Proposal of a Classification for Sulcus Following Microlaryngoscopy with a Retrospective Study of the Results of a Laser-assisted Sulcus Release Surgery

Abstract

Ab s t r Ac t Background: Sulcus vocalis has historically remained challenging in terms of both diagnosis and management. The problem is further compounded by a lack of clarity in its classification as an accurate estimation of its presence and depth can be established only during microlaryngoscopy (MLS). We have thus proposed a classification of sulcus following MLS, which would allow for uniform grading. A laserassisted sulcus release (LASR) technique is described which was performed in 7 patients and 10 vocal folds of isolated sulcus cases with outcome measures studied retrospectively. Materials and methods: The classification proposed of sulcus following MLS is based on depth of invagination of the sulcus, length of the sulcus, presence of keratin debris within, and associated presence of mucosal bridges, polyps and cysts. A LASR technique was performed for type A and D sulci (based on proposed classification) where the multiple points of release were made with a CO2 laser Acublade perpendicular to the lips of the sulcus. All patients received preand postoperative voice therapy. Preoperative and 3 months’ postoperative stroboscopy and vocal outcome measures were reviewed retrospectively. Results: Stroboscopic improvement of the mucosal wave and amplitude with decreased phonatory gap and decreased ventricular hyperadduction was observed in all patients postoperatively. There was a significant improvement of grade, roughness, breathiness, asthenia, strain (GRBAS) and maximum phonatory time (MPT) (p < 0.05). Conclusion: The LASR technique performed for type A and D sulci in our limited case series revealed 3-month postoperative stroboscopic improvement along with improvement in vocal parameters. We plan to continue this study to include a larger sample size.