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Figure 1. Vocal fold nodules (i.e., nodules or singer’s nodes) are bilateral lesions of the mid- membranous vocal fold. The lesions are usually fairly symmetric. The glottic closure pattern of vocal fold nodules is hourglass shaped. Stroboscopic examination of vocal fold nodules reveals incomplete glottic closure and minimal disruption of the muscosal wave amplitude. Treatment of vocal fold nodules usually is nonsurgical. (See the article on nomenclature of voice disorders by Rosen and Murry and the articles by Casper and Murry and Carroll else- where in this issue.) (Courtesy of Clark A. Rosen, MD, Pittsburgh, PA.)

Figure 2. A left vocal fold polyp and a contralateral reactive lesion on the right vocal fold. Often vocal fold lesions such as a cyst or polyp are seen with a reactive lesion on the contra- lateral vocal fold. Careful observation of the reactive lesion results in identifying a tongue and groove relationship of the vocal fold lesion (polyp or cyst) and the reactive lesion on the opposite vocal fold. When a reactive lesion is present, the glottic closure pattern is hourglass shaped. The reactive lesion usually is smaller than the vocal fold cyst or polyp. (See the article on phonomicrosurgery II by Garret and Ossoff and the article on nomenclature of voice dis- orders by Rosen and Murry elsewhere in this issue.) (Courtesy of Clark A. Rosen, MD, Pitts- burgh, PA.)

Figure 3. A subepithelial vocal fold cyst is present on the left vocal fold. The boundaries of the vocal fold cyst can be seen through the translucent vocal fold epithelium. Vocal fold cysts can be categorized by the location within the vocal fold, which are subepithelial or deep. A vocal fold cyst usually is treated with combined treatments of voice therapy and phonomicro- surgical excision. (See the article on nomenclature of voice disorders by Rosen and Murry, and the articles by Garrett and Ossoff and Casper and Murry elsewhere in this issue.) (Cour- tesy of Clark A. Rosen, MD, Pittsburgh, PA.)

Figure 4. Microflap approach to the vocal fold. A microflap immediately following the removal of a subepithelial vocal fold cyst with cold steel dissection (see Figure 3). Note the translucent nature of the microflap, which presumably is composed of the vocal fold epithelium and the superficial layer of the lamina propria. The microflap is laid back to its anatomic position following removal of the lesion (cyst or polyp) for complete epithelial preservation and optimal healing and recovery. (See the article by Garrettand Ossoff elsewhere in this issue.) (Courtesy of Clark A. Rosen, MD, Pittsburgh, PA.)

Figure 5. Sulcus vocalis is a specialized form of vocal fold scar that is characterized as a loss of the normal architecture and composition of the lamina propria of the vocal fold. This figure demonstrates bilateral sulcus vocalis deformities; the right is more severe than the left. A bulge in the superior aspect of the right midmembranous vocal fold is indicative of a deep vocal fold cyst associated with the sulcus vocalis. Treatment of sulcus vocalis usually involves voice therapy and phonomicrosurgery. (See the article on vocal fold scars by Rosen elsewhere in this issue.) (Courtesy of Clark A. Rosen, MD, Pittsburgh, PA.)

Figure 6. An intraoperative view of vocal fold scar that tethers the vocal fold epithelium (cover) to the vocal ligament (body). A pair of blunt microdissectors are retracting the vocal fold epithelium anterior and posterior to the vocal fold scar. There are multiple treatment options for vocal fold scar, both nonsurgical and surgical. Optimal treatment following the release of the vocal fold scar is placement of small fat grafts into the site of the vocal fold scar and suture fixation of the intact microflap into position. (See the article on vocal fold scars by Rosen elsewhere in this issue.) (Courtesy of Clark A. Rosen, MD, Pittsburg, PA.)

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