Vocal Fold

Type III thyroplasty for the treatment of glottic gap in a patient undergoing laryngofissure cordectomy for squamous cell carcinoma of the vocal fold: Technique and outcome

May 31, 2010     Tolga Kandogan, MD


A 44-year-old man presented with squamous cell carcinoma (T1aN0M0) on the left vocal fold and was prepared for a combined laryngofissure cordectomy and type III thyroplasty. The author performed both procedures together-not only to lower the tension on the healthy vocal fold, but also to determine whether the thyroplasty would successfully close the glottic gap created by the cordectomy, resulting in relatively fast improvement in the patient's voice. Satisfactory glottic closure and a satisfactory voice result were achieved rather quickly. The patient was satisfied with his new voice, both in the early and late postoperative periods.

Acute dysphonia secondary to vocal fold hemorrhage after vardenafil use

May 31, 2010     Vikas Singh, MD, Seth M. Cohen, MD, MPH, Bernard Rousseau, PhD, J. Pieter Noordzij, MD, C. Gaelyn Garrett, MD, and Robert H. Ossoff, DMD, MD


Owing to their vasodilatory effects, the phosphodiesterase-5 inhibitors have become widely used for the treatment of erectile dysfunction. Among the reported adverse events of these agents are epistaxis, variceal bleeding, intracranial hemorrhage, and hemorrhoidal bleeding. We report a case of vocal fold hemorrhage that occurred after vardenafil use in a 31-year-old man who was a professional singer.

Type I thyroplasty revision 1 year after a window was mistakenly created on the cricoid cartilage

April 30, 2010     Hilmi Alper Şenkal, MD and Taner Yilmaz, MD


Unilateral vocal fold paralysis causes glottic incompetence and can result in significant morbidity. To prevent such morbidity, surgeons treat affected patients with vocal fold medialization techniques; type I thyroplasty medialization surgery is widely used for this purpose. In this procedure, a window is opened on the thyroid cartilage to allow for placement of a silicon prosthesis to medialize the vocal fold. A 38-year-old woman presented to our clinic for evaluation of hoarseness and a low-pitched voice, which we diagnosed as being caused by left vocal fold paralysis. Two years earlier, she had undergone a thyroidectomy for the treatment of benign thyroid disease. One year after that, she underwent type I thyroplasty medialization surgery at another center. During that operation, the surgeon had mistakenly created the window on the cricoid cartilage rather than the thyroid cartilage. When he inserted the silicon prosthesis into the cricoid window, the patient developed acute respiratory obstruction. At that point, the prosthesis was removed and the operation was terminated. One year later, she presented to us, and we performed a revision type I thyroplasty. Intraoperatively, we discovered that the original window had been opened on the cricoid cartilage instead of the thyroid cartilage, which was intact. We left the cricoid window untouched, opened a new window on the thyroid cartilage, and completed the type I thyroplasty in the usual fashion. The patient's postoperative recovery was uneventful, and she was doing well at 5 years of follow-up. To the best of our knowledge, no case of a thyroplasty window being opened on a cricoid cartilage has been reported in the literature.

Correlation between the Voice Handicap Index and voice laboratory measurements after phonosurgery

March 31, 2010     Jeffrey Cheng, MD and Peak Woo, MD, FACS


Phonosurgery is an effective treatment for some vocal fold pathologies, and the Voice Handicap Index (VHI) survey has been shown to be a useful instrument for evaluating treatment effectiveness. We conducted a nonrandomized, prospective study of 21 patients who underwent phonosurgery for the treatment of non-neoplastic vocal fold lesions at our academic tertiary-care referral center. Our goals were to compare pre- and postoperative VHI scores (subjective assessments) and pre- and postoperative results of acoustic and aerodynamic tests (objective assessments). We sought to determine if there was any correlation between the subjective and objective findings. We looked for differences between professional voice users (n = 10) and nonprofessional voice users (n = 11) in both subjective and objective measures. We found statistically significant differences between pre- and postoperative values in three of four VHI parameters, but in only one of 13 objective measures. There was no correlation between preoperative VHI scores and preoperative acoustic and aerodynamic test results. The professional voice users expressed greater postoperative improvement as reflected by lower VHI scores than did the nonprofessional voice users, confirming that the former are more negatively affected by a voice disability.

Vocal fold cyst

March 31, 2010     Amy L. Rutt, DO and Robert T. Sataloff, MD, DMA, FACS

Influence of the macroscopic features of vocal fold polyps on the quality of voice: A retrospective review of 101 cases

March 1, 2010     Gursel Dursun, MD, Selmin Karatayli-Ozgursoy, MD, Ozan Bagis Ozgursoy, MD, Zahide Ciler Tezcaner, MD, Isil Coruh, Audiometrist, and Mehmet Akif Kilic, MD


We conducted a study to examine six macroscopic features of vocal fold polyps and to investigate their influence on quality of voice. We retrospectively reviewed the records of 101 consecutive patients with vocal fold polyps who had undergone microlaryngeal surgery for polyp removal after conservative measures had failed. All patients had undergone videolaryngostroboscopy and perceptual and acoustic voice analyses. The six macroscopic features of these vocal fold polyps were morphologic type, location, position, shape, size, and the presence or absence of a reactive lesion on the contralateral vocal fold. Among our statistically significant findings were that gelatinous polyps tended to be broad-based; polyps located on the superior surface tended to be hemorrhagic; small polyps were mostly located on the middle one-third of the vocal fold, and most of them were broad-based; and all of the polyps that were accompanied by reactive lesions on the contralateral vocal fold were located on the free edge. Moreover, jitter was found to be low in small polyps. Finally, noise-to-harmonics ratios were significantly higher in patients with anterior polyps and in those with pedunculated polyps. We conclude that each of the six macroscopic features of vocal fold polyps affected vocal function to a certain degree. We believe that our study provides additional information to otolaryngologists and speech language pathologists who deal with vocal fold polyps.

Removal of vocal fold papillomata and a laryngeal web

March 1, 2010     C. Richard Stasney, MD, Margarita Rodriguez, BS, and Jeremy Hathway, MS

Type 2 sulcus vocalis: Sulcus vergeture

January 1, 2010     Edward J. Damrose, MD, FACS

A giant vocal fold polyp causing dyspnea

December 1, 2009     Takeshi Kusunoki, MD, Ryohei Fujiwara, MD, Kiyotaka Murata, MD, and Katsuhisa Ikeda, MD

Syringomyelia with syringobulbia presenting as vocal fold paralysis

June 30, 2009     Borlingegowda Viswanatha, MS, DLO


A 36-year-old woman presented with a history of change in voice of 1 month's duration and difficulty swallowing and episodes of nasal regurgitation of 6 days' duration. Examination revealed paralysis of the right vocal fold and the right side of the soft palate. On further investigation, she was found to have syringomyelia with syringobulbia and a Chiari type I malformation. She underwent foramen magnum decompression surgery and was followed up for 1 year. Her dysphagia and nasal regurgitation resolved, but no functional improvement was seen in either her vocal fold or palate.

Vocal fold mucosal bridge without sulcus vocalis in a smoker

May 31, 2009     Mauro Zernotti, MD, Cristina Jackson-Menaldi, PhD, and Adam D. Rubin, MD

Vocal fold immobility from a primary minor salivary gland small-cell carcinoma: Case report

February 1, 2009     Robert L. Witt, MD, FACS and Patrick A. Wilson, MD, FCAP


Small-cell carcinoma of a minor salivary gland is a rare and to the best of our knowledge previously unreported cause of vocal fold immobility. We describe the case of a 68-year-old woman who presented with hoarseness, dysphagia, and weight loss. Examination revealed left vocal fold immobility. She had no other obvious abnormality of the upper airway, neck, or skin. Computed tomography and magnetic resonance imaging demonstrated a 4-cm submucosal oropharyngeal mass with extension to the parapharyngeal space and involvement of the carotid sheath and the foramen ovale at the skull base; imaging also revealed cervical adenopathy. Fine-needle aspiration biopsy identified the mass as a small-cell carcinoma, a finding that was confirmed by immunohistochemistry. Extensive tumor invasion and multiple comorbidities precluded an aggressive management strategy, and the patient was treated palliatively. She died of her disease shortly after her diagnosis. Vocal fold immobility of unknown etiology mandates imaging from the skull base to the upper mediastinum.

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