Clinical and Voice Outcome Differences in Vocal Cord Cysts with and Without Sulcus Vocalis: Insights From a Tertiary Center in Saudi Arabia

Background: Vocal cord cysts are common benign lesions causing dysphonia, while sulcus vocalis, a groove on the vocal fold, can coexist with cysts and complicate treatment. This study compares clinical characteristics and voice outcomes in patients with vocal cord cysts, with and without sulcus vocalis. Methods: This retrospective study was conducted at King Abdulaziz University Hospital, Riyadh, Saudi Arabia, from 2012 to 2023. Patients with vocal cord cysts who underwent microlaryngeal surgery were included. Sulcus vocalis was suspected preoperatively using videostroboscopic examination and confirmed intraoperatively during microlaryngoscopy with visual inspection and palpation. They were divided into 2 groups: with and without coexisting sulcus vocalis. Voice outcomes were assessed using pre- and postoperative Voice Handicap Index-10 (VHI-10) scores. Results: A total of 54 patients with vocal cord cysts were included, with 31 (57.4%) having coexisting sulcus vocalis and 23 (42.6%) without. Patients with sulcus vocalis were significantly older (median age 30 vs 22 years, P = .008) and had lower smoking rates (6.45% vs 52.17%, P < .001). They also exhibited worse voice outcomes, with higher preoperative (30 vs 22, P = .002) and postoperative VHI-10 scores (20 vs 10, P < .001) and smaller median VHI-10 improvements (8 vs 12 points, P = .047). Mucosal bridges were more common in the sulcus group (19.35% vs 0%, P = .032), but no significant differences in cyst type (epidermoid or mucus retention), recurrence rates, or follow-up duration were observed between the 2 groups. Conclusion: Sulcus vocalis worsens voice outcomes in patients with vocal cord cysts, highlighting the need for comprehensive preoperative evaluation. Future research should explore combined surgical treatments for both conditions.