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Webbing and Leukoplakia


									 By Emily Perry
28 February 2010
 Tissue that grows over the glottis and between the
  vocal folds.
 A laryngeal web growing across the glottis between the
  two vocal folds inhibits normal fold vibration, often
  producing a high-pitched rough sound during
 Webs can be present at birth or acquired.
 If present at birth, it is detected at the time of birth,
  and is the result of the glottal membrane failing to
  separate in embryonic development.
 Depending on the size of the web, the baby will
  produce stridor (inhalation noises), shortness of
  breath, and often a different high-pitched cry.
 Approximately three-fourths of all laryngeal webs
  cross the glottis.
 The presence of webbing at birth requires immediate
 Usually, the infant’s larynx will recover over a period of
  four to six weeks.
 Acquired webs result from some kind of bilateral trauma or
    medial edges of the vocal folds.
   Anything that might serve as an irritant to the mucosal surface of
    the folds may be in the initial cause of the webbing.
   Any surface irritation due to prolonged infection or trauma may
    cause the inner margins of the two fold surfaces to grow together.
   To explain further, one principle of plastic surgery is that, when
    approximated together, offended tissue surface will tend to grow
    and fuse together. The same principle explains why webbing
   The offended surface of the two approximated folds tends to
    grow together, in this case forming a thin membrane across the
 Webbing grows across the glottis in an anterior to posterior
   Severe laryngeal infections sometimes cause enough glottal
    irritation to lead to web formation.
   Bilateral surgery of the folds, perhaps for papilloma and
    nodules can also be followed by a web.
   External trauma to the folds, such as a direct hit on the
    thyroid cartilage that causes it to fracture, may damage the
    folds behind it, thus creating enough glottal irritation for a
    web to develop.
   Laryngeal or tracheal surgery is the most frequent event
    producing the postsurgical acquired web.
 Laryngeal web may cause severe dysphonia as well as
    shortness of breath, depending on how extensively the
    webbing crosses the glottis.
   The treatment for the formation of webbing is surgery.
   The webbing is cut, freeing the two folds.
   To prevent the surgically removed web from growing again,
    a vertical keel is placed between the two folds and kept
    their until complete healing has been achieved.
   A keel is about the size of a fingernail and is put between
    the vocal folds, preventing them from approximating.
 The patient is then on vocal rest as long as the keel is in
  place, because it presence inhibits normal fold vibration.
 When the keel is removed, often in six to eight weeks, the
  patient generally requires some voice therapy to restore
  normal phonation.
 If there was extensive damage to the larynx from the
  trauma, it may well be impossible after healing and voice
  therapy to ever develop the same kind of normal voice the
  patient had before the accident.
 The prognosis for voice recovery after webbing and its
  surgical treatment is highly individualized , depending on
  the extent of the trauma and size of the web.
 Leukoplakia are whitish patches that are lesions to the
    surface membrane of mucosal tissue and that often extend
    beneath the surface in subepithelial space.
   The primary etiology of these white patches is continuous
    irritation of membranes. The most common cause is heavy
   Although the lesions are classified as benign tumors, they
    are considered precancerous lesions and must be followed
   Within the vocal tract, common sites of leukoplakia are
    under the tongue and on the vocal folds.
   It is important to note that it is difficult or impossible to
    distinguish between leukoplakia and cancer of the larynx
    by visual inspection along.
 Although leukoplakia on or under the tongue have only
  minimal effects on voice, leukoplakia on the vocal folds
  dramatically alter voice.
 The added lesion mass to the vocal folds lowers voice pitch
  and frequently causes hoarseness and sometimes
 Also, because leukoplakia are random in size and location,
  they often cause the vocal folds to be asymmetrical, which
  may result in diplophonia as each fold vibrates at a different
  frequency because of its different size or mass.
 Leukoplakia that occupies space on the glottal margin may
  prevent optimal approximation of the folds, contributing to
  breathiness, reduced loudness, and overall dysphonia.
 The treatment of leukoplakia is medical-surgical , and
 voice therapy only contributes to developing the best
 voice possible .

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