst must be removed surgically by means of microlaryngoscopic surgery. Because incomplete removal may lead to recurrence, every effort must be made to remove the cyst intact. At the same time, the overlying mucosa must be preserved and draped over the area where the cyst was removed to minimize the chance of scar. This type of surgery is technically challenging, since the cyst, which is usually fragile, may be attached to surrounding tissue and is likely to burst or leak if not handled very gently.

 

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