Sulcus vocalis (also called vocal cord sulcus or vocal fold sulcus) is one of the most difficult disorders of the vocal cords to diagnose and treat. The exact cause of its formation is not fully understood. It is thought to be present from birth in about half of cases. Inappropriate and abusive use of the vocal cords (phonotrauma) or rupture of a vocal cord cyst have also been reported as possible causes.
What are the problems with vocal cords with sulcus vocalis?
Examination of sulcus vocalis shows thinning of the vocal cord tissue in the superficial part of the lamina propria, one of the layers necessary for the vocal cords to vibrate. In some cases the groove is so deep that the important support layer known as the vocal ligament may not even be present. According to Ford's classification there are 3 types: type 1 is called a physiologic vocal cord sulcus, type 2 is described as a linear indentation along the free edge of the vocal cord, and type 3 is called a deep, sac-like cavity.
How is vocal cord sulcus diagnosed?
Sulcus vocalis can be diagnosed by videolaryngostroboscopy. However, in some cases a definitive diagnosis can only be made by microscopic examination under surgical conditions.
Can sulcus be treated? What are the treatment options?
Treatment of sulcus vocalis primarily involves voice therapy, surgery, or a combination of both. Surgical treatment options include:
- Cutting and removal of the sulcus epithelium.
- Incision and removal of the sulcus epithelium, with grafting using fat, fascia or other material taken from the person.
- Incision and removal of the sulcus epithelium, with vertical incisions along the sulcus line.
- Excision of the sulcus and primary suturing of the resulting defect.
- Laser procedures.
- Vocal cord filling (injection laryngoplasty).
- Injection of steroids or other regenerative substances.
- Excision and primary suturing of the defect, combined with medialization laryngoplasty.
The appropriate treatment modality should be chosen specifically for the patient, based on the patient's vocal needs and the possibilities provided by the existing condition. Patients' expectations regarding the outcome of treatment with vocal cord surgery should be realistic. Many patients may need more than one surgery. The combination of voice therapy with phonosurgery has a positive effect on treatment success.
