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Vocal Fold Scarring: Frontiers

Key Glossary Terms

Vocal Fold Scar
Abnormal scar tissue in the vibrating layer of the vocal fold that causes voice problems

Lamina Propria
Vibrating component of the vocal folds that covers the vocal fold muscle or body; the lamina propria is composed of three layers: superficial, intermediate, and deep lamina propria

Mucosal Wave
Wave-like motion of the vibrating layer of the vocal fold as seen upon slow motion-like viewing through stroboscopy

Stroboscopy
Laryngoscopy with synchronized strobe light that provides a slow motion-like view of vocal fold vibration (mucosal wave); stroboscopy is the key tool used to analyze vocal fold vibration

Glossary

Unresolved Issues: Frontier Techniques in Vocal Fold Scarring

No surgical treatment options are widely accepted for the treatment of voice problems due to vocal fold scarring. In fact, some surgeons believe that the success rate of any surgery for vocal fold scars is so low that most or all patients should forgo surgery until future methods are developed and proven. However, many experienced voice surgeons believe that surgery can be helpful.
The use of steroids to treat vocal fold scarring, either by mouth in pill form, or either inhaled or injected into the vocal fold, is controversial. Most doctors do not believe that steroid administrations to the scarred vocal fold can generate significant improvement.
However, some surgeons believe that elevating the covering of the vocal fold in a "microflap" fashion, releasing the scarred tissue and then laying this tissue back into place, is an effective surgical option for vocal fold scarring despite the obvious high probability of reformation of vocal fold scars at the surgical site. Often, after a release has been performed, surgeons will inject or deposit steroids in the area of the vocal fold scar to minimize reformation of the scarred tissue within the vocal fold. This surgical technique has not been widely used or proven to be highly effective due to the reformation of scar tissue at the "release" location(s).
Injecting collagen into the vocal fold has been done for many years in an attempt to compensate for lost lamina propria tissue due to vocal fold scarring and to soften the stiff, hard scar tissue within the vocal fold. Some surgeons have had good success with collagen injections for the treatment of vocal fold scarring, while others feel that this is not a successful surgical treatment option.
Studies are also being conducted on surgical implantation of a material within the vocal fold (into the lamina propria) in an attempt to reconstruct the vocal fold and improve the overall vocal fold vibration and function. The most commonly used material for this type of procedure is the patient's own fat, however recently patients' fascia has also been used for this purpose. Fascia is a strong, tendon-like tissue that covers large muscles such as the muscles of the leg and arm. Fascia is composed predominantly of collagen fibers. Some surgeons have found these fat or fascia procedures to be quite satisfactory, while others do not believe they are a good alternative for the treatment of vocal fold scarring.
Development of new treatment options for vocal fold scarring is the focus of much interest and research. One such example is a new biomedical implant material that can be placed or injected within the scarred vocal fold to modify the structure and function of the lamina propria. Research is also being conducted on using various bioengineering techniques to achieve the same goal.

Treatment

Advisory Note

Patient education material presented here does not substitute for medical consultation or examination, nor is this material intended to provide advice on the medical treatment appropriate to any specific circumstances.

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