RESUMO
BACKGROUND: Sulcus vocalis reflects varying degrees of vocal cord lamina propria (LP) damage. Many interventions have been discussed in the literature for addressing sulcus vocalis, but there is no universally accepted gold standard for its management. AIM: We aim in our study to collectively evaluate the effectiveness of different relevant interventions in the literature used for sulcus vocalis or vocal fold scar. METHODS: We searched five electronic databases to collect all relevant studies. Records were screened for eligibility. Data were extracted from the included studies independently. Our continuous outcomes were pooled in our single-arm meta-analysis as mean change (MC) and with 95% confidence interval (CI). RESULTS: Our systematic review and meta-analysis included 43 studies encompassing 1302 patients. The jitter parameter indicated that laser degeneration and LP regeneration/scar degradation led to the highest improvements compared to their baseline, with pooled MC of -0.897 and -0.893, respectively. Graft interposition showed a MC of -0.848, while medialization and dissection had less pronounced changes at -0.200. Shimmer parameter results were similar, with medialization and laser degeneration leading to MC of -2.129 and -2.123, while LP regeneration/scar degradation and graft interposition showed smaller changes MC -1.530 and -1.217. For the noise-to-harmonic ratio (NHR) parameter, LP regeneration/scar degradation demonstrated MC = -0.028. In aerodynamics outcomes, graft interposition and LP regeneration/scar degradation showed the highest MCs in mean phonatory time (MPT) (4.214 and 3.467, respectively). Endoscopic outcomes for mucosal wave showed high improvements in medialization and graft interposition (MC = 10.40 and 10.18, respectively). Perceptual outcomes favored graft interposition in various parameters, while laser degeneration performed well in most categories. Graft interposition and LP regeneration/scar degradation had a high voice handicap index (VHI) (MC = -27.195 and -19.269, respectively). CONCLUSION: Laser degeneration and LP regeneration/scar degradation were particularly effective in improving acoustic parameters. In aerodynamics, graft interposition and LP regeneration/scar degradation improved vocal efficiency compared to their baselines. Medialization and laser degeneration had the largest impact compared to their baseline on shimmer and MPT. Endoscopic assessments showed that medialization and graft interposition had high improvement in mucosal waves, and perceptual outcomes were generally high with graft interposition and laser degeneration.
RESUMO
The authors report an unusual case of monostotic fibrous dysplasia involving the middle turbinate. Only four cases of fibrous dysplasia (FD) involving the middle turbinate had previously been documented globally, all of which entailed severe presentation and were treated surgically. We report the first case of asymptomatic monostotic FD of the middle turbinate in the Middle East, followed over a span of 10 years. Fibro-osseous lesions are rare, benign tumors of the sinonasal and orbital regions. Craniofacial FD most commonly affects the maxilla and mandible, followed by the frontal, parietal, and occipital bones. The prevalence of most patients presenting with monostotic craniofacial FD is between 10% and 29%. It is typically found incidentally, and is most likely to be asymptomatic. The risk of skull base damage and cerebrospinal fluid leaks is increased in this case due to the involvement of the middle turbinate and the expansion of FD into the lateral lamella and the cribriform plate. Our patient was managed conservatively with regular follow-up due to the minor clinical symptoms despite the extent of the disease. We aim to elucidate the specific challenges associated with middle turbinate involvement and contribute to the growing body of knowledge in this field, ultimately improving the care and quality of life for individuals affected by this condition.
