SULCUS VOCALIS - A RATIONAL ANALYTICAL APPROACH TO DIAGNOSIS AND MANAGEMENT

The term sulcus vocalis has been applied to a spectrum of disorders ra nging from minor vocal fold indentations to destructive lesions causin g severe dysphonia. To clarify the pathophysiology and to develop a mo re rational approach to treatment, we report a series of sulcus patien ts including 20 surgical cases. Clinical and histopathologic analysis produced a clinically useful classification: type 1 is a physiologic v ariant accentuated by atrophy but with intact lamina propria; types 2 (sulcus vergeture) and 3 (sulcus vocalis) are characterized by severe dysphonia, loss of vibratory activity, and destruction of the function al superficial lamina propria. These latter cases respond favorably to microsurgery designed to remove destroyed tissue, release scar contra cture, and promote mucosal redraping by regional undermining. Further study of the extracellular matrix of the superficial lamina propria (R einke's space) might indicate a common pathway in the pathogenesis of sulcus deformities and other related benign vocal fold lesions.