Sulcus vocalis: excision, primary suture and medialization laryngoplasty: personal experience with 44 cases

Abstract

This is a prospective, cohort study to present personal experience on excision of sulcus, primary suture of defect and medialization laryngoplasty. An article about this subject is not present in medical literature. Forty-four patients with sulcus vocalis who were operated on by excision, primary suture of epithelial defect and medialization laryngoplasty were included. Pre- and postoperative evaluations included GRBAS, VHI-30, stroboscopy, aerodynamic and acoustic analysis. Grade, roughness and breathiness of GRBAS were significantly better postoperatively (p < 0.05), whereas asthenia and strain were not (p > 0.05). All VHI-30 results decreased significantly after surgery (p < 0.01). Glottal closure and mucosal wave amplitude during stroboscopy improved significantly postoperatively (p < 0.05), whereas symmetry and periodicity did not (p > 0.05). Maximum phonation time, mean airflow rate, mean efficiency and mean pressure of aerodynamic analysis improved significantly after surgery (p < 0.05). However, mean resistance and mean power were not significantly different (p > 0.05). All parameters, except F ₀ and soft phonation index during acoustic analysis with /a/, and except F ₀, voice turbulence index and soft phonation index during acoustic analysis with constant phrase improved significantly after surgery (p < 0.05). Surgical treatments of sulcus vocalis are not satisfactory enough, yet. Excision of sulcus, primary suture of epithelial defect and medialization laryngoplasty is one of the successful surgical options. Intact vocal ligament at the bottom of sulcus is a good prognostic sign for good postoperative voice result. Success appears to depend on how long, how wide and how deep sulcus is. Good patient selection may increase the percentage of happy patients.