Review of the Surgical Treatment and Current Status of the Regenerative Approach for Sulcus Vocalis

Abstract

We herein review the typical surgical treatments and current status of the regenerative approach for sulcus vocalis. Sulcus vocalis demonstrates as pathophysiology of the fibrosis in the VF (Vocal Fold) as VF scarring and is one of the main reasons for permanent dysphonia, resulting from injury to the unique layered structure of the VFs. The clinical pathology of sulcus vocalis has been classified as types Ⅰ to Ⅲ based on previous research from Ford. However, the diagnosis may be difficult, even with the help of stroboscopy, and the etiology remains controversial, with arguments for each theory still underway. Surgery with supplementary injection laryngoplasty of the VFs is the main treatment option for pathological sulcus vocalis. However, other effective treatment options based on regenerative medicine are needed. According to previous basic research, the increased collagen and decreased hyaluronic acid within VF scarring lead to a loss of pliability of the VFs and thereby significantly decrease their capacity to vibrate. As there is currently no definitive treatment for VF scarring, regenerative medicine and tissue engineering have become increasingly important research areas within the field of otolaryngology. This review focuses on emerging techniques for restoring VF pliability using various approaches, including surgical procedures. We also identify several obstacles hindering further advances in this area of research.