Sulcus Vocalis: A Rational Analytical Approach to Diagnosis and Management

1996 ◽  
Vol 105 (3) ◽  
pp. 189-200 ◽  
Author(s):  
Charles N. Ford ◽  
Katsuhide Inagi ◽  
Aliaa Khidr ◽  
Diane M. Bless ◽  
Kennedy W. Gilchrist
Keyword(s):  
Lamina Propria ◽  
Vocal Fold ◽  
Rational Approach ◽  
Common Pathway ◽  
Scar Contracture ◽  
Benign Vocal Fold Lesions ◽  
Sulcus Vocalis ◽  
Histopathologic Analysis ◽  
Superficial Lamina

The term sulcus vocalis has been applied to a spectrum of disorders ranging from minor vocal fold indentations to destructive lesions causing severe dysphonia. To clarify the pathophysiology and to develop a more rational approach to treatment, we report a series of sulcus patients including 20 surgical cases. Clinical and histopathologic analysis produced a clinically useful classification: type 1 is a physiologic variant accentuated by atrophy but with intact lamina propria; types 2 (sulcus vergeture) and 3 (sulcus vocalis) are characterized by severe dysphonia, loss of vibratory activity, and destruction of the functional superficial lamina propria. These latter cases respond favorably to microsurgery designed to remove destroyed tissue, release scar contracture, and promote mucosal redraping by regional undermining. Further study of the extracellular matrix of the superficial lamina propria (Reinke's space) might indicate a common pathway in the pathogenesis of sulcus deformities and other related benign vocal fold lesions.

Vocal Fold Submucosal Infusion Technique in Phonomicrosurgery

1996 ◽  
Vol 105 (5) ◽  
pp. 341-347 ◽  
Author(s):  
Erik S. Kass ◽  
Robert E. Hillman ◽  
Steven M. Zeitels
Keyword(s):  
Lamina Propria ◽  
Retrospective Review ◽  
Vocal Fold ◽  
Malignant Lesions ◽  
Sulcus Vocalis ◽  
Infusion Technique ◽  
Superficial Lamina

Phonomicrosurgery is optimized by maximally preserving the vocal fold's layered microstructure (laminae propriae). The technique of submucosal infusion of saline and epinephrine into the superficial lamina propria (SLP) was examined to delineate how, when, and why it was helpful toward this surgical goal. A retrospective review revealed that the submucosal infusion technique was used to enhance the surgery in 75 of 152 vocal fold procedures that were performed over the last 2 years. The vocal fold epithelium was noted to be adherent to the vocal ligament in 29 of the 75 cases: 19 from previous surgical scarring, 4 from cancer, 3 from sulcus vocalis, 2 from chronic hemorrhage, and 1 from radiotherapy. The submucosal infusion technique was most helpful when the vocal fold epithelium required resection and/or when extensive dissection in the SLP was necessary. The infusion enhanced the surgery by vasoconstriction of the microvasculature in the SLP, which improved visualization during cold-instrument tangential dissection. Improved visualization facilitated maximal preservation of the SLP, which is necessary for optimal pliability of the overlying epithelium. The infusion also improved the placement of incisions at the perimeter of benign, premalignant, and malignant lesions, and thereby helped preserve epithelium uninvolved by the disorder.

Reinke's Edema: Phonatory Mechanisms and Management Strategies

1997 ◽  
Vol 106 (7) ◽  
pp. 533-543 ◽  
Author(s):  
Steven M. Zeitels ◽  
Glenn W. Bunting ◽  
Robert E. Hillman ◽  
Traci Vaughn
Keyword(s):  
Lamina Propria ◽  
Fundamental Frequency ◽  
Vocal Fold ◽  
Management Strategies ◽  
Vocal Folds ◽  
Vocal Fold Vibration ◽  
Reinke’S Edema ◽  
Subglottal Pressure ◽  
Almost All ◽  
Superficial Lamina

Reinke's edema (RE) has been associated typically with smoking and sometimes with vocal abuse, but aspects of the pathophysiology of RE remain unclear. To gain new insights into phonatory mechanisms associated with RE pathophysiology, weused an integrated battery of objective vocal function tests to analyze 20 patients (19 women) who underwent phonomicrosurgical resection. Preoperative stroboscopic examinations demonstrated that the superficial lamina propria is distended primarily on the superior vocal fold surface. Acoustically, these individuals have an abnormally low average speaking fundamental frequency (123 Hz), and they generate abnormally high average subglottal pressures (9.7 cm H20). The presence of elevated aerodynamic driving pressures reflects difficulties in producing vocal fold vibration that are most likely the result of mass loading associated with RE, and possibly vocal hyperfunction. Furthermore, it is hypothesized that in the environment of chronic glottal mucositis secondary to smoking and reflux, the cephalad force on the vocal folds by the subglottal driving pressure contributes to the superior distention of the superficial lamina propria. Surgical reduction of the volume of the superficial lamina propria resulted in a significant elevation in fundamental frequency (154 Hz) and improvement in perturbation measures. In almost all instances, both the clinician and the patient perceived the voice as improved. However, these patients continued to generate elevated subglottal pressure (probably a sign of persistent hyperfunction) that was accompanied by visually observed supraglottal strain despite the normalsized vocal folds. This finding suggests that persistent hyperfunctional vocal behaviors may contribute to postsurgical RE recurrence if therapeutic strategies are not instituted to modify such behavior.

Clinical Analysis of Benign Vocal Fold Lesions with Occult Sulcus Vocalis

2019 ◽  
Author(s):  
Yang Xiao ◽  
Feifei Liu ◽  
Lijing Ma ◽  
Tiantian Wang ◽  
Wei Guo ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Clinical Analysis ◽  
Benign Vocal Fold Lesions ◽  
Sulcus Vocalis

Use of Co2 Laser versus conventional microlaryngeal surgery in treatment of vocal fold benign lesions

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hesham El-Halaby ◽  
Marwa M El-Begermy ◽  
Mina Zakaria Hakim
Keyword(s):  
Lamina Propria ◽  
Co2 Laser ◽  
Vocal Fold ◽  
Meta Analysis ◽  
Vocal Folds ◽  
Superficial Layer ◽  
Sufficient Evidence ◽  
Benign Lesions ◽  
Benign Vocal Fold Lesions ◽  
Microlaryngeal Surgery

Abstract Background Benign superficial lesions of vocal fold (nodule, polyp, cyst and Reinke's edema) arise from the epithelium and the lamina propria. Vocal abuse and misuse presumably lead to excessive mechanical stress and trauma in the membranous portion of vocal fold, resulting in wound formation. Wound healing leads to remodeling of the superficial layer of the lamina propria. This tissue remodeling leads to formation of benign vocal fold lesions. These lesions are classically treated by conventional microsurgery and recently by CO2 laser. The use of the CO2 laser for the surgical treatment of Minor Associated Pathological Lesions (MAPL's) is still controversial. Some preferred cold instruments, whereas others appreciate CO2 laser as a novel alternative to conventional microsurgery for benign vocal fold lesions. To summarize the reviewed literature the issue of CO2 laser versus cold instruments is still controversial and the stage is open for more studies. Aim The aim of this study is to investigate the effect of Co2 Laser versus cold instruments in the treatment of benign lesions of the vocal folds regarding voice outcome & vocal fold function. Methodology A meta-analysis study is done to assess the use of Co2 Laser versus conventional microlaryngeal surgery in treatment of vocal fold benign lesions. Results This study does not reveal any detectable differences in clinical outcomes in patients with nodules, polyps and cysts who underwent excision via CO2 laser or cold instruments. Conclusion There is no sufficient evidence to determine if conventional surgery or CO2 assisted surgery is better.

scholarly journals Outcome Analysis in Patients with Benign Vocal Fold Lesions

2016 ◽  
Vol 6 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Arpit Sharma ◽  
Jyoti Dabholkar ◽  
Nitish Virmani
Keyword(s):  
Vocal Cord ◽  
Vocal Fold ◽  
Treatment Modalities ◽  
Outcome Analysis ◽  
Accurate Analysis ◽  
Maximum Phonation Time ◽  
Multidimensional Assessment ◽  
Benign Vocal Fold Lesions ◽  
Sulcus Vocalis ◽  
Vocal Nodules

ABSTRACT Introduction Benign vocal cord lesions cause significant dysphonia by disrupting the normal vibratory function of the vocal fold mucosa. Multidimensional assessment of voice characteristics allows for an accurate analysis of voice impairment and can be used to assess the outcome of different treatment modalities. Aims To evaluate the outcome in patients treated for benign vocal fold lesions using multidimensional voice assessment Materials and methods Thirty adult patients with benign vocal fold lesions were treated according to standard protocols and followed up for 6 months. Voice was evaluated by visual analog scale (VAS), GRBAS (grade, roughness, breathiness, asthenia, strain) scale, maximum phonation time (MPT), S/Z ratio, and acoustic parameters using PRAAT. Pre- and posttreatment voice was compared. Results Benign lesions observed were vocal polyps (16), vocal nodules (7), vocal fold cysts (5), vocal cord papilloma (1), and sulcus vocalis (1). Mean VAS rating improved from 7.5 to 2 at 3 months and 1.6 at 6 months. Mean GRBAS score improved from 7.5 to 2.96 at 3 months and 2.3 at 6 months. Maximum phonation time increased from 9.43 seconds to 14.16 seconds at 3 months and 14.46 seconds at 6 months. S/Z ratio reduced from 1.37 to 1.16 at 3 months and 1.15 at 6 months. Jitter reduced from 1.81 to 1% at 3 months and 0.97% at 6 months; shimmer decreased from 6.07 to 2.19% at 3 months and to 2.03% at 6 months. Harmonic-to-noise ratio values improved from 8.01 to 10.78 dB at 3 months and 10.96 dB at 6 months; mean F0 increased from 207.27 to 217.89 Hz at 3 months and 219.65 Hz at 6 months. Conclusion A single measurement of voice cannot be used as a reliable outcome measure. Perceptual, aerodynamic, acoustic, and self-analysis together allow a multidimensional assessment of voice characteristics. How to cite this article Virmani N, Sharma A, Dabholkar J. Outcome Analysis in Patients with Benign Vocal Fold Lesions. Int J Phonosurg Laryngol 2016;6(1):8-13.

Imaging the Mucosa of the Human Vocal Fold with Optical Coherence Tomography

2005 ◽  
Vol 114 (9) ◽  
pp. 671-676 ◽  
Author(s):  
James A. Burns ◽  
Steven M. Zeitels ◽  
R. Rox Anderson ◽  
James B. Kobler ◽  
Mark C. Pierce ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Lamina Propria ◽  
Vocal Fold ◽  
Imaging Techniques ◽  
Vocal Folds ◽  
Superficial Layer ◽  
Optical Coherence ◽  
Cross Sectional ◽  
Superficial Lamina

Objectives: Discerning the layered microstructure of the vocal folds is critical for effective phonomicrosurgery. Optical coherence tomography (OCT), a noncontact, noninvasive technology that provides cross-sectional images by means of backscattered light, offers the potential for delineating these layers in vivo. Methods: The glottal mucosa of 3 human cadaver larynges was imaged with conventional OCT and polarization-sensitive OCT (PS-OCT). Images were obtained through the epithelium and lamina propria. Results: Although the superficial layer of the lamina propria appeared quite homogeneous, the outer surface of the superficial lamina propria was correlated with an increase in backscatter with OCT. The superficial lamina propria and vocal ligament were correlated with a marked increase in tissue birefringence with PS-OCT. Conclusions: This preliminary study demonstrates the capacity of OCT and PS-OCT for visualizing the layered microstructure of the vocal fold mucosa. We believe that these imaging techniques will have applications in the exploration of solutions to vocal fold scarring and in imaging vocal fold disorders in the clinic and operating room.

scholarly journals Cogels of Hyaluronic Acid and Acellular Matrix for Cultivation of Adipose-Derived Stem Cells: Potential Application for Vocal Fold Tissue Engineering

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Dongyan Huang ◽  
Rongguang Wang ◽  
Shiming Yang
Keyword(s):  
Tissue Engineering ◽  
Stem Cells ◽  
Extracellular Matrix ◽  
Hyaluronic Acid ◽  
Lamina Propria ◽  
Vocal Fold ◽  
Adipose Derived Stem Cells ◽  
Acellular Matrix ◽  
Decellularized Extracellular Matrix ◽  
Superficial Lamina

Stem cells based tissue engineering has been one of the potential promising therapies in the research on the repair of tissue diseases including the vocal fold. Decellularized extracellular matrix (DCM) as a promising scaffold has be used widely in tissue engineering; however, it remained to be an important issue in vocal fold regeneration. Here, we applied the hydrogels (hyaluronic acid [HA], HA-collagen [HA-Col], and HA-DCM) to determine the effects of hydrogel on the growth and differentiation of human adipose-derived stem cells (hADSCs) into superficial lamina propria fibroblasts. hADSCs were isolated and characterized by fluorescence-activated cell sorting. The results indicated that HA-DCM hydrogel enhanced cell proliferation and prolonged cell morphology significantly compared to HA and HA-Col hydrogel. Importantly, the differentiation of hADSCs into fibroblasts was also promoted by cogels of HA-Col and HA-DCM significantly. The differentiation of hADSCs towards superficial lamina propria fibroblasts was accelerated by the secretion of HGF, IL-8, and VEGF, the decorin and elastin expression, and the synthesis of chondroitin sulfate significantly. Therefore, the cogel of HA-DCM hydrogel was shown to be outstanding in apparent stimulation of hADSCs proliferation and differentiation to vocal fold fibroblasts through secretion of important growth factors and synthesis of extracellular matrix.

Pediatric Benign Vocal Fold Lesions: A Team Approach

2009 ◽  
Vol 19 (3) ◽  
pp. 105-112 ◽  
Author(s):  
Geralyn Harvey Woodnorth ◽  
Roger C. Nuss
Keyword(s):  
Vocal Fold ◽  
Evaluation Process ◽  
Team Approach ◽  
Speech Language Pathologist ◽  
Benign Vocal Fold Lesions ◽  
Different Types ◽  
Team Evaluation ◽  
Surgical Treatments ◽  
Review Current ◽  
Vocal Fold Nodules

Abstract Many children with dysphonia present with benign vocal fold lesions, including bilateral vocal fold nodules, cysts, vocal fold varices, and scarring. Evaluation and treatment of these children are best undertaken in a thoughtful and coordinated manner involving both the speech-language pathologist and the otolaryngologist. The goals of this article are (a) to describe the team evaluation process based on a “whole system” approach; (b) to discuss etiological factors and diagnosis; and (c) to review current medical, behavioral, and surgical treatments for children with different types of dysphonia.

Sign in / Sign up

Export Citation Format

Share Document