title: Sulcus vocalis: A new clinical paradigm based on a re-evaluation of histology.
abstract: Sulcus vocalis is an epithelial invagination adherent to deep tissues of the vocal fold. Traditionally, dysphonia is believed to result from attenuation or absence of lamina propria and consequent alteration of mucosal dynamics. This conception does not account for several clinical features of the lesion, most notably inflammation. The goal of this study is to elucidate the clinical nature of sulcus by re-examination of its histopathology.
  
  
  
  Retrospective review.
  
  
  
  Clinical features, including stroboscopic examination, and hematoxylin and eosin sections of 19 lesions in 15 patients who underwent surgery were reviewed.
  
  
  
  Epithelial change was found uniformly in all specimens, consisting of parakeratosis (78.9%), epithelial thickening (77.8%), dyskeratosis (63.2%), basement membrane thickening (47%), epithelial inflammation (52.6%), and retention of keratin debris (36.8%). In contrast, submucosal findings were less prevalent. Seven patients (36.8%) had essentially normal subepithelial tissues. Submucosal inflammation was present in seven (36.8%), and other submucosal changes in four of 17 (23.5%). Clinical characteristics demonstrated general improvement after surgical intervention in most cases.
  
  
  
  Sulcus vocalis appears to have an important component of epithelial pathology, with especially high prevalence of parakeratosis, dyskeratosis, and epithelial thickening. Clinical changes may result from prominent perilesional inflammation related to epithelial changes instead of or in addition to any alteration of the lamina propria. Surgical treatment, when necessary, should refocus on removal of pathologic epithelium as a source of inflammation independent of reconstructive considerations.
  
  
  
  4 Laryngoscope, 126:1397-1403, 2016.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lee
authors.affiliation: the Sean Parker Institute for the Voice, Department of Otolaryngology-Head & Neck Surgery, Weill Cornell Medical College, New York, New York.
authors.forename: Lucian
authors.initials: L
authors.lastname: Sulica
authors.affiliation: College of Physicians & Surgeons, Columbia University, New York, New York.
authors.forename: Alana
authors.initials: A
authors.lastname: Aylward
authors.affiliation: Department of Pathology & Laboratory Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Theresa
authors.initials: T
authors.lastname: Scognamiglio
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006652:Histological Techniques; D006801:Humans; D007633:Keratins / Q000032:analysis; D007818:Laryngeal Diseases / Q000150:complications / Q000473:pathology*; D007820:Laryngeal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010241:Parakeratosis / Q000209:etiology / Q000473:pathology; D012189:Retrospective Studies; D049489:Stroboscopy / Q000379:methods; D014827:Vocal Cords / Q000473:pathology*; D055815:Young Adult
chemical_list: D007633:Keratins
keywords: Vocal fold sulcus; larynx; microlaryngoscopy; phonotrauma; sulcus vocalis