Perioperative Voice Recovery: A Wound-Healing Perspective

Abstract

To describe the wound healing process through an oversimplified graphic, a classic cartoon in a Dermatology Clinics textbook shows a Volkswagen Beetle, with the license plate TRAUMA that has driven through a wooden fence, leaving both a substantive hole in the fence and piles of broken wooden planks. The obvious priority would be to rebuild the fence so that it is identical to its pretrauma state. This analogy and accompanying graphic provide a framework for a unique perspective on wound healing. For the sake of simplicity, let us assume that the vocal fold is a fence, and instead of a Volkswagen Beetle, the trauma is surgical excision of a vocal fold lesion. Immediately following surgery, the human body initiates the process of rebuilding vocal fold tissue. From a physiological perspective, it would be ideal to regain the original architecture of the vocal fold to ensure minimal alteration to phonatory physiology. Unfortunately, beyond the 2nd trimester of gestation, wounds heal with subsequent scarring. In the vocal folds, this scarring can have significant deleterious effects on vocal fold pliability and lead to dysphonia. However, investigators have shown that wounds heal regeneratively (i.e., no scarring) in the fetal environment. This observation provides potential targets for therapies to direct wound healing toward a more favorable outcome. In this article, I provide a brief overview of the biochemical processes associated with wound healing. Subsequently, I outline the underlying rationale for tissue mobilization in the context of acute vocal fold injury.