Surgery for vocal fold lesions is usually performed under general anesthesia. However, surgery under local anesthesia may be necessary when considering the waiting period before surgery or hospitalization, the condition of the lesion, the need to operate while checking the voice, or the physical and social circumstances of the patient. Office-based voice surgery under local anesthesia allows voice monitoring while checking vocal fold movement and mucosal waves during and immediately after surgery. In addition, the use of an electronic endoscope allows clear observation of the lesion, and multiple physicians can check the lesion on a monitor, which is useful for improving the procedure and safety. There are several methods of accessing the vocal folds under local anesthesia, including percutaneous and oral approaches, depending on the lesion. Pathology findings include vocal fold atrophy, sulcus, recurrent laryngeal nerve palsy, vocal fold polyps, and laryngeal cysts. Possible techniques include excision of lesions using scalpels, shears, and forceps and injection of artificial materials or corticosteroid preparations. Suppression of the pharyngeal reflex is essential for the transoral approach and is key to the success or failure of the procedure. We herein report the selection criteria for transnasal endoscopic microsurgery of the larynx and preoperative procedures, including anesthesia, surgical procedures, and postoperative management.
