Vocal fold surgery has traditionally been performed as microsurgery under general anesthesia due to the intricate surgical field. Recent advancements in endoscopy and instrumentation have enabled minimally invasive outpatient procedures. This article describes a novel approach for vocal fold surgery under topical anesthesia with endoscopic visualization while the patient is conscious. Two primary techniques are used. The first involves injecting various materials into the vocal folds using a curved Cathelin needle inserted above the thyrohyoid notch. The second includes endoscopic excision of vocal fold lesions using wire forceps. Cathelin needles may also be used to incise polyp or cyst bases. Indications for the injection technique include vocal cord paralysis, atrophy, scarring, polypoid changes, and Botulinum toxin injection for spasmodic dysphonia. The excision method is indicated for vocal cord polyps, nodules, and cysts. The primary advantage of this awake procedure is that it allows real-time assessment of vocal cord vibration using stroboscopy during surgery.
