Structural Changes in Vocal Fold : Leukoplakia and Hyperkeratosis

Leukoplakia and Hyperkeratosis

Epithelial hyperplasia is a general term that describes abnormal changes in the mucous membranes of the vocal folds. These changes usually occur in response to combinations of hyper functional voice use and chemical irritants, especially alcohol and tobacco use. Two vocal fold pathologies seen in adults, typically classified as precancerous lesions, are leukoplakia and hyperkeratosis. These lesions appear as irregular thickening of the vocal fold cover and usually have some discoloration associated with the tissue irregularity. Lesions that go beyond the outermost layer of the vocal folds and invade the intermediate and deep layers are at high risk for signaling early carcinoma. The lesions are usually bilateral but can occur unilaterally. The lesions increase the mass and stiffness of the cover of the fold.

Leukoplakia (shown at right) is a pre-diagnostic term that means "white plaque" and describes the appearance of a thick white substance that covers the vocal folds in diffuse patches, usually on the top surface of the vocal fold. The pathology of leukoplakia is variable, and may include both benign and malignant lesions. Hyperkeratosis is a layered buildup of keratinized cell tissue and is distinctive for its leaf-like appearance and consists of a horny overgrowth of irregular margins on the vocal folds.

Both of these lesions are treated as cautionary signs for possible future malignancy. People who have such lesions are instructed to avoid future exposure to tobacco smoke, chemical inhalants, and other irritants. Usually, surgery will be conducted to confirm the diagnosis with a small biopsy and to remove lesion from the vocal fold cover. Often, voice therapy is used to ensure that voice conservation strategies and vocal hygiene are in place and to assist in recovery of voice quality and assist in modifying the behaviors that contributed to the causes.

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