Surgical management of sulcus vocalis and vocal fold scarring

Although fibrous tissue is an essential supportive structure in the larynx and vocal fold, disordered fibroplasia can cause contraction and disturb the viscoelastic properties that are essential for vocal fold function. Sulcus vocalis is a specific example of vocal fold scarring, and it presents the same essential challenge in restoration of function. Vocal fold scar and sulcus vocalis share glottic insufficiency, breathy voice quality, and resistance to tissue alteration as hallmarks. Multiple surgical strategies have been devised to help improve vocal fold closure and pliability. The approaches are open and endoscopic, conceptually direct or indirect, and may or may not involve direct tissue implantation to the vocal fold cover. Specific commentary is provided regarding these different surgical techniques. Future treatment pathways are explored.