2 Operation method
All 11 patients underwent general anesthesia and endotracheal
intubation. In the supine position, the operative cavity was exposed
under the supporting laryngoscope (Karl Storz, Germany). Under the
microscope, the lesions were removed along the pedicle of granuloma with
2W CO2 laser, and the carbon scab was completely removed and the
bleeding was fully stopped by cold instruments or
CO2 laser. Local infiltration anesthesia with 2%
epinephrine saline was applied to the affected ventricular band. The
diameter of the wound was measured and the 1.5 times of the diameter of
the pedicled mucosal flap was obtained from the affected ventricular
band with scissors. The pedicle was left behind the ventricular band and
rotated 90 degrees to cover the wound of granuloma. 7-0 vicryl
absorbable suture was used to intermittently suture 3-5 needles between
the free merge of the mucosal flap and the normal mucosa around the
vocal fold wound to make sure that the surface of the mucosal flap is
smooth without warping, the wound is completely covered, the pedicle is
not twisted, and the tension is moderate (Figure 1). 2U Botulinum toxin
A was injected into the middle part of bilateral vocal cords at the end
of operation. The excised granuloma lesions were sent for pathological
examination. After the operation, antibiotics and aerosol inhalation
were given for 3 days, and the sound was silenced for 2 weeks, and
correct the bad living habits. All 11 patients were treated with PPI for
8 weeks postoperatively.