This is a severe form of true vocal fold scarring in which there is loss of lamina propria with the epithelium directly adhered to the vocal ligaments. There is loss of mucosal waves and the affected side appeared stiff with resultant phonatory gap. The patient's voice is voice harsh and breathy. Examination under anaesthesia is required to confirm the diagnosis and ascertain the degree of scarring. In this endoscopi image, the epithelium is seen stuck directly to the vocal ligament of the vocal cord (arrows) and was confirmed by probing and diagnostic saline infiltration.
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