Scarring of the vocal folds can occur as the result of blunt laryngeal
trauma or, more commonly, as the result of surgical, iatrogenic injur
y after excision or removal of vocal fold lesions. The scarring result
s in replacement of healthy tissue by fibrous tissue and can irrevocab
ly alter vocal ford function and lead to a decreased or absent vocal f
old mucosal wave. The assessment and treatment of persistent dysphonia
in patients with vocal fold scarring presents both diagnostic and the
rapeutic challenges to the voice treatment team. The common causes of
vocal fold scarring are described, and prevention of vocal fold injury
during removal of vocal fold lesions is stressed. The anatomic and hi
stologic basis for the subsequent alterations in voice production and
contemporary modalities for clinical and objective assessment will be
discussed. Treatment options will be reviewed, including nonsurgical t
reatment and voice therapy, collagen injection, fat augmentation, endo
scopic laryngoplasty, and Silastic medialization.