The “M” shaped microflap for treatment of complex Reinke’s Space Oedema of the vocal cords

Reinke's Space Oedema is characterized by a subepithelial collection of fluid and pseudo-myxomatous tissue within the lamina propria superficialis of the vocal cord. We have observed, in a number of cases, the phenomenon of bilobular and/or centrally located Reinke's Space Oedema. Bilobular oedema occurs when the sub-epithelial oedema is organised as a double bulge of the vocal cord in the superoinferior plane due to adhesions or sulcus at the free edge of the vocal cord. Herewith, a simple, yet easily reproducible, modified technique is presented of an "M" shaped microflap for the treatment of bilobular and also centrally located Reinke's Space Oedema of the vocal cords, using Carbon Dioxide laser and/or cold micro instruments allowing maintenance of an appropriate amount of lamina propria superficialis and easy coverage of the potentially exposed part of the ligament. Our technique involves removal of the upper bulge of the affected vocal cord with Carbon Dioxide laser or cold instruments, followed by an "M" shaped remodelling of the microflap so that the mucosa can be effectively draped over the lamina propria superficialis and vocal ligament.