Intracordal Cysts Overview

Intracordal Cysts

• Intracordal cysts are classified as either mucous retention or epidermal inclusion types.
• Mucous retention cysts are caused by the duct of a mucous gland becoming plugged and retaining glandular secretions.
• Epidermal cysts contain accumulated keratin.
• The epidermal cyst may result from a nest of epithelial cells buried congenitally in the subepithelial layer or from healing of mucosa injured by voice abuse over buried epithelial cells.
• Cysts may rupture spontaneously.
• If the opening is small, some epidermal debris may be retained and may create an open cyst.
• If the opening is as large as the cyst, the resulting empty pocket becomes a glottic sulcus.

Epidemiology

• The most prominent epidemiologic finding is a history of vocal overuse.
• Vocal overuse is common in epidermal cysts, but less so in mucous retention cysts.

Diagnosis

• Patients with epidermal cysts have many of the same symptoms and voice abuse factors as patients with nodules.
• Patients with epidermal cysts are more likely to experience diplophonia in the upper vocal range.
• Patients with epidermal cysts may manifest an abrupt and irreducible transition to severe impairment at a relatively specific frequency.
• Mucous retention cysts often cause less vocal limitation than expected from their laryngeal appearance.
• Epidermal inclusion cysts often cause more limitation than expected.
• Mucous retention cysts often originate just below the free margin of the fold with significant medial projection from the fold.
• Epidermal cysts project less from the fold.
• Under strobe illumination, as the fundamental frequency of phonation increases, the mucosa overlying the cyst often stops vibrating before the mucosa anterior and posterior to the cyst.
• Diagnosis can be confirmed in some patients only at the time of microlaryngoscopy.

Treatment

• General supportive measures, such as hydration and potential acid reflux management, may be helpful but will not resolve the problem.
• Voice therapy is more appropriate for people with epidermal cysts.
• Voice therapy is not often needed for mucous retention cysts, but may be needed to avoid the risk of another lesion.
• Patients with large mucous retention cysts and no history of voice abuse may be scheduled for surgery promptly.
• Mucous retention cysts are often removed by dissection that leaves the overlying mucosa intact.
• Results of surgery are not as uniformly good as for nodules and polyps.
• Maximal postoperative recovery takes longer than for nodule or polyp surgery (many months rather than a few weeks).
• Follow-up supportive voice therapy from the speech pathologist or singing teacher assists vocal rehabilitation.
• A return to active voice use or training should occur within a few days of surgery.

This quiz covers the classification, causes, and epidemiology of intracordal cysts, focusing on mucous retention and epidermal inclusion types. Learn about the symptoms, diagnosis, and the role of vocal overuse in these conditions. Test your knowledge on this important vocal health topic.