If surgery is necessary for varix or ectasia, which technique is ideal?

• A. Cold instrument dissection
• B. Laser dissection
• C. Ultrasonic dissection
• D. Electrocautery

Answer: (A)

Managing varix or ectasia surgically centers on removing the abnormal vessel without harming the delicate vocal fold lining. The ideal approach uses cold instrument dissection, because sharp, non-thermal cutting preserves the epithelium and superficial lamina propria, minimizes scar formation, and preserves the mucosal wave essential for good voice. Heat-based methods—laser, electrocautery, or ultrasonic dissection—introduce thermal spread that can injure the mucosa and underlying tissue, increasing the risk of scarring and vibratory dysfunction. By avoiding heat, cold dissection provides precise lesion removal with better preservation of vocal fold vibration, making it the best choice for this scenario.