Management of Vocal Fold Leukoplakia

Vocal fold leukoplakia (VFL) is a descriptive term for a white plaque in the true vocal folds (TVF). It is estimated at 10.2 cases per 100,000 males and 2.1 per 100,000 females. The most critical aspect of managing a VLF is achieving an accurate pathological diagnosis, since a white plaque in the TVF can have numerous differential diagnoses. Patients with VFL usually complain of hoarseness and vocal strain. The common cause of VFL is premalignant lesions with primary risk factors of tobacco and alcohol consumption. Inflammatory aggressors such as laryngopharyngeal reflux disease are proven to affect directly the incidence of VFL. Infectious agents such as human papilloma virus and Helicobacter pylori may also play a role in the development of VFL. Frequent differential diagnosis includes laryngeal candidiasis, prolonged ulcerative laryngitis, previous head and neck radiotherapy, and, more rarely, lichen planus. The clinical investigation for a VLF includes laryngeal exam through a rigid or a flexible laryngoscope; videochromoendoscopy is a useful tool. Biopsy is mandatory so a pathological diagnosis is made. The most accepted classification for VFL and premalignant lesions is the fifth edition of the World Health Organization, and it uses a two-tiered system. The treatment for VFL and premalignant lesions can be done by cold knife surgery, KTP laser, or CO₂ laser.