목적: Microsurgical removal with a microflap technique via direct laryngoscopy is considered the primary treatment option for vocal cysts. However, the microflap technique is technically difficult and challenging. Therefore, we developed the 'cotton ball self-retraction' technique to aid in vocal cyst surgery and reduce the cyst rupture incidence. This study aimed to evaluate the efficacy of this technique in microflap dissection for vocal cysts by comparing its treatment outcomes with those of the conventional technique as well as investigate the rate of recurrence using a retrospective chart review. 방법:We reviewed the medical records of 169 patients who underwent surgery with the microflap technique for vocal cysts from December 2006 to December 2017. The patients were divided into two groups: 78 patients underwent laryngomicrosurgery using the conventional microflap technique (group A), whereas the remaining 91 patients underwent surgery with the microflap technique with cotton ball self-retraction (group B). The voice outcomes and operative data of the two groups were retrospectively reviewed and compared. 결과:The cyst ruptured intraoperatively in 42 of 78 (53.8%) patients in group A and 17 of 91 (18.6%) patients in group B. Recurrence during the follow-up period was detected in 9 of 78 (11.5%) patients in group A and 2 of 91 (2.19%) patients in group B. The degrees of improvement in assessed voice parameters were not significantly different between the groups. 결론:The cotton ball technique allows accurate and effective dissection during microflap surgery for intracordal cysts.