Ectasias and varices of the vocal fold: Clearing the striking zone

Vascular malformations such as ectasias and varices (Es and Vs) are frequen tly encountered in patients who present with recurrent vocal fold hemorrhag e and/or other traumatic vocal fold lesions. This study examined Es and Vs with regard to their anatomic presentation, phonomicrosurgical management, and treatment outcome. Forty-two patients (39 of them singers) were treated for a total of 87 Es and Vs: 67 of 87 (77%) were on the superior surface o f the vocal fold and 20 of 87 (23%) were on the medial surface of the vocal fold. Eighty-three percent were located in the middle musculomembranous re gion (the striking zone), where the greatest aerodynamically induced sheari ng stresses occur during phonation. Treatment was performed with carbon dio xide laser cauterization (13 patients), or a new technique utilizing cold i nstrument excision by means of epithelial cordotomies (23 patients), while a combined approach was employed in 6 patients. Comparisons of preoperative and postoperative stroboscopy revealed improvement or no significant chang e in all patients in whom the cold instrument technique was used, and incre ased epithelial stiffness was noted in 4 of 19 patients in whom the carbon dioxide laser was used. Clearing the striking zone appears to have halted f urther hemorrhages by removing the the fragile Es and Vs from this injury-p rone region of the vocal fold. Interpretations of stroboscopic examinations were directed at providing new insights into the biomechanical forces of v ocal fold vibration that probably contribute to the genesis of Es and Vs in the vocal folds.