European Archives of Oto-Rhino-Laryngology

, Volume 273, Issue 5, pp 1207–1214 | Cite as

Proposal for a descriptive guideline of vascular changes in lesions of the vocal folds by the committee on endoscopic laryngeal imaging of the European Laryngological Society

  • Christoph ArensEmail author
  • Cesare Piazza
  • Mario Andrea
  • Frederik G. Dikkers
  • Robin E. A. Tjon Pian Gi
  • Susanne Voigt-Zimmermann
  • Giorgio Peretti


In the last decades new endoscopic tools have been developed to improve the diagnostic work-up of vocal fold lesions in addition to normal laryngoscopy, i.e., contact endoscopy, autofluorescence, narrow band imaging and others. Better contrasted and high definition images offer more details of the epithelial and superficial vascular structure of the vocal folds. Following these developments, particular vascular patterns come into focus during laryngoscopy. The present work aims at a systematic pathogenic description of superficial vascular changes of the vocal folds. Additionally, new nomenclature on vascular lesions of the vocal folds will be presented to harmonize the different terms in the literature. Superficial vascular changes can be divided into longitudinal and perpendicular. Unlike longitudinal vascular lesions, e.g., ectasia, meander and change of direction, perpendicular vascular lesions are characterized by different types of vascular loops. They are primarily observed in recurrent respiratory papillomatosis, and in pre-cancerous and cancerous lesions of the vocal folds. These vascular characteristics play a significant role in the differential diagnosis. Among different parameters, e.g., epithelial changes, increase of volume, stiffness of the vocal fold, vascular lesions play an increasing role in the diagnosis of pre- and cancerous lesions.


Endoscopy Superficial vascular lesions Vascular loops Vocal fold Carcinoma 


  1. 1.
    Voigt-Zimmermann S, Arens C (2014) Vascular lesions of vocal folds—Part I: horizontal vascular lesions. Laryngo-Rhino-Otol 93(1):1–12CrossRefGoogle Scholar
  2. 2.
    Arens C, Glanz H, Voigt-Zimmermann S (2015) Vascular lesions of vocal folds—part 2: vertical vascular lesions. Laryngo-Rhino-Otol 94(11):738–744CrossRefGoogle Scholar
  3. 3.
    Piazza C, Del Bon F, Peretti G, Nicolai P (2012) Narrow band imaging in endoscopic evaluation of the larynx. Curr Opin Otolaryngol Head Neck Surg 20(6):472–476CrossRefPubMedGoogle Scholar
  4. 4.
    Mihashi S, Okada M, Kuria K, Nagata K, Oda M, Hirano M, Nakashima T (1981) Vascular network of the vocal fold. In: Stevens KN, Hirano M (eds) Vocal fold physiology. University of Tokyo Press, Tokyo, pp 45–57Google Scholar
  5. 5.
    Nakai Y, Masutani H, Moriguchi M, Matsunaga K, Sugita M (1991) Microvascular structure of the larynx. A scanning electron microscopic study of microcorrosion casts. Acta Otolaryngol (Stockh) Suppl 486:254–263CrossRefGoogle Scholar
  6. 6.
    Schossee A, Voigt-Zimmermann S, Kropf S, Arens C (2015) Evaluation of a classification model of horizontal vascular lesions of the vocal folds. Laryngo-Rhino-Otol. doi: 10.1055/s-0035-1559677
  7. 7.
    Spiegel JR, Sataloff RT, Hawkshaw M, Rosen DC (1996) Vocal fold hemorrhage. Ear Nose Throat J 75(12):784–789PubMedGoogle Scholar
  8. 8.
    Postma GN, Courey MS, Ossoff RH (1998) Microvascular lesions of the true vocal fold. Ann Otol Rhinol Laryngol 107(6):472–476CrossRefPubMedGoogle Scholar
  9. 9.
    Hochman I, Sataloff RT, Hillman RE, Zeitels SM (1999) Ectasias and varices of the vocal fold: clearing the striking zone. Ann Otol Rhinol Laryngol 108(1):10–16CrossRefPubMedGoogle Scholar
  10. 10.
    Carroll TL, Smith LJ (2009) Acute vocal fold hemorrhage caught on video during office exam. Laryngoscope 119(3):589–590CrossRefPubMedGoogle Scholar
  11. 11.
    Inoue H, Honda T, Yoshida T, Nishikage T, Nagahama T, Yano K, Nagai K, Kawano T, Yoshino K, Tani M, Takeshita K, Endo M (1996) Ultra-high magnification endoscopy of the normal esophageal mucosa. Digestive Endosc 8(2):134–138CrossRefGoogle Scholar
  12. 12.
    Inoue H, Honda T, Nagai K, Kawano T, Yoshino K, Takeshita K, Endo M (1997) Ultra-high magnification endoscopic observation of carcinoma in situ of the esophagus. Digestive Endosc 9(1):16–18CrossRefGoogle Scholar
  13. 13.
    Inoue H, Kaga M, Sato Y, Sugaya S, Kudo S (2007) Magnifying endoscopic diagnosis of tissue atypia and cancer invasion depth in the area of pharyngo-esophageal squamous epithelium by NBI enhanced magnification image: IPCL pattern classification. In: Cohen J (ed) Comprehensive atlas of high resolution endoscopy and narrow, vol imaging. Blackwell Publishing Ltd, Oxford, pp 49–66Google Scholar
  14. 14.
    Arens C, Glanz H, Wönckhaus J, Hersemeyer K, Kraft M (2007) Histologic assessment of epithelial thickness in early laryngeal cancer or precursor lesions and its impact on endoscopic imaging. Eur Arch Otorhinolaryngol 264(6):645–649CrossRefPubMedGoogle Scholar
  15. 15.
    Kraft M, Lüerssen K, Lubatschowski H, Woenckhaus J, Schöberlein S, Glanz H, Arens C (2008) Mucosal lesions in the larynx: predictive value of new imaging modalities for a histological diagnosis. HNO 56(6):609–613CrossRefPubMedGoogle Scholar
  16. 16.
    Tjon Pian Gi REA, San Giorgi MRM, Slagter-Menkema L, van Hemel BM, van der Laan BFAM, van den Heuvel ER, Dikkers FG, Schuuring EMD (2015) Clinical course of recurrent respiratory papillomatosis: comparison between aggressiveness of human papillomavirus-6 and human papillomavirus-11. Head Neck 37(11):1625–1632. doi: 10.1002/hed.23808 CrossRefPubMedGoogle Scholar
  17. 17.
    Lukes P, Zabrodsky M, Lukesova E, Chovanec M, Astl J, Betka JA, Plzak J (2014) The role of NBI HDTV magnifying endoscopy in the prehistologic diagnosis of laryngeal papillomatosis and spinocellular cancer. Biomed Res Int:285–486Google Scholar
  18. 18.
    Kleinsasser O (1991) Microlaryngoscopy and endolaryngeal microsurgery: technique and typical findings. Schattauer, StuttgartGoogle Scholar
  19. 19.
    Arens C, Glanz H, Dreyer T, Malzahn K (2003) Compact endoscopy of the larynx. Ann Otol Rhinol Laryngol 112(2):113–119CrossRefPubMedGoogle Scholar
  20. 20.
    Ni XG, He S, Xu ZG, Gao L, Lu N, Yuan Z, Lei SQ, Zhang GYM, Yi JL, Wang XL, Zhang L, Li XY, Wang GQ (2011) Endoscopic diagnosis of laryngeal cancer and precancerous lesions by narrow band imaging. J Laryngol Otol 125(3):288–296CrossRefPubMedGoogle Scholar
  21. 21.
    Gökcan KM, Dursun G (2009) Vascular lesions of the vocal fold. Eur Arch Otorhinolaryngol 266(4):527–533CrossRefPubMedGoogle Scholar
  22. 22.
    Watanabe A, Taniguchi M, Tsujie H, Hosokawa M, Fujita M, Sasaki S (2008) The value of narrow band imaging endoscope for early head and neck cancers. Otolaryngol Head Neck Surg 138(4):446–451CrossRefPubMedGoogle Scholar
  23. 23.
    Piazza C, Cocco D, De Benedetto L, Del Bon F, Nicolai P, Peretti G (2010) Narrow band imaging and high definition television in the assessment of laryngeal cancer: a prospective study on 279 patients. Eur Arch Otorhinolaryngol 267(3):409–414CrossRefPubMedGoogle Scholar
  24. 24.
    Tjon Pian Gi RE, Halmos GB, van Hemel BM, van den Heuvel ER, van der Laan BF, Plaat BE, Dikkers FG (2012) Narrow band imaging is a new technique in visualization of recurrent respiratory papillomatosis. Laryngoscope 122(8):1826–1830CrossRefPubMedGoogle Scholar
  25. 25.
    Andrea M (1981) Vasculature of the anterior commissure. Ann Otol Rhinol Laryngol 90(1 Pt 1):18–20CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Christoph Arens
    • 1
    Email author
  • Cesare Piazza
    • 2
  • Mario Andrea
    • 3
  • Frederik G. Dikkers
    • 4
  • Robin E. A. Tjon Pian Gi
    • 4
  • Susanne Voigt-Zimmermann
    • 1
  • Giorgio Peretti
    • 5
  1. 1.Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital, Otto-von-Guericke-University of MagdeburgMagdeburgGermany
  2. 2.Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of BresciaBresciaItaly
  3. 3.Faculty of MedicineUniversity of LisboaLisbonPortugal
  4. 4.Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
  5. 5.Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of GenoaGenoaItaly

Personalised recommendations