Objective: The purpose of this literature review is to explore whether the lack of lymphatic drainage of the vocal cords is a potentially beneficial adaptation, as in cases such as malignancy of the larynx, or if it is a burden like in the setting of Reinke’s edema and to decipher possible parallels between lymphatic patterns within other regions of the body.
Background: Previous research has demonstrated a concentration of lymphatics at the vocal process which declines precipitously towards the anterior membranous vocal fold. We chose to explore relevance and consequences of these findings in the clinical arena.
Methods: A literature review was performed to address 1) the significance of this finding based on the role of lymphatics in other regions of the body, 2) relevance to its role with generation or resolution of edema, 3) overall lymphatics of the larynx, 4) pathogenesis of common vocal fold diseases, and 5) clinical examples of consequences with this vocal fold anatomy.
Results: Our review found that Reinke’s edema is one scenario where traumatic exposure or excess voice use leads to perhaps stagnant edema that thus permits time for development of the crosslinked matrix. On the other hand, isolated early squamous cell carcinoma tends to be locally advanced with low likelihood of lymph node spread; once it extends through the vocal ligament to gain access to lymphatics in the thyroarytenoid muscle, there is a much higher likelihood of regional metastasis. Other clinical scenarios and relevance to disease management are discussed.
Conclusion: Although there is a paucity of translational research relative to vocal fold lymphatics, we believe that there is sufficient evidence to support that there is a trade-off with benefit in some circumstances, compromised with a burden on others.