Diagnostic and therapeutic pitfalls in benign vocal fold diseases

Abstract

More than half of patients presenting with hoarseness show benign vocal fold changes. The clinician should be familiar with the anatomy, physiology and functional aspects of voice disorders and also the modern diagnostic and therapeutic possibilities in order to ensure an optimal and patient specific management. This review article focuses on the diagnostic and therapeutic limitations and difficulties of treatment of benign vocal fold tumors, the management and prevention of scarred vocal folds and the issue of unilateral vocal fold paresis.

Keywords: benign vocal fold lesions; evaluation of voice; phonosurgery; unilateral vocal fold paralysis; vocal fold scarring; voice disorder; voice therapy.

Table 1. Localisation of benign vocal fold lesions

Figure 1. Laryngeal papillomatosis

Figure 2. Vocal fold polyp

Figure 3. a) Reinke’s edema; b) Bilateral massive vocal fold thickening due to Reinke’s edema

Figure 4. a) Vocal fold cyst; b) Vocal fold cyst with corresponding scars; c) Epidermoid cyst

Figure 5. a and b) Soft vocal fold; c) Hard vocal fold nodules

Figure 6. Bamboo nodes

Figure 7. Vocal process granuloma and microweb

Figure 8. Postintubation granulomas of the larynx

Figure 9. Bilateral vocal fold scarring

Figure 10. Bilateral sulcus glottidis

Figure 11. a, b and c) Vocal fold cyst and mucosal bridge after dissection

Figure 12. a) Unilateral vocal fold paralysis with persistent insufficiency of glottal closure; b) Same patient with complete glottal closure, 18 months after vocal fold augmentation with hyaluronic acid