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Use of the Microdebrider for Reinke's Edema Surgery

INTRODUCTION Numerous terms have been used to denote the clinical entity we recognize as Reinke’s edema. These terms include polypoid corditis, polypoid laryngitis, polypoid degeneration, and chronic hypertrophic laryngitis. Reinke’s edema, a condition of diffuse polypoid changes in the subepithelial compartment, has been observed as clinical entity since the introduction of the conventional laryngoscope and the origin of laryngology. Kajek credited Reinke with identification of the subepithelial compartment of the vocal fold that is superficial to the vocal ligament, bounded anteriorly by Broyle’s ligament, and limited posteriorly by the vocal process of the arytenoid cartilage. Hirano has identified this compartment as the superficial lamina propria. Zeitels noted that this compartment underlies the vibratory epithelium of the musculo-membranous vocal fold, which can be identified caudally by the inferior arcuate line. Most series have reported a much higher percentage of women with Reinke’s edema; however, this probably reflects the social unacceptability of the voice quality for women, which leads to their seeking medical attention. There may also be an endocrinological aberration that has not yet been elucidated. A strong association between smoking and Reinke’s edema is reported, frequently with vocal abuse. Laryngopharyngeal reflux was cited recently as a potential cofactor in the development of Reinke’s edema. The surgical management of this disorder is necessary when the voice remains objectionable to the patient. Often, the common practice of stripping the polyps away results in aphonia for many weeks after surgery, and the final voice achieved may sound unacceptably high and husky to the patient. Edema reduction with minimal mucosal damage is the surgical strategy recommended for earlier and optimal return of voice. The aim of this report is to present a new technique to achieve this strategy (edema reduction and minimal mucosal damage) with a new surgical tool—the microdebrider—in the surgical therapy for Reinke’s edema.