Advertisement

European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 1, pp 159–165 | Cite as

Mucosal bridges (MB): a 9-year retrospective study of their incidence with a third variant proposed

  • Nupur Kapoor NerurkarEmail author
  • Arundhatee Sapre
  • Rahul Gosavi
Laryngology
  • 54 Downloads

Abstract

Background

Mucosal bridges (MBs) are rare laryngeal lesions that may cause dysphonia of varying degrees. We propose the existence of a third variant of MB besides thin and thick MBs, and have termed this as an incomplete mucosal bridge (IMB). The concept of an IMB has not been previously discussed in literature. Thin and thick MBs are attached anteriorly and posteriorly on the membranous vocal fold and may cause dysphonia because of their separate vibratory characteristics from the main vocal fold. We propose the presence of an entity named as IMB, which is typically identified by palpation of a slit on the superior surface of the membranous vocal fold.

Aim

To propose and describe the existence of IMBs. Furthermore, to study the percentage of various types of MBs found while performing microlaryngeal surgeries (MLS) for benign glottic lesions, over a 9-year period at our Voice Clinic.

Method

An IMB may be described as a MB that does not open at its medial edge. Thus it appears as an epithelial slit on the surface of the vocal fold. On palpating this slit with a microflap elevator, a flat pocket lying just below and parallel to the vocal fold epithelium is identified. These pockets are always directed medially (never laterally) and just stop short of opening up at the medial edge. These IMBs differ from sulci and focal pit as sulci and focal pits are not covered with a hood of epithelium. Our operative records of all MLS performed for benign glottic lesions were audited from 2009 to 2017 for cases of MBs.

Results

A total of 1728 MLS for benign glottic lesions were performed from 2009 to 2017 and 27 MBs were identified in 23 patients, 16 being male. A total of 11 IMBs were identified in 10 patients, with 1 case revealing a bilateral IMB. Other associated lesions were cysts, sulci, and polyps. A total of 14 thin MBs were identified in 11 patients with 3 cases revealing these bilaterally. Two thick MBs were identified in two separate cases, with one case having a bilobed hemorrhagic polyp attached to the thick MB.

Conclusion

Our study found MBs in 1.33% of patients being operated for benign glottic lesions. The incidence of MBs in this group was 1.56% with IMBs accounting for 0.63%, thin MBs accounting for 0.81% and thick MBs in 0.11%. We recommend all patients undergoing MLS be actively palpated for the presence of mucosal bridges including IMBs especially if a small slit is found on the surface of the vocal fold. This is vital for accurate identification and documentation of all the lesions responsible for the patients voice quality. Ours is an ongoing study and we propose to analyze the vocal outcomes associated with surgical management of these IMBs.

Keywords

Mucosal bridge Sulcus Phonomicrosurgery 

References

  1. 1.
    Rosen CA, Simpson BC (2008) Vocal fold scar and sulcus vocalis. Oper Tech Laryngol 23:144–153Google Scholar
  2. 2.
    Benninger M (2015) Vocal fold scar. In: Sataloff R (eds) Comprehensive textbook of otorlaryngology: head and neck surgery, Jaypee, laryngology, vol 56. Jaypee Brothers Medical Publishers (P) Ltd, India, pp 715–721Google Scholar
  3. 3.
    Bouchayer M, Cornut G (1991) Phonosurgery. In: Fawkus M (ed) Voice disorders and their management, 2nd edn, vol 18. Springer, Boston, MA, pp 337–355CrossRefGoogle Scholar
  4. 4.
    Martins RH, Tavares EL, Fabro AT, Martins MG, Dias NH (2012) Mucosal bridge of the vocal fold: difficulties in the diagnosis and treatment. J Voice 26(1):127–131CrossRefGoogle Scholar
  5. 5.
    Remacle M, Hantzakos A, Matar N, Oswal V (2014) Laser surgery for common laryngeal pathology. In: Oswal V (ed) Lasers in otorhinolaryngology and head and neck surgery, 2nd edn, vol 1, Kugler, Amsterdam, The Netherlands, pp 117–131Google Scholar
  6. 6.
    Bouchayer M, Cornut G, Witzig E, Loire R, Roch JB, Bastian RW (1985) Epidermoid cysts, sulci, and mucosal bridges of the true vocal cord: a report of 157 cases. Laryngoscope 95(9 Pt 1):1087–1094Google Scholar
  7. 7.
    Sataloff RT, Rosen C, Hawkshaw M (1997) Occult mucosal bridge of the vocal fold. Ear Nose Throat J 76(12):850Google Scholar
  8. 8.
    Welham NV, Dailey SH, Ford CN, Bless DM (2007) Voice handicap evaluation of patients with pathologic sulcus vocalis. Ann Otol Rhinol Laryngol 116(6):411–417CrossRefGoogle Scholar
  9. 9.
    Villaret AB, Piazza C, Rossini M, Peretti G (2007) Triple mucosal bridge of the glottis. Otolaryngol Head Neck Surg 137(4):678–679CrossRefGoogle Scholar
  10. 10.
    Tanaka S, Hirano M, Umeno H, Tanaka Y (1991) Mucosal bridge of the vocal fold. Nippon Jibiinkoka Gakkai Kaiho 94(12):1853–1856 (Japanese) CrossRefGoogle Scholar
  11. 11.
    Nerurkar NK (2017) Cysts, sulci and mucosal bridges, In: Nerurkar NK, Roychowdhary AB (eds) Textbook of laryngology, vol 15. APSI Jaypee, India, pp 155–170Google Scholar
  12. 12.
    Tavares ELM, Brasolotto A, Santana MF, Padovan CA, Martins RHG (2011) Epidemiological study of dysphonia in 4–12 year-old children. Braz J Otorhinolaryngol 77(6):736–746CrossRefGoogle Scholar
  13. 13.
    Sakae FA, Sasaki F, Sennes LU, Tsuji DH, Imamura R (2012) Vocal fold polyps and cover minimum structural alterations: associated injuries? J Voice 26(1):127–131CrossRefGoogle Scholar
  14. 14.
    Villagomez VJ, Rosen CA (2000) Vocal fold cyst and contralateral occult sulcus mucosal bridge. Ear Nose Throat J 79:910–911Google Scholar
  15. 15.
    Sataloff RT, Chowdhury F, Joglekar S, Hawkshaw MJ (2011) Sulcus vocalis. In: Sataloff RT, Chowdhury F, Joglekar S, Hawkshaw MJ (eds) Atlas of endoscopic laryngeal surgery, vol 22. Jaypee, India, pp 130–132CrossRefGoogle Scholar
  16. 16.
    Schweinfurth J, Ossoff RH (2018) http://emedicine.medscape.com/article/866094-overview#a8. Accessed 31 Mar 2018
  17. 17.
    Tan M, Pitman MJ (2011) A case of bilateral vocal fold mucosal bridges, bilateral trans-vocal fold type III sulci vocales, and an intracordal polyp. J Voice 25(4):484–486CrossRefGoogle Scholar
  18. 18.
    Kim H (2008) New surgical technique for mucosal bridge of vocal fold: sandwich mucosal flap surgery (Yeson Voice Center Website). http://www.yesonvc.net/introduce/researchView.asp?idx=27. Accessed 22 Mar 2017

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Nupur Kapoor Nerurkar
    • 1
    Email author
  • Arundhatee Sapre
    • 2
  • Rahul Gosavi
    • 2
  1. 1.Voice and Swallowing CenterBombay Hospital and Medical Research CenterMumbaiIndia
  2. 2.Bombay Hospital and Medical Research CenterMumbaiIndia

Personalised recommendations