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Introduction: Mucosal Bridges (MBs) are defined as benign connective tissue abnormalities of unclear etiology that extend over the free surface of the vocal fold, are attached to the front and back of the vocal fold but are not attached to its free surface, and are histologically covered by stratified squamous epithelium. In order to overcome these drawbacks, we aimed to retrospectively evaluate and present the preoperative and postoperative results of patients with MB, who were applied the method we call "Mucosal Bridge Reconstruction" (MBR), which we apply as suturing rather than resection of the MB. Methods: Between January 2016 and February 2020, 5 patients who applied to the voice clinic due to dysphonia and were diagnosed with MB via laryngostroboscopic examination and direct laryngoscopy under general anesthesia were included in the study. Dr Speech software was used for acoustic analysis; mean fundamental frequency (fo), jitter %, shimmer %, and noise to harmonic ratio (NHR) were objectively measured and recorded. Voice Handicap Index-10 (VHI-10) was used for positive self-reporting of the severity of vocal symptoms. GRBAS scale (G: Grade, R: Roughness, B: Breathiness, A: Asthenia, and S: Strain) was also used (by the same clinician) for clinic subjective evaluation. Results: Patient age ranged from 33 to 55 years and mean patient age was 42 years. Mean duration of symptoms was 22 months (range 16-30). Mean postoperative follow-up time was 14 months (range 6-24). Unilateral MB was observed in all patients (2 left, 3 right). There was a significant improvement in objective and subjective assessment methods in all our patients after surgery. Conclusions: According to the results of our few patients, MBR offers a physiological and anatomical approach to the treatment of patients with MB. The outcomes of delicate microlaryngeal surgery are promising. [ABSTRACT FROM AUTHOR]

Esophageal mucosal bridge is an elastic stretchable structure, connecting across the lumen, extending either obliquely or horizontally, more commonly seen in the mid or lower esophagus. It can be either congenital or secondary (acquired). Acquired ones are secondary to reflux esophagitis, corrosive esophageal injury, drug-induced esophagitis, radiation esophagitis, Crohn’s disease, Mallory-Weiss syndrome, malignant tumors, and infections like candidiasis, HSV, CMV, or tuberculosis. We present a case of an elderly female, who presented with progressive dysphagia for 3 months, more commonly to solids without any history of anorexia or weight loss. No history of corrosive ingestion, radiation exposure, or prior history of any surgical or endoscopic intervention was present. Upper gastrointestinal endoscopy revealed esophageal mucosal bridge at 20 and 25 cm from incisors and mucosal tag. Endoscopic resection was carried out successfully with hot biopsy forceps and needle knife after prophylactic application of hemoclips at two ends of each bridge, without any adverse event. Esophageal mucosal bridge, though rarely reported, should be kept in the differential diagnosis of patients presenting with dysphagia. Endoscopic resection with hot biopsy forceps or needle knife seems to be effective.

Background: Mucosal bridges (MBs) are rare laryngeal lesions that may cause dysphonia of varying degrees. We propose the existence of a third variant of MB besides thin and thick MBs, and have termed this as an incomplete mucosal bridge (IMB). The concept of an IMB has not been previously discussed in literature. Thin and thick MBs are attached anteriorly and posteriorly on the membranous vocal fold and may cause dysphonia because of their separate vibratory characteristics from the main vocal fold. We propose the presence of an entity named as IMB, which is typically identified by palpation of a slit on the superior surface of the membranous vocal fold.Aim: To propose and describe the existence of IMBs. Furthermore, to study the percentage of various types of MBs found while performing microlaryngeal surgeries (MLS) for benign glottic lesions, over a 9-year period at our Voice Clinic.Method: An IMB may be described as a MB that does not open at its medial edge. Thus it appears as an epithelial slit on the surface of the vocal fold. On palpating this slit with a microflap elevator, a flat pocket lying just below and parallel to the vocal fold epithelium is identified. These pockets are always directed medially (never laterally) and just stop short of opening up at the medial edge. These IMBs differ from sulci and focal pit as sulci and focal pits are not covered with a hood of epithelium. Our operative records of all MLS performed for benign glottic lesions were audited from 2009 to 2017 for cases of MBs.Results: A total of 1728 MLS for benign glottic lesions were performed from 2009 to 2017 and 27 MBs were identified in 23 patients, 16 being male. A total of 11 IMBs were identified in 10 patients, with 1 case revealing a bilateral IMB. Other associated lesions were cysts, sulci, and polyps. A total of 14 thin MBs were identified in 11 patients with 3 cases revealing these bilaterally. Two thick MBs were identified in two separate cases, with one case having a bilobed hemorrhagic polyp attached to the thick MB.Conclusion: Our study found MBs in 1.33% of patients being operated for benign glottic lesions. The incidence of MBs in this group was 1.56% with IMBs accounting for 0.63%, thin MBs accounting for 0.81% and thick MBs in 0.11%. We recommend all patients undergoing MLS be actively palpated for the presence of mucosal bridges including IMBs especially if a small slit is found on the surface of the vocal fold. This is vital for accurate identification and documentation of all the lesions responsible for the patients voice quality. Ours is an ongoing study and we propose to analyze the vocal outcomes associated with surgical management of these IMBs. [ABSTRACT FROM AUTHOR]

Summary: Mucosal bridges are rare laryngeal lesions probably of genetic origin. They may cause dysphonia of varying degrees, especially when associated with other laryngeal lesions such as vocal sulci and cysts. Reports on mucosal bridges are rare, and the better treatment is inconclusive. Aim: To report the authors’ experience in 14 cases of mucosal bridge showing details on endoscopic examinations and treatment. Study Design: Retrospective study. Methods: We reviewed the medical records of 14 patients with a diagnosis of mucosal bridge confirmed by videolaryngostroboscopy and direct laryngoscopy who attended the Outpatient Clinic of Voice Disorders of the Discipline of Otorhinolaryngology, Botucatu Medical School, São Paulo State University, São Paulo. Data collected included information on gender, age, symptoms, time of onset, history of intubation, smoking status, alcohol intake, associated laryngeal lesions, treatment, and GRBAS (grade of hoarseness, roughness, breathiness, asthenia, and stress) scale ratings. Results: Of 14 patients, 10 were females and four were males. There was a prevalence of adults (n=12), with only two of the patients being younger than 13 years (10 and 13 years). Mucosal bridges showed no correlations with smoking, alcohol intake, or gastroesophageal and sinonasal symptoms. Voice abuse was reported in 50% of the cases that consisted of patients who had high-voice demand occupations. In seven cases, mucosal bridges were associated with other laryngeal lesions, particularly vocal cysts and sulci. All patients who underwent surgery and phonotherapy showed improved vocal quality. Conclusions: We documented 14 patients with dysphonia caused by mucosal bridge. Promising results were obtained with surgery. [Copyright &y& Elsevier]

Summary: The objective of this study was to review four vocal pathologies difficult to diagnose (vocal sulci, submucosal cysts, pseudocysts, and mucosal bridges) seen in the Principe de Asturias University Hospital Voice Unit (Alcalá de Henares, Madrid, Spain) over a 9-year period. This study was to show the prevalence of these pathologies out of the total number of benign vocal pathologies, basing our findings on clinical and stroboscopic criteria; and to analyze the stroboscopic-surgical correlation of the series over the last 3½ years. This study was a retrospective review of the stroboscopies carried out between 1993 and 2002, of the suspected diagnoses offered by three ENT specialists. The data were based on the video archives of the unit and surgical notes. We reviewed 4206 stroboscopies, 189 (4.5%) corresponded to new cases. Within this group, we found the following distribution: 48% of vocal sulci, 42% of submucosal cysts, 10% of pseudocysts, and 0% of mucosal bridges. Seventy-nine percent showed unilateral pathology. The sulci showed the highest percentage of bilaterality (33%). The stroboscopic-surgical correlation (1999–2002) was positive in 69% of the sulci, 78% of the cysts, and 100% of the pseudocysts. In our series, 4.5% of the stroboscopies were performed on these groups of difficult diagnosis. For these pathologies, the stroboscopy is the exploratory method that offers more information and that allows us to obtain an optimal correlation between diagnostic suspicion and surgical evidence. [Copyright &y& Elsevier]

Summary: Introduction: We present a patient with a novel finding of bilateral mucosal bridges, bilateral type III trans-vocal fold sulci vocales, and a vocal fold polyp. Although sulci and mucosal bridges occur in the vocal folds, it is rare to find multiples of these lesions in a single patient, and it is even more uncommon when they occur in conjunction with a vocal fold polyp. To our knowledge, this is the first description of a vocal fold polyp in combination with multiple vocal fold bridges and multiple type III sulci vocales in a single patient. Objective: To describe and visually present the diagnosis and treatment of a patient with an intracordal polyp, bilateral mucosal bridges, as well as bilateral type III trans-vocal fold sulci vocales. Methods: Presentation of a set of high definition intraoperative photos displaying the extent of the vocal fold lesions and the resection of the intracordal polyp. Results: This patient presented with only 6 months of significant dysphonia. It was felt that the recent change in voice was because of the polyp and not the bridges or sulci vocales. Considering the patient''s presentation and the possible morbidity of resection of mucosal bridges and sulci, only the polyp was excised. Postoperatively, the patient''s voice returned to his acceptable mild baseline dysphonia, and the benefit has persisted 6 months postoperatively. Conclusion: The combination of bilateral mucosal bridges, bilateral type III sulcus vocalis, and an intracordal polyp in one patient is rare if not novel. Treatment of the polyp alone returned the patient''s voice to his lifelong baseline of mild dysphonia. [Copyright &y& Elsevier]

An esophageal mucosal bridge is a rare finding that is seldom encountered on upper endoscopy. They most commonly present secondary to an underlying inflammatory disorder and cause chest pain and dysphagia, among other symptoms. More rarely, they present asymptomatically with no identifiable inflammatory conditions. Our case consists of a 31-year-old woman who presented with an asymptomatic, noninflammatory mucosal bridge of the esophagus. To our knowledge, this makes the third such case. The rarity of this condition coupled with the lack of epidemiologic data available make this case worthy for literature review., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Summary: A mucosal bridge of the true vocal fold is a rare, benign anatomical finding that can cause dysphonia. It has been described by some in the literature as “occult” as it is often not visibly evident on flexible nasopharyngolaryngoscopy or strobovideolaryngoscopy, but mistakenly diagnosed as a sulcus vocalis (Sataloff RT, Rosen C, Hawkshaw M. Occult mucosal bridge of the vocal fold. Ear Nose Throat J. 1997; 76(12):850). Final diagnosis is usually not made until microscopic direct laryngoscopy is performed and palpation of the true vocal fold reveals the mucosal bridge (Tanaka S, Hirano M, Umeno H, Tanaka Y. Mucosal bridge of the vocal fold [Japanese].Nippon Jibiinkoka Gakkai Kaiho. 1991; 94(12):1853–1856). We describe a case of a 15-year-old boy complaining of long-standing hoarseness and found to have bilateral mucosal bridges of the true vocal folds. Previous reports cite cases of a unilateral mucosal bridge. We believe this is the first reported case of bilateral mucosal bridges. [Copyright &y& Elsevier]

Endoscopic images of the mucosal bridge with gastric ulcer are unusual. The mucosal bridge is presumed to have changed to a special form based on repeated development of gastric ulcer. The clinical course of mucosal bridge is unclear., Competing Interests: Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.