title: Cause of vocal fold scar.
abstract: OBJECTIVE
  The prolonged debilitation, loss of income, and decrement in quality of life caused by vocal fold scar is exacerbated by our inability to successfully treat this difficult problem. As technology focuses on developing innovative treatments, we need to fully appreciate and understand the mechanisms giving rise to glottal scar, on both a macroscopic and microscopic level. This review examines recent literature pertaining to the gross and molecular mechanisms which give rise to vocal fold scar.
  
  
  RESULTS
  Mechanisms of vocal fold scar production have been examined in both macroscopic and microscopic detail. Trauma and injury involving any aspect of the lamina propria, particularly the deeper layers, may result in epithelial tethering and scar formation. At the molecular level, early inflammatory cytokines activate and recruit fibroblasts which then drive the fibrotic cascade. Transforming growth factor-β enhances fibrosis and is balanced by tissue matrix metalloproteinases and hepatocyte growth factor activity. Molecular signaling offers novel opportunities to intervene in scar formation.
  
  
  CONCLUSIONS
  New work investigating the cause of vocal fold scar identifies complex molecular processes leading to fibrosis in the lamina propria. Improved mechanistic understanding offers insight into prevention strategies and possible targets for antifibrotic therapies that may help prevent or treat this debilitating condition.
authors.affiliation: Centre for Voice and Swallowing, University of California, Davis, Sacramento, California 95817, USA. jacquieallen@yahoo.com
authors.forename: Jacqui
authors.initials: J
authors.lastname: Allen
mesh_terms: D001707:Biopsy, Needle; D002921:Cicatrix / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D005260:Female; D005347:Fibroblasts / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D007818:Laryngeal Diseases / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D008967:Molecular Biology; D010699:Phonation / Q000502:physiology; D014827:Vocal Cords / Q000293:injuries / Q000473:pathology*; D014833:Voice Quality