Iatrogenic Vocal Fold Scar Workup

  • Author: John Schweinfurth, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Jun 15, 2010
 

Other Tests

Videostroboscopy

  • Videostroboscopy reveals a decreased or absent mucosal wave, and often the medial edge of the injured cord does not approximate to the other during phonation. In addition, the cords may be at different levels, leading to incomplete closure.
  • In sulcus vocalis, videostroboscopy reveals an area of decreased mucosal wave corresponding to the sulcus and more clearly shows associated incomplete closure.
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Histologic Findings

Obtaining pathology slides from the original surgery may be helpful. The size of the resected specimen and the presence of muscle or dense collagen and elastin fibers indicate a deep dissection, which is more likely to involve scar formation.

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Contributor Information and Disclosures
Author

John Schweinfurth, MD  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, American Laryngological Association, American Medical Association, and Triological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Robert H Ossoff, DMD, MD  Assistant Vice-Chancellor for Compliance and Corporate Integrity and Maness Professor of Laryngology and Voice, Vanderbilt Medical Center

Robert H Ossoff, DMD, 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 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.

Specialty Editor Board

Clark A Rosen, MD  Director, University of Pittsburgh Voice Center; 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: Bioform Medical Consulting fee Consulting; Bioform Medical Consulting fee Speaking and teaching

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Robert M Kellman, MD  Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University

Robert M Kellman, 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, American Neurotology Society, American Rhinologic Society, American Society for Head and Neck Surgery, Medical Society of the State of New York, and Triological Society

Disclosure: GE Healthcare Honoraria Review panel membership

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; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

  1. 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].

  2. 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].

  3. Benninger MS, Alessi D, Archer S, et al. Vocal fold scarring: current concepts and management. Otolaryngol Head Neck Surg. Nov 1996;115(5):474-82. [Medline].

  4. 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].

  5. 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].

  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. Gray SD. Basement membrane zone injury in vocal nodules. In: Gauffin J, Hammarberg B, eds. Vocal Fold Physiology. San Diego, Calif: Singular Press; 1991.

  9. 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].

  10. Hartl DM, Hans S, Vaissiere J, et al. Laryngeal aerodynamics after vocal fold augmentation with autologous fat vs thyroplasty in the same patient. Arch Otolaryngol Head Neck Surg. Aug 2005;131(8):696-700. [Medline].

  11. 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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This patient underwent right mucosal stripping for nodules. Note the thickened and irregular right cord. On videostroboscopy, the cord was immobile.
This patient underwent right mucosal stripping for leukoplakia. The patient had prominent symptoms of glottal incompetence. Note the atrophic lateralized appearance of the right true cord. Videostroboscopy revealed significant glottal gapping.
A catastrophic result from bilateral mucosal stripping for vocal nodules in an award-winning professional singer. The arrow indicates what appears to be the right true cord encased in scar tissue.
 
 
 
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