No One-Size-Fits-All Technique or Clear Decision-Making Pattern for Treating Vocal Fold Sulcus/Scars

by Linda Kossoff •

When treating patients with vocal fold sulcus or scars, are there different outcomes with direct approaches, indirect approaches, or a combination of both? 

BOTTOM LINE 

There does not seem to be a one-size-fits-all treatment or clear decision-making pattern for adult patients with vocal fold sulcus or scars, suggesting the need for more subjective and objective decision-making tools. 

BACKGROUND: Vocal fold sulcus and scars are benign vocal fold lesions with fibrotic changes to the vocal fold mucosa that modify the pliability of the mucosa, causing vocal impairments. Heterogeneity in these patients’ clinical appearance makes diagnosis and treatment a challenge, and there is no gold standard in surgical treatment. 

STUDY DESIGN: Literature search. 

SETTING: Voice and Swallowing Clinic, Department of Otolaryngology–Head and Neck Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium. 

SYNOPSIS: Researchers conducted a database search for studies on vocal scar and/ or vocal sulcus surgical treatment. Thirty-one studies totaling 617 patients were included for qualitative synthesis. Fifteen studies focused solely on sulcus, five solely on scars, and 11 included a combination of benign vocal fold pathologies. Researchers classified treatment techniques as direct (including dissection, graft interposition, or lamina propria (LP) regeneration/scar degradation); indirect (focused mainly on glottic gap correction and not addressing the LP defect); or combined. Analysis showed that self-reported outcomes were the most frequently improved. However, the heterogeneity among the 31 study designs, employed techniques, and measured outcomes did not allow for any conclusion based on the existing published evidence regarding the predominance of a specific technique over others. Although there was no clear decision-making pattern in the literature, authors identified a trend toward sequential approaches, starting with less invasive procedures. Authors suggest a classification for the different proposed treatments based on the pathophysiology of sulcus and scar, to improve data presentation. Study limitations concern individual study quality and possible bias. 

CITATION: Medeiros N, Castro MEM, Titske van Lith-Bijl J, and Desuter GRR. A systematic review on surgical treatments for sulcus vocalis and vocal fold scar. Laryngoscope. 2022;132:822-830.