Resection of the sulcus using CO2 laser and reconstruction with microflap to improve the voice

This study aims to evaluate the therapeutic outcomes of CO₂ laser resection of the sulcus and reconstruction under microlaryngoscopy.

This retrospective analysis included 22 patients (10 females and 12 males, with an average age of 24.9 years) diagnosed with pathological sulcus vocalis who underwent our surgical procedure, which involved vaporization of the sulcus using a CO₂ laser, followed by separation and suturing of the mucosal flaps. Outcome measures included the Voice Handicap Index (VHI)-30, jitter, shimmer, harmonics-to-noise ratio (HNR), maximum phonation time (MPT), maximum loudness phonation time (MLPT), the RBH (Roughness, Breathiness, Hoarseness) perceptual voice evaluation, and strobolaryngoscopic assessments of mucosal wave, amplitude, and sulcus severity before and 7 months after surgery, and the measurements were compared.

Subjective improvements were observed, with statistically significant improvements in VHI-30 scores and all subscales (P < 0.05). Voice analysis demonstrated improvements in jitter and shimmer(P < 0.05). As in the RBH perceptual assessment, statistically significant improvements were observed postoperatively in the B score of the postoperative vowel (P < 0.05). Mucosal wave, amplitude, and bilateral sulcus severity scores showed improvement postoperatively (P < 0.05).

CO₂ laser resection and reconstruction of the sulcus under microlaryngoscopy is an effective surgical method for treating sulcus vocalis. This technique significantly improves patients' subjective voice and voice quality mightily by enhancing vocal fold vibration and restoring normal vocal fold shape.