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.