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Review
. 2023 Apr 20;8(3):720-729.
doi: 10.1002/lio2.1060. eCollection 2023 Jun.

Options for treatment of a small glottic gap

Yolanda D Heman-Ackah  1 , Chandra M Ivey  2 , Ronda Alexander  3
Affiliations
Review

Options for treatment of a small glottic gap

Yolanda D Heman-Ackah et al. Laryngoscope Investig Otolaryngol. .

Abstract

Background: Glottic insufficiency, or glottic gap as it is commonly called, is a common cause of dysphonia, producing symptoms of soft voice, decreased projection, and vocal fatigue. The etiology of glottic gap can occur from issues related to muscle atrophy, neurologic impairment, structural abnormalities, and trauma related causes. Treatment of glottic gap can include surgical and behavioral therapies or a combination of the two. When surgery is chosen, closure of the glottic gap is the primary goal. Options for surgical management include injection medialization, thyroplasty, and other methods of medializing the vocal folds.

Methods: This manuscript reviews the current literature regarding the options for treatment of glottic gap.

Discussion: This manuscript discusses options for treatment of glottic gap, including the indications for temporary and permanent treatment modalities; the differences between the available materials for injection medialization laryngoplasty and how they affect the vibratory function of the vocal folds and vocal outcome; and the evidence that supports an algorithm for treatment of glottic gap.

Level of evidence: 3a-Systematic review of case-control studies.

Keywords: glottic gap; injection laryngoplasty; thyroplasty; vocal paresis.

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Conflict of interest statement

Yolanda Heman‐Ackah and Chandra Ivey have nothing to disclose. Ronda Alexander discloses that she is a consultant for Smith and Nephew and receives consulting fees or honoraria as an independent contractor/speakers bureau/advisory committees/review panels.

Figures

FIGURE 1
FIGURE 1
Vibratory cycle. From the Voice Foundation Website. https://voicefoundation.org/health‐science/voice‐disorders/anatomy‐physiology‐of‐voice‐production/understanding‐voice‐production/
FIGURE 2
FIGURE 2
Presbyphonia.
FIGURE 3
FIGURE 3
Bilateral sulcus vocalis.
FIGURE 4
FIGURE 4
Ford's sulcus vocalis classification.
FIGURE 5
FIGURE 5
Bilateral type I sulcus vocalis intraoperative photo.
FIGURE 6
FIGURE 6
Right vocal fold scar.
FIGURE 7
FIGURE 7
Left superior laryngeal nerve paresis.
FIGURE 8
FIGURE 8
Fat injection into left vocal fold. From Arch Otolaryngol Head Neck Surg. 2010;136 (5):457‐462. doi:10.1001/archoto.2010.42.
FIGURE 9
FIGURE 9
Thyroplasty insertion.
FIGURE 10
FIGURE 10
Thyroplasty configuration to glottic gap.
FIGURE 11
FIGURE 11
Presbyphonia preoperative.
FIGURE 12
FIGURE 12
Presbyphonia post hyaluronic acid injection medialization laryngoplasty.
FIGURE 13
FIGURE 13
Bilateral sulcus vocalis.
FIGURE 14
FIGURE 14
Bilateral sulcus vocalis post carboxymethylcellulose injection medialization laryngoplasty.
FIGURE 15
FIGURE 15
Left superior laryngeal nerve paresis.
FIGURE 16
FIGURE 16
Left superior laryngeal nerve paresis post type I thyroplasty with Gore‐Tex®.
See this image and copyright information in PMC

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