[Diagnosis and management of sulcus vocalis].
OBJECTIVE
To clarify the pathophysiology of sulcus vocalis and to develop a more rational approach to treatment.


METHODS
Twenty-nine cases of sulcus vocalis patients were divided into three classification: Type I is a physiologic variant and no dysphonia (11 cases). Types II (sulcus vergeture, 13 cases) and III (sulcus vocalis, 5 cases) are characterized by severe dysphonia and loss of vibratory activity. Eighteen cases of dysphonia were treated by surgery and phonation training. The operations included fat injection into vocal cords (9 cases of types II and 1 cases of types III, including 1 case of types III of second operation), fat implantation into sulcus vergeture after incision (4 cases of types II and 1 cases of types III) and undermining of the mucosa and sulcus vocalis resection (4 cases of types III, including 1 case of second operation). Phonatory function and video laryngostroboscopic data were evaluated before and after surgery and phonation training treatment in 18 patients. The mean follow-up time was 15.3 months.


RESULTS
Ten cases of types II had excellent results after fat injection into vocal cords (n = 6) and fat implantation into sulcus vergeture after incision (n = 4). Three cases of types II improved after fat injection into vocal cords. Three cases of type III had excellent results after sulcus vocalis resection. One case of type III had excellent results by Second operation (sulcus vocalis resection) after fat injection into vocal cord. One case of type III improved by Second operation (fat injection into vocal cords) after fat implantation into sulcus vergeture after incision. No postoperative complications were noted.


CONCLUSIONS
Accurate classification of sulcus vocalis is important and then adapt treatment to different types. Fat implantation into sulcus vergeture to type II and sulcus vocalis resection to type III were the best choice methods.
Wen
Wu
W
Department of Otorhinolaryngology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China. wenwu@smmu.edu.cn
Zhou
Shui-miao
SM
Zhang
Ru-xin
RX
Shen
Xiao-hua
XH
Wang
Su-min
SM
Huang
Yi-deng
YD
Sun
Guang-bin
GB
Geng
Li-ping
LP
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007818:Laryngeal Diseases / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D014827:Vocal Cords / Q000503:physiopathology