eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Laryngology

Sulcus Vocalis: Follow-up

Author: John Schweinfurth, MD, Associate Professor, Department of Otolaryngology, University of Mississippi Medical Center
Coauthor(s): Robert Ossoff, DMD, MD, MS, Chair, Professor, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center
Contributor Information and Disclosures

Updated: Nov 17, 2008

Outcome and Prognosis

In 2 studies, microsurgical techniques were used on 30 patients with pathologic sulcus. Voice improvement was reported in the majority of subjects using objective measures. Using fat implantation methods, Sataloff et al described voice improvement and limited return of mucosal wave.6 Most patients can expect significant voice improvement from either technique, but results are not equal to premorbid conditions in most cases. Additionally, insufficient data exists on the longevity of improvement.

Future and Controversies

Future injectable materials may more closely simulate composition of the intermediate layer and hyaluronic acid, but consistent placement and long-term positional stability remain difficult. Certainly, the best way to treat scarring is to prevent it. Improperly performed or timed surgical intervention can result in irreversible dysfunction and dysphonia. Conservative treatment should be exhausted before surgical intervention is considered, which should be based on the modern concept of vocal fold microanatomy and histology. Use of microflap techniques avoids a raw mucosal surface that heals by secondary intention and may result in a sulcus.

 


More on Sulcus Vocalis

Overview: Sulcus Vocalis
Workup: Sulcus Vocalis
Treatment: Sulcus Vocalis
Follow-up: Sulcus Vocalis
Multimedia: Sulcus Vocalis
References
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References

  1. Nakayama M, Ford CN, Brandenburg JH, et al. Sulcus vocalis in laryngeal cancer: a histopathologic study. Laryngoscope. Jan 1994;104(1 Pt 1):16-24. [Medline].

  2. Bouchayer M, Cornut G, Witzig E, et al. Epidermoid cysts, sulci, and mucosal bridges of the true vocal cord: a report of 157 cases. Laryngoscope. Sep 1985;95(9 Pt 1):1087-94. [Medline].

  3. Archer SM, Banks ER. Intracordal injection of autologous fat for augmentation of the mucosally damaged canine vocal fold: a long-term histologic study. 2nd World Congress on Laryngeal Cancer. 1994.

  4. Gray SD, Bielamowicz SA, Titze IR, et al. Experimental approaches to vocal fold alteration: introduction to the minithyrotomy. Ann Otol Rhinol Laryngol. Jan 1999;108(1):1-9. [Medline].

  5. Paniello RC, Sulica L, Khosla SM, et al. Clinical experience with Gray's minithyrotomy procedure. Ann Otol Rhinol Laryngol. Jun 2008;117(6):437-42. [Medline].

  6. Sataloff RT, Spiegel JR, Hawkshaw M, et al. Autologous fat implantation for vocal fold scar: a preliminary report. J Voice. Jun 1997;11(2):238-46. [Medline].

  7. Chan RW, Titze IR. Viscosities of implantable biomaterials in vocal fold augmentation surgery. Laryngoscope. May 1998;108(5):725-31. [Medline].

  8. Dailey SH, Ford CN. Surgical management of sulcus vocalis and vocal fold scarring. Otolaryngol Clin North Am. Feb 2006;39(1):23-42. [Medline].

  9. Ford CN, Inagi K, Khidr A, et al. Sulcus vocalis: a rational analytical approach to diagnosis and management. Ann Otol Rhinol Laryngol. Mar 1996;105(3):189-200. [Medline].

  10. Gray S. Basement membrane zone injury in vocal nodules. Vocal fold phyisiology. 1991.

  11. Gray SD, Bielamowicz SA, Titze IR, et al. Experimental approaches to vocal fold alteration: introduction to the minithyrotomy. Ann Otol Rhinol Laryngol. Jan 1999;108(1):1-9. [Medline].

  12. Hammond TH, Zhou R, Hammond EH, et al. The intermediate layer: a morphologic study of the elastin and hyaluronic acid constituents of normal human vocal folds. J Voice. Mar 1997;11(1):59-66. [Medline].

  13. Hsiung MW, Pai L. Autogenous fat injection for glottic insufficiency: analysis of 101 cases and correlation with patients' self-assessment. Acta Otolaryngol. Feb 2006;126(2):191-6. [Medline].

  14. Pontes P, Behlau M. Treatment of sulcus vocalis: auditory perceptual and acoustical analysis of the slicing mucosa surgical technique. J Voice. Dec 1993;7(4):365-76. [Medline].

  15. Titze IR. The physics of small-amplitude oscillation of the vocal folds. J Acoust Soc Am. Apr 1988;83(4):1536-52. [Medline].

  16. Tsunoda K, Kondou K, Kaga K, et al. Autologous transplantation of fascia into the vocal fold: long-term result of type-1 transplantation and the future. Laryngoscope. Dec 2005;115(12 Pt 2 Suppl 108):1-10. [Medline].

  17. Varela DG, Grellet M. [Vocal fold superficial layer of lamina propria histology after the position of mucosa pediculated flap: canine experimental study]. Braz J Otorhinolaryngol. May-Jun 2005;71(3):318-24. [Medline].

  18. Yanagihara N. Significance of harmonic changes and noise components in hoarseness. J Speech Hear Res. Sep 1967;10(3):531-41. [Medline].

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Further Reading

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Keywords

sulcus vocalis, vocal fold scarring, benign voice disorders, mucosal scarring, hoarseness, voice fatigue, loss of range, vocal fold groove

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Contributor Information and Disclosures

Author

John Schweinfurth, MD, Associate Professor, Department of Otolaryngology, University of Mississippi Medical Center
John Schweinfurth, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Robert Ossoff, DMD, MD, MS, Chair, Professor, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center
Robert Ossoff, DMD, MD, MS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Bronchoesophagological Association, American College of Chest Physicians, American College of Surgeons, American Laryngological Association, American Laryngological Rhinological and Otological Society, American Medical Association, American Rhinologic Society, American Society for Head and Neck Surgery, American Society for Laser Medicine and Surgery, Sigma Xi, and Southeastern Surgical Congress
Disclosure: Nothing to disclose.

Medical Editor

Clark A Rosen, MD, Director, University of Pittsburgh Voice Center; Associate Professor, Department of Otolaryngology and Communication Science and Disorders, University of Pittsburgh School of Medicine
Clark A Rosen, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Stephen G Batuello, MD, Consulting Staff, Colorado ENT Specialists
Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American Medical Association, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
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