Initial view with white sphere (cyst) shining through upper surface of left vocal fold.

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After injection of lidocaine for hydrodissection (Bouchayer).

Note ballooning of the fold and that this technique also reveals the inward dimpling of an incipient sulcus at arrow

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This incision must be ~ 75% longer than the diameter of the cyst. The most difficult parts of the dissection are typically adherence to the vocal ligament, and to the diaphanous overlying mucosal flap (held here in micro-alligator forceps)

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As is occasionally the case, the cyst has leaked some of its contents, but its outline is still clearly visible, allowing complete and precise removal.

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Scissors are used to release the cyst from filmy attachments, precisely at its margin.

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Retraction of the flap reveals the gossamer nature of the still-intact overlying mucosa at arrow.

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The flap is released and returned to its original position; the incipient sulcus is still seen.

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