Vocal cord trauma may disrupt the vocal cords where they attach at the front of the larynx. If the vocal cords heal slightly apart at the anterior commissure, air escapes through the front of the vocal cords. It really becomes impossible for a person to close this gap without the help of surgery.
Arrow points to an anterior opening created after removing a squamous cell carcinoma from the left anterior vocal cord. The vocal processes meet. The right membranous vocal cord reaches the midline, but air leaks out anteriorly.