The vocal ligament is the free upper border of the conus elasticus, forming the structural core of the true vocal fold. It runs from the vocal process of the arytenoid cartilage posteriorly to the inner surface of the thyroid cartilage at the anterior commissure anteriorly. The vocal ligament lies immediately deep to the stratified squamous epithelium and the superficial lamina propria (Reinke space), and directly covers the vocalis muscle beneath.
Provides the structural framework of the vocal fold, determines its tension and stiffness which governs fundamental frequency of the voice, and transmits the force of the cricothyroid and vocalis muscles to produce precise vocal fold vibratory characteristics.
The vocal ligament integrity is disrupted in sulcus vocalis (scarring between the mucosa and the ligament from surgery or trauma), producing a stiff, poorly vibrating vocal fold with a breathy and weak voice that is very difficult to rehabilitate. In phonosurgery, procedures on the vocal fold aim to preserve the vocal ligament and the superficial lamina propria above it. In laryngeal framework surgery (thyroplasty), a silicone implant medialises the arytenoid and displaces the vocal ligament medially to improve vocal fold approximation in paralysis.
Overly aggressive removal of vocal fold mucosa or polyps breaches the vocal ligament, causing permanent scarring that replaces the pliable superficial lamina propria with a rigid scar layer, fundamentally altering vocal fold vibration and producing a sulcus vocalis with persistent dysphonia.
