title: Subepithelial vocal fold infusion: a useful diagnostic and therapeutic technique.
abstract: OBJECTIVE
  Preservation of the maximum amount of subepithelial superficial lamina propria (SLP) remains an important goal during microlaryngoscopic surgery of phonatory mucosa. Volume expansion of the SLP (Reinke's space) with subepithelial infusion of saline solution has been widely adopted since its introduction in 1991. This technique has evolved so that it is currently used to assist with determining the depth of vocal fold disease, defining residual pliable SLP, enhancing microsurgical precision, and identifying unrecognized disease. The purpose of this investigation was to examine the indications, methods, and benefits of subepithelial infusion of saline solution as an adjunct technique during phonomicrosurgery.
  
  
  METHODS
  In a prospective case series, we collected data on 280 consecutive microlaryngoscopy procedures performed over a 12-month period. Subepithelial infusion of saline solution was included in 178 procedures.
  
  
  RESULTS
  New disease was identified in 20 of the 178 patients (scar in 15, sulcus in 4, and a mucosal bridge in 1). The depth of needle placement varied depending on the specific disease: 118 of the 178 infusions were done just below the epithelial basement membrane, and 60 infusions were performed deeper within the SLP, just superficial to the vocal ligament. The infusion technique provided surgical assistance in multiple ways, including identifying residual SLP (130 patients), defining the SLP-lesion interface (65 patients), lifting scar (60 patients),providing tension for cordotomy (47 patients), expanding the SLP volume to protect against laser damage (45 patients), and providing hydrostatic compression of vascular ectasias or varices for photoangiolysis (7 patients). The microlaryngoscopy procedures during which infusion was not performed (102 of 280 procedures) were primarily for nonglottic cancer (46 patients), stenosis (30 patients), or arytenoid granuloma (13 patients).
  
  
  CONCLUSIONS
  Subepithelial infusion of the SLP with saline solution is a useful microsurgical adjunct during diagnosis and treatment of phonatory mucosal lesions.
authors.affiliation: Department of Surgery, Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Burns
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Friedman
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Lutch
authors.forename: Steven M
authors.initials: SM
authors.lastname: Zeitels
mesh_terms: D055154:Dysphonia / Q000209:etiology / Q000628:therapy; D006801:Humans; D007818:Laryngeal Diseases / Q000175:diagnosis* / Q000601:surgery*; D007820:Laryngeal Mucosa / Q000473:pathology / Q000601:surgery; D007828:Laryngoscopy; D008866:Microsurgery; D009339:Needles; D011446:Prospective Studies; D012965:Sodium Chloride / Q000627:therapeutic use*
chemical_list: D012965:Sodium Chloride