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Vocal fold scars: current concepts and future directions. Consensus report of the phonosurgery committee of the European laryngological society

  • Laryngology
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Abstract

Scarring of the vocal folds leads to a deterioration of the highly complex micro-structure with consecutively impaired vibratory pattern and glottic insufficiency. The resulting dysphonia is predominantly characterized by a reduced vocal capacity. Despite the considerable progress in understanding of the underlying pathophysiology, the treatment of scarred vocal folds is still an unresolved chapter in laryngology and phonosurgery. Essential for a successful treatment is an individual, multi-dimensional concept that comprises the whole armamentarium of surgical and non-surgical (i.p. voice therapy) modalities. An ideal approach would be to soften the scar, because the reduced pliability and consequently the increased vibratory rigidity impede the easiness of vibration. The chosen phonosurgical method is determined by the main clinical feature: Medialization techniques for the treatment of glottic gap, or epithelium freeing techniques for improvement of vibration characteristics often combined with injection augmentation or implantation. In severe cases, buccal mucosa grafting can be an option. New developments, include treatment with anxiolytic lasers, laser technology with ultrafine excision/ablation properties avoiding coagulation (Picosecond infrared laser, PIRL), or techniques of tissue engineering. However, despite the promising results by in vitro experiments, animal studies and first clinical trials, the step into clinical routine application has yet to be taken.

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Acknowledgments

The authors would like to acknowledge Claus Gerstenberger, PhD for his contribution in all graphic-design related works.

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Authors and Affiliations

  1. Department of Phoniatrics, ENT University Hospital Graz, Speech and Swallowing, Medical University Graz, Auenbruggerplatz 26, 8036, Graz, Austria

    G. Friedrich & M. Gugatschka

  2. Department of Otorhinolaryngology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    F. G. Dikkers

  3. Department of Otorhinolaryngology, University Hospitals Magdeburg, Otto-von-Guericke University, Magdeburg, Germany

    C. Arens

  4. Louvain University Hospital of Mont-Godinne, Dinant, Belgium

    M. Remacle

  5. Department of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf Hamburg, Hamburg, Germany

    M. Hess

  6. Service ORL Et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Timone, Marseille, France

    A. Giovanni

  7. Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Pointe À Pitre, Guadeloupe, France

    S. Duflo

  8. 1st Department of Otolaryngology, Head and Neck Surgery, University of Athens Medical School, Hippokration General Hospital, Athens, Greece

    A. Hantzakos

  9. Department of Head and Neck Surgery, Division Otolaryngology, Catholic University of Louvain at Mont-Godinne, Louvain, Belgium

    V. Bachy

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  1. G. Friedrich
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  2. F. G. Dikkers
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  3. C. Arens
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  4. M. Remacle
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  5. M. Hess
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  6. A. Giovanni
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  7. S. Duflo
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  8. A. Hantzakos
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  9. V. Bachy
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  10. M. Gugatschka
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Corresponding author

Correspondence to M. Gugatschka.

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Friedrich, G., Dikkers, F.G., Arens, C. et al. Vocal fold scars: current concepts and future directions. Consensus report of the phonosurgery committee of the European laryngological society. Eur Arch Otorhinolaryngol 270, 2491–2507 (2013). https://doi.org/10.1007/s00405-013-2498-9

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  • DOI: https://doi.org/10.1007/s00405-013-2498-9

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