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European Archives of Oto-Rhino-Laryngology

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01-09-2013 | Laryngology

Vocal fold scars: current concepts and future directions. Consensus report of the phonosurgery committee of the European laryngological society

Authors: G. Friedrich, F. G. Dikkers, C. Arens, M. Remacle, M. Hess, A. Giovanni, S. Duflo, A. Hantzakos, V. Bachy, M. Gugatschka

Published in: European Archives of Oto-Rhino-Laryngology | Issue 9/2013

Abstract

Scarring of the vocal folds leads to a deterioration of the highly complex micro-structure with consecutively impaired vibratory pattern and glottic insufficiency. The resulting dysphonia is predominantly characterized by a reduced vocal capacity. Despite the considerable progress in understanding of the underlying pathophysiology, the treatment of scarred vocal folds is still an unresolved chapter in laryngology and phonosurgery. Essential for a successful treatment is an individual, multi-dimensional concept that comprises the whole armamentarium of surgical and non-surgical (i.p. voice therapy) modalities. An ideal approach would be to soften the scar, because the reduced pliability and consequently the increased vibratory rigidity impede the easiness of vibration. The chosen phonosurgical method is determined by the main clinical feature: Medialization techniques for the treatment of glottic gap, or epithelium freeing techniques for improvement of vibration characteristics often combined with injection augmentation or implantation. In severe cases, buccal mucosa grafting can be an option. New developments, include treatment with anxiolytic lasers, laser technology with ultrafine excision/ablation properties avoiding coagulation (Picosecond infrared laser, PIRL), or techniques of tissue engineering. However, despite the promising results by in vitro experiments, animal studies and first clinical trials, the step into clinical routine application has yet to be taken.

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Title: Vocal fold scars: current concepts and future directions. Consensus report of the phonosurgery committee of the European laryngological society
Authors: G. Friedrich
F. G. Dikkers
C. Arens
M. Remacle
M. Hess
A. Giovanni
S. Duflo
A. Hantzakos
V. Bachy
M. Gugatschka
Publication date: 01-09-2013
Publisher: Springer Berlin Heidelberg
Published in: European Archives of Oto-Rhino-Laryngology / Issue 9/2013
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-013-2498-9

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Vocal fold scars: current concepts and future directions. Consensus report of the phonosurgery committee of the European laryngological society

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