Mismatching of the levels of the vocal cords. Vocal cord scissoring may in some cases be asymptomatic, but more often it introduces a rough quality to the voice, because the desired mirror-image bilateral symmetry of oscillation will be lost.


Photos:

Scissoring of the Vocal Cords

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Scissoring of the vocal cords (1 of 1)

The left vocal cord (right of image) rides up over the right, posteriorly.

Vocal Cord Scissoring, Made More Obvious by Atrophy

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Vocal cord scissoring, made more obvious by atrophy (1 of 4)

The vocal processes in this patient are extremely visible because the rest of the vocal cord on each side is atrophic and bowed.

Vocal cord scissoring, made more obvious by atrophy (2 of 4)

The vocal cords approach each other for voicing. Note the evident asymmetry between the vocal processes. The left vocal process (right of image) projects further anteriorly than does the opposite process. It is also at a higher (more cephalad) level.

xt3-41020110Vocal cord scissoring, made more obvious by atrophy (3 of 4)

Phonation, closed phase of vibration, under strobe lighting. Note the overlap (scissoring) of the left vocal process (right of image) on top of the other process.

Vocal cord scissoring, made more obvious by atrophy (4 of 4)

Phonation, at a higher pitch, at which the scissoring of the left vocal process (right of image) on top of the other becomes even more evident.

Scissoring Arytenoids After Years of Vocal Effort

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Voice remains effortful after radiation for carcinoma (1 of 4)

This man was severely hoarse for years, due to what looked like carpet-variant papillomas/ HPV effect. Each of many biopsies across many years confirmed “ papilloma” often with severe atypia. Twice, the lesions tested negative for HPV DNA. After many years, he developed a carcinoma and received radiation with durable cure depicted here. Voice, however, remained rough and effortful.

Approaching phonatory position (2 of 4)

As he is approaching phonatory position (hence the blurring), right vocal process (left of photo) is overly turned medially.

Phonation (3 of 4)

As the vocal cords close, the overlap of right (left of photo) on top of left (right of photo) becomes very obvious.

Scissoring arytenoids (4 of 4)

The right vocal process (left of photo) rides up on top of the left vocal cord (right of photo). This, along with the stiffness of his cords caused by multiple prior surgical procedures and then radiation, accounts for his hoarse voice.