Lesions of the vocal tract, particularly the vocal folds, occur in the vast majority of people whose work requires the use and emission of the voice. Changes caused by various factors may interfere with the normal functioning of the speech organ, and late intervention and diagnosis may lead to the development of neoplastic lesions. Appropriate differential diagnosis is a very important element, especially taking into account prevention in people in the risk group.
Retention cysts arise from a pathological accumulation of thick mucus, in the mucous membrane gland, resulting in a markedly raised vocal fold. A characteristic feature of cysts is their location, namely they occur in the upper part of the vocal fold, unlike other pathological lesions occurring in this area. Cysts do not tend to appear on the free edges of the vocal folds and, as they do not produce very significant symptoms, their detection is often at a very late stage of their development.
Pathological proliferation of the squamous epithelium, with inflammation and epithelial dysplasia present, is the cause of papillomas on the vocal folds. This is a common problem in compulsive smokers and, like any other problem, should not be underestimated. A papilloma, if it causes a reaction of the lining and has features of dysplasia, should be treated as a pre-cancerous condition, since, according to the observations of specialists, this type of lesion becomes malignant in about 5% of cases.
Another type of disorder associated with abnormalities of the vocal folds is chronic inflammation of the laryngeal mucosa.
Pre-cancerous lesions
Squamous cell carcinomas of the head and neck arise from pre-neoplastic lesions in up to 20% of cases. Hence, prevention and early intervention in the event of abnormalities are of great importance. The risk of their occurrence is compounded by the fact that they can develop over a very long period of time in a completely asymptomatic manner, so that when they are detected, they are already at an advanced stage of development. According to WHO guidelines, a lesion that represents an increased risk in terms of strabismogenesis should be defined as a pre-neoplastic lesion.
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However, correct differential diagnosis poses many problems. This is due to the fact that the surface of the vocal tract, including the vocal folds, is covered by stratified squamous epithelium, which is keratinised.
As a result of exposure to a number of irritants, dysplasia of the epithelial cells within the vocal folds can occur. These factors may include smoke, inhaled chemicals, significant vocal effort, impaired nasal patency, excessive secretions or reflux disease.
Dysplasia, on the other hand, refers to abnormal maturation of the epithelium, which causes a change in the cytoarchitecture of the cells in the mucous membrane, namely, their growth, crowding and, as a result, pathological changes in the thickness of the epithelium. It is possible to speak of several phases of dysplasia, depending on the thickness of the mucosa, ranging from low-grade dysplasia, through high-grade dysplasia, pre-invasive carcinoma, to lesions that are diagnosed as invasive carcinoma. [2]
