Glottic sulcus, before surgery (1 of 3)
Glottic sulcus, normal light, showing retained material/ granulation emerging from within the sulcus. There is a partial ring of capillaries around the sulcus on the right (left of photo), but no significant vessels within the sulcus (also see next photo).
Glottic sulcus, before surgery (2 of 3)
Same patient. Narrow-band illumination shows the vascular markings more clearly.
Glottic sulcus (1 of 10)
This young patient has a husky, air-wasting voice quality. View of the vocal cords, in breathing position. An abnormality can be seen, especially on the right cord (left of photo, at arrows).
Glottic sulcus (2 of 10)
Under strobe lighting, during phonation, open phase of vibration, at a normal speech frequency (pitch), showing an unusually large amplitude of vibration.
Glottic sulcus (4 of 10)
Closer view, during inspiratory phonation, reveals very clearly that this patient has sulci on both cords, with the open pocket especially visible on the right cord (left of photo).
Sulcus with bowing, just prior to injection (5 of 10)
At the prephonatory instant, under standard light. In addition to a sulcus, this patient has congenital bowing.
Sulcus with bowing, just prior to injection (6 of 10)
Phonation, under standard light, at the pitch E-flat 4 (~311 Hz). Notice in particular the generous width of the zone of vibratory blurring, which correlates with the flaccid, large-amplitude vibration seen in photo 2's strobe view.
Voice gel injection (7 of 10)
The left vocal cord (right of photo) is now being injected with voice gel. The injection is centered so that the undersurface, free margin, and ventricle all show evidence of bulging.
After the injection (9 of 10)
After voice gel injection is completed. At the prephonatory instant. Notice the reduced gap between the vocal cords (compare with photo 5).
Glottic sulcus and glottic furrow (1 of 4)
This patient has a glottic sulcus on the left vocal cord (right of image) and a glottic furrow on the right vocal cord.
Glottic sulcus and glottic furrow (2 of 4)
Same patient, inspiratory (breathing in) phonation. Note how this accentuates the opening of the sulcus on the left vocal cord (right of image).
Glottic sulcus and glottic furrow (3 of 4)
Same patient. Compare with photo 4 to observe the vibratory appearance of the sulcus and furrow.
Glottic sulcus (1 of 2)
Note that the "lips" of the glottic sulcus are open; compare to image #2. Also see the video for this.
Glottic sulcus operation (1 of 7)
Preoperative exam image, the glottic sulcus is indicated by arrows. (In the remaining photos the view of the larynx is reversed, so the affected area will be on the opposite side of the photo).
Glottic sulcus operation (2 of 7)
Initial operative view showing inflammation, capillary prominence, and margin swelling of the right vocal cord. The sulcus is indicated by arrows, but can be seen much more easily in the next photo.
Glottic sulcus operation (3 of 7)
Rolling the cord laterally with an instrument causes the sulcus to gape open.
Glottic sulcus operation (4 of 7)
A needle is inserted lateral to the still-gaping sulcus to infiltrate for both vasoconstriction and hydrodissection.
Glottic sulcus operation (4 of 7)
The epithelial-lined “pocket” is nearly dissected free from the interior of the cord.
Glottic sulcus operation (5 of 7)
The medial and lateral mucosal flaps are retracted to show the deep layer from which the epithelial-lined pocket was dissected.
Surgical removal of glottic sulcus (1 of 4)
At beginning of surgery, the cord is infiltrated with lidocaine/epinephrine to provide hydrodissection and to expand the mucosa. Line of the sulcus is seen proceding anteriorly from the point of the needle entry.
Surgical removal of glottic sulcus (2 of 4)
An elliptic incision has been made around the lips of the sulcus.
Surgical removal of glottic sulcus (3 of 4)
Right-curved alligator clip tents the medial mucosal flap. Arrows indicate the fine line that represents the opening into the sulcus. Curved scissors dissect the anterior aspect of the sulcus pocket from the underlying vocal ligament.