Sulcus Vocalis (SV) is a benign vocal cord lesion, characterized by parallel invagination of the epithelium, extending variably towards the deeper layers of the lamina propria (LP) and adhering to the vocal ligament [1]. As a result, the ductility of the mucosa is altered, leading to an impaired mucosal wave, glottic incompetence with low intensity, and limited vocal range [2,3].

Though various surgical treatments have been suggested in literature, there is a significant clinical variability in reported outcomes, and no gold standard has been established to date [[4], [5], [6], [7]]. In essence, surgical treatments aim to restore the normal mucosal wave and enhance phonation by reducing the glottic gap [4,[8], [9], [10]].

Several surgical techniques have been proposed to achieve this, ranging from the placement of grafts (temporal fascia or tragal perichondrium) at the lamina propria level, to injection laryngoplasty with autologous fat, to thyroplasty type I, or the usage of photoangiolytic lasers [[2], [3], [4],7].

Graft implantation of temporal fascia or tragal perichondrium tends to provide better voice quality and Voice Handicap Index (VHI) reduction results compared to vocal fold augmentation or thyroplasty type I techniques. However, these techniques are technically intricate, even when performed by an experienced surgeon [11].

Some researchers propose a combination of two techniques: the dissection of the SV, along with the implantation of temporal fascia and fat injection. This approach replaces the stiffened scar tissue as well as the Speech Language Pathology (SLP), and medializes the atrophied vocal fold [6,12].

The diversity of surgical techniques described in literature is due to the fact that none consistently lead to predictable and reproducible results.

To our knowledge, there are no critical analyses evaluating the qualitative and quantitative outcomes of different surgical approaches. Thus, we conducted a systematic review and meta-analysis to assess the role of surgical techniques in improving perceptual, aerodynamic, and acoustic outcomes in patients with SV.