Structural Changes in Vocal Fold : Congenital and Acquired Webs

Congenital and Acquired Webs

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Anterior Web

Webs of the vocal folds occur when there is a tissue bridge between the two vocal folds at the very front portion (anterior). Congenital (from birth) webs arise when the vocal folds fail to separate during the tenth week of embryonic development. Webbing may causes various degrees of shortness of breath and stridor (noisy breathing), depending upon the extent of the web. The voice qualities of children with congenital webs will range from normal voice to a severe dysphonia, again depending on the length and thickness of the web. In some cases, virtually no effects are noted in either breathing or voice quality. Treatment typically includes surgery to separate the web. Voice therapy may have a role in post-operative rehabilitation, to encourage proper development of voice pitch and quality.

Other small acquired webs may develop in the anterior commissure in the post-operative period following vocal fold surgeries that involve the anterior membranous portion of the folds, or following vocal trauma. These micro webs, also called synechias, occur when irritation of the anterior commissure reheals as a small fibrotic web. The effect of this micro web on voice quality can be variable, and surgical management is occasionally warranted, especially in elite performers.

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