Vocal Fold Scarring: Current Concepts and Management

TLDR

Scarring of the vocal folds, often from surgical injury, replaces healthy tissue with fibrous tissue, disrupts the mucosal wave, and poses diagnostic and therapeutic challenges for persistent dysphonia. The study aims to describe common causes of vocal fold scarring, emphasize prevention during lesion removal, and outline the anatomical, histologic, and assessment modalities related to voice changes. The authors review the anatomical and histologic basis of voice changes, contemporary assessment methods, and treatment options such as nonsurgical therapy, collagen injection, fat augmentation, endoscopic laryngoplasty, and Silastic medialization.

Abstract

Scarring of the vocal folds can occur as the result of blunt laryngeal trauma or, more commonly, as the result of surgical, latrogenic injury after excision or removal of vocal fold lesions. The scarring results in replacement of healthy tissue by fibrous tissue and can irrevocably alter vocal fold function and lead to a decreased or absent vocal fold mucosal wave. The assessment and treatment of persistent dysphonia in patients with vocal fold scarring presents both diagnostic and therapeutic challenges to the voice treatment team. The common causes of vocal fold scarring are described, and prevention of vocal fold injury during removal of vocal fold lesions is stressed. The anatomic and histologic basis for the subsequent alterations in voice production and contemporary modalities for clinical and objective assessment will be discussed. Treatment options will be reviewed, including nonsurgical treatment and voice therapy, collagen injection, fat augmentation, endoscopic laryngoplasty, and Silastic medialization.