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Iatrogenic Vocal Fold Scar Workup

  • Author: John Schweinfurth, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Nov 17, 2015
 

Other Tests

Videostroboscopy

See the list below:

  • 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.[3]
  • 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 Laryngological Association, Triological Society, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Robert H Ossoff, DMD, MD Maness Professor of Laryngology and Voice, Department of Otolaryngology, Executive Medical Director, Vanderbilt Voice Center, Vanderbilt Medical Center

Robert H Ossoff, DMD, MD is a member of the following medical societies: American Head and Neck Society, 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, The Triological Society, American Medical Association, American Rhinologic Society, American Society for Laser Medicine and Surgery, Sigma Xi, Southeastern Surgical Congress

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 Head and Neck Society, American Rhinologic Society, Triological Society, American Neurotology Society, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, 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, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

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, Pennsylvania Medical Society

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Merz North America Inc<br/>Received consulting fee from Merz North America Inc for consulting; Received consulting fee from Merz North America Inc for speaking and teaching.

References
  1. Choi SH, Zhang Y, Jiang JJ, Bless DM, Welham NV. Nonlinear dynamic-based analysis of severe dysphonia in patients with vocal fold scar and sulcus vocalis. J Voice. 2012 Sep. 26(5):566-76. [Medline]. [Full Text].

  2. Selleck AM, Moore JE, Rutt AL, Hu A, Sataloff RT. Sulcus Vocalis (Type III): Prevalence and Strobovideolaryngoscopy Characteristics. J Voice. 2015 Jul. 29 (4):507-11. [Medline].

  3. Woo P. 4K Video-Laryngoscopy and Video-Stroboscopy: Preliminary Findings. Ann Otol Rhinol Laryngol. 2015 Jul 26. [Medline].

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

  5. Cantarella G, Baracca G, Forti S, Gaffuri M, Mazzola RF. Outcomes of structural fat grafting for paralytic and non-paralytic dysphonia. Acta Otorhinolaryngol Ital. 2011 Jun. 31(3):154-60. [Medline]. [Full Text].

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

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

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

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

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

  11. 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. 2005 Aug. 131(8):696-700. [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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