Sulcus Vocalis: Results of Excision Without Reconstruction.

OBJECTIVE: Sulcus is an epithelial invagination of the membranous vocal fold. Its phonatory effects are usually attributed to fibrosis, thinning, and/or the absence of the superficial lamina propria (SLP). Surgical treatment is typically focused on reconstruction of the SLP. The purpose of this study is to assess the effects of excision without SLP reconstruction or replacement. METHODS: Records of patients who underwent surgical treatment of sulcus vocalis (Ford type 3) by excision without reconstruction were reviewed for demographic and historical information. Pre- and postoperative stroboscopic examinations were evaluated blindly by fellowship-trained laryngologists using a modified Voice-Vibratory Assessment with Laryngeal Imaging assessment. A Wilcoxon signed-rank test was used to compare pre- and postoperative amplitude, mucosal wave, nonvibrating portion, regularity, erythema, and vascularity. RESULTS: Examinations of 16 vocal folds in 13 patients (8 females:5 males; mean age = 30 years, range 13 to 48 years) were evaluated by six raters each, yielding 168 sets of observations. Statistically significant improvement was seen in amplitude (95% confidence interval [CI] 3.6,14.3), mucosal wave (95% CI 6.1, 17.9), nonvibrating portion (95% CI -19.6, -2.7), erythema (95% CI -19.9, -3.3), and vascularity (95% CI -19.0, -0.75). The parameter of regularity, although improved, did not prove to be significant. CONCLUSION: Excision alone appears to be an adequate and generally successful treatment for sulcus vocalis (Ford type 3). In contrast to established paradigms, restoration of the SLP does not appear to be essential to meaningful clinical improvement. Significant pathologic effects of sulcus vocalis may result from epithelial abnormalities alone. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:2208-2212, 2020.

Dynamic ventrorostral displacement of the dorsal laryngeal mucosa in horses.

The objectives of this report were to describe the occurrence and features of dynamic ventrorostral displacement of the dorsal laryngeal mucosa (VRDDLM) in a group of Thoroughbred horses presented for investigation of poor performance and/or abnormal respiratory noise. Records from 600, dynamic, endoscopic examinations of the upper respiratory tract of horses were reviewed. Horses with VRDDLM were identified as those in which the dorsal laryngeal mucosa progressively obscured the interarytenoid notch and dorsoaxial portion of the corniculate processes of the arytenoid cartilages during high-speed exercise. The condition was recognised in 12 horses. Concurrent abnormalities of the respiratory tract of eight horses were also identified and included, axial deviation of the aryepiglottic folds, vocal cord prolapse, unilateral and bilateral ventromedial luxation of the apex of the corniculate process of the arytenoid cartilage, and intermittent dorsal displacement of the soft palate. VRDDLM is a rare abnormality of the upper portion of the respiratory tract of horses that may be associated with abnormal respiratory noise and potentially poor performance. The significance of the condition is not known, but the presence of this condition in combination with other, obstructive diseases of the equine airway warrants further investigation.

Bilateral occult mucosal bridges of the true vocal folds.

A mucosal bridge of the true vocal fold is a rare, benign anatomical finding that can cause dysphonia. It has been described by some in the literature as "occult" as it is often not visibly evident on flexible nasopharyngolaryngoscopy or strobovideolaryngoscopy, but mistakenly diagnosed as a sulcus vocalis (Sataloff RT, Rosen C, Hawkshaw M. Occult mucosal bridge of the vocal fold. Ear Nose Throat J. 1997; 76(12):850).(2) Final diagnosis is usually not made until microscopic direct laryngoscopy is performed and palpation of the true vocal fold reveals the mucosal bridge (Tanaka S, Hirano M, Umeno H, Tanaka Y. Mucosal bridge of the vocal fold [Japanese].(4)Nippon Jibiinkoka Gakkai Kaiho. 1991; 94(12):1853-1856). We describe a case of a 15-year-old boy complaining of long-standing hoarseness and found to have bilateral mucosal bridges of the true vocal folds. Previous reports cite cases of a unilateral mucosal bridge. We believe this is the first reported case of bilateral mucosal bridges.

Airway obstruction in the mentally handicapped.

We have presented a case of laryngomalacia in an 18-year-old mentally retarded woman treated with epiglottoplasty. The preoperative and postoperative appearance of the larynx during aspiration was documented using video and still photography. Diagnosis was made by fiberoptic nasopharyngoscopy and laryngoscopy.

Congenital stridor caused by redundant arytenoid mucosa.

Two cases of congenital stridor caused by merely unusual redundancy of the mucosa covering the arytenoids are reported in this paper. The stridor was noted only when the patients were awake, and was not affected by postural changes of patients. The patients who did not reach their full mental and physical development had congenital abnormalities: cleft palate in one case, and hypertrichiosis, short palpebral fissures of camptodactyly in the other. No abnormalities were revealed in the patients on examinations of chromosomes, thyroid hormones and brains using the techniques of computerized axial tomographic scanning and electroencephalography. The diagnosis of these cases should be confirmed by a direct laryngoscopy or a laryngofiberscopy. Although the etiology of redundant arytenoid mucosa is not known, it may be suggested that this condition is incidental to other congenital abnormalities.