VOCAL FOLD SCARRING - CURRENT CONCEPTS AND MANAGEMENT

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.