Unsedated Office-Based KTP Laser Excision of Large Vocal Fold Polyps: A Two-Case Series

Office-based angiolytic potassium titanyl phosphate (KTP) laser surgery is widely used for benign vocal fold lesions, but very large pedunculated polyps are often managed under general anesthesia (GA) because of dynamic glottic narrowing and airway concerns. We report two clinically stable male patients with large pedunculated vocal fold polyps causing approximately 30%–52% glottic airway area occupancy at maximal abduction who underwent unsedated, office-based KTP excision under topical anesthesia. Both procedures were completed without desaturation, airway compromise, or conversion to GA. Histopathology confirmed vocal fold polyps, and early follow-up (2 weeks and 1 month) demonstrated symptomatic improvement with objective improvement in GRBAS and acoustic measures. These cases suggest that, with strict patient selection and a defined airway contingency pathway, unsedated office-based treatment may be feasible even for selected large ball-valve polyps, potentially expanding the indications for awake local-anesthesia management.