Vocal cord trauma may disrupt the vocal cords where they attach at the front of the larynx. If the vocal cords heal slightly apart anteriorly, 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.
Arrows point to an anterior opening, secondary to scarring after a surgery on the larynx that injured the attachment of the vocal cords to the thyroid cartilage.