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Wang J, Mao W, Fang R, Wei C, He P. Use of 532 nm Potassium Titanyl Phosphate Laser on Vocal Fold Scars Under Topical Anesthesia: A Pilot Study. Ann Otol Rhinol Laryngol 2021; 131:715-723. [PMID: 34423674 DOI: 10.1177/00034894211041819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This pilot study aims to evaluate the efficacy of 532 nm potassium titanyl phosphate (KTP) laser under topical anesthesia in patients with vocal fold scars. METHODS A series of 18 patients with vocal fold scars of varying degrees were treated. The KTP laser was used under local anesthesia in the outpatient clinic. It was set to deliver 6 W of power using a continuous output mode. Close-to-contact mode was used for laser irradiation, and contact mode was used for ablation and excision of the lesions. Some of the patients received laser scar ablation on both vocal folds; the scarred vocal fold on one side and the hypertrophic vocal fold on the other. Parameters include glottic closure, amplitude, and mucosal wave pattern were measured using laryngeal stroboscopic examination. Aerodynamic and voice evaluations were carried out using maximum phonation time (MPT), jitter, shimmer, Voice Handicap Index questionnaire (VHI-30), and GRBAS scale. RESULTS In total, 21 surgeries were performed on 18 patients. Glottic closure, amplitude, and mucosal wave pattern showed improvement 2 months postoperatively (P < .05). There was significant improvement in the postoperative scores for VHI-30, VHI-emotional sub-scale, VHI-physical sub-scale, and GRBAS (P < .05). There was no significant difference in the MPT and VHI-functional sub-scale before and after the operation (P > .05). Re-adhesion of the anterior commissure was observed in 2 patients with Type III scars. CONCLUSION The 532 nm KTP laser is an effective tool for the treatment of vocal fold scars. Further research is required to determine if serial laser applications could improve outcomes for this challenging condition. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jiajia Wang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Wenjing Mao
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Rui Fang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Chunsheng Wei
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Peijie He
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
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Bonilha HS, Desjardins M, Garand KL, Martin-Harris B. Parameters and Scales Used to Assess and Report Findings From Stroboscopy: A Systematic Review. J Voice 2017; 32:734-755. [PMID: 29103609 DOI: 10.1016/j.jvoice.2017.09.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Laryngeal endoscopy with stroboscopy, a critical component of the assessment of voice disorders, is rarely used as a treatment outcome measure in the scientific literature. We hypothesized that this is because of the lack of a widely used standardized, validated, and reliable method to assess and report laryngeal anatomy and physiology, and undertook a systematic literature review to determine the extent of the inconsistencies of the parameters and scales used in voice treatment outcome studies. STUDY DESIGN Systematic literature review. METHODS We searched PubMed, Ovid, and Cochrane for studies where laryngeal endoscopy with stroboscopy was used as a treatment outcome measure with search terms representing "stroboscopy" and "treatment" guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. RESULTS In the 62 included articles, we identified 141 terms representing 49 different parameters, which were further classified into 20 broad categories. The six most common parameters were magnitude of glottal gap, mucosal wave amplitude, location or shape of glottal gap, regularity of vibration, phase symmetry, and presence and size of specific lesions. Parameters were assessed on scales ranging from binary to 100 points. The number of scales used for each parameter varied from 1 to 24, with an average of four different scales per parameter. CONCLUSIONS There is a lack of agreement in the scientific literature regarding which parameters should be assessed to measure voice treatment outcomes and which terms and scales should be used for each parameter. This greatly diminishes comparison and clinical implementation of the results of treatment outcomes research in voice disorders. We highlight a previously published tool and recommend it for future use in research and clinical settings.
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Affiliation(s)
- Heather Shaw Bonilha
- Department of Health Science and Research, Medical University of South Carolina, Charleston, South Carolina; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Maude Desjardins
- Department of Health Science and Research, Medical University of South Carolina, Charleston, South Carolina
| | - Kendrea L Garand
- Department of Health Science and Research, Medical University of South Carolina, Charleston, South Carolina; Department of Speech Pathology and Audiology, University of South Alabama, Mobile, Alabama
| | - Bonnie Martin-Harris
- Department of Health Science and Research, Medical University of South Carolina, Charleston, South Carolina; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina; Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois.
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Su CY, Alswiahb JN, Hwang CF, Hsu CM, Wu PY, Huang HH. Endoscopic Laser Anterior Commissurotomy for Anterior Glottic Web: One-Stage Procedure. Ann Otol Rhinol Laryngol 2017; 119:297-303. [DOI: 10.1177/000348941011900505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives The conventional method for preventing web formation after anterior glottic web surgery is keel insertion. However, this presents risks of airway compromise and granulation tissue formation, which could necessitate tracheotomy in addition to a secondary procedure for keel removal. We introduce a novel, 1-stage endoscopic laser anterior commissurotomy for preventing anterior glottic web re-formation. Methods Twenty patients with glottic webs involving the anterior commissure were studied. The lesions were removed by transoral carbon dioxide laser microsurgery. In all patients, the anterior glottic web was vaporized along with the inner perichondrium of the thyroid cartilage over the anterior commissure area, creating a raw vertical break “alley” between the anterior vocal folds that measured between 0.3 and 0.5 cm in width and between 0.8 and 2 cm in length. The preoperative and postoperative vocal folds and voice quality were evaluated by videostrobolaryngoscopy and voice recordings. Results All 20 patients had anterior glottic webs ranging from 11 % to 64% of the length from the anterior commissure to the vocal process. None of the patients developed restenosis at the anterior commissure of a severity similar to that of the initial lesion during follow-up (mean, 13 months; range, 3 to 44 months). All patients except 1 reported satisfaction with their voice improvement. Outcome analysis revealed that partial re-formation of the web was noted in 4 patients. Conclusions One-stage, endoscopic laser anterior commissurotomy was effective and relatively safe for removing glottic webs, for preventing anterior glottic web re-formation, and for improving vocal fold performance among our patients.
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Affiliation(s)
- Chih-Ying Su
- Memorial Hospital-Kaohsiung Medical Center, Department of Otolaryngology, Chang Gung University College of Medicine (Su), Kaohsiung, and the Dr Su Voice Beauty Clinic (Su), Taipei City, Taiwan
| | - Jamil N. Alswiahb
- Memorial Hospital-Kaohsiung Medical Center, Department of Otolaryngology, Chang Gung University College of Medicine (Su), Kaohsiung, and the Dr Su Voice Beauty Clinic (Su), Taipei City, Taiwan
| | - Chung-Feng Hwang
- Memorial Hospital-Kaohsiung Medical Center, Department of Otolaryngology, Chang Gung University College of Medicine (Su), Kaohsiung, and the Dr Su Voice Beauty Clinic (Su), Taipei City, Taiwan
| | - Cheng-Ming Hsu
- Memorial Hospital-Kaohsiung Medical Center, Department of Otolaryngology, Chang Gung University College of Medicine (Su), Kaohsiung, and the Dr Su Voice Beauty Clinic (Su), Taipei City, Taiwan
| | - Pei-Yin Wu
- Memorial Hospital-Kaohsiung Medical Center, Department of Otolaryngology, Chang Gung University College of Medicine (Su), Kaohsiung, and the Dr Su Voice Beauty Clinic (Su), Taipei City, Taiwan
| | - Hsun-Hsien Huang
- Memorial Hospital-Kaohsiung Medical Center, Department of Otolaryngology, Chang Gung University College of Medicine (Su), Kaohsiung, and the Dr Su Voice Beauty Clinic (Su), Taipei City, Taiwan
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Gillespie MB, Dozier TS, Day TA, Martin-Harris B, Nguyen SA. Effectiveness of Calcium Hydroxylapatite Paste in Vocal Rehabilitation. Ann Otol Rhinol Laryngol 2017; 118:546-51. [DOI: 10.1177/000348940911800802] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives We determined the effectiveness of calcium hydroxylapatite (CaHA) paste in vocal rehabilitation. Methods We examined a retrospective case series of 39 adult patients who underwent CaHA paste injection for vocal fold rehabilitation over a 5-year period. The outcomes included the change in the Voice Handicap Index (VHI) score; procedure-related complications; and the need for follow-up voice procedures. Results The VHI scores demonstrated overall improvement, with a decrease from the preoperative mean of 61.2 ± 24.0 to a postoperative mean of 35.9 ± 26.3 (p = 0.0001) after a mean follow-up time of 17.8 ± 13.6 months. The procedure was more likely to succeed in patients with paralysis and/or paresis than in patients with glottic soft tissue defects. After injection, the VHI scores worsened in 3 of 7 patients (43%) in the soft tissue defect group, compared to only 2 of 28 (7%) in the paralysis and/or paresis group (p = 0.04). Four of 7 patients with soft tissue defects (57%) required secondary vocal procedures to improve the voice, compared to only 2 of 32 (6%) in the paralysis and/or paresis group (p = 0.006). Conclusions Injection of CaHA paste results in significantly improved vocal scores in the majority of patients. Use of the paste was less satisfactory in patients with soft tissue defects because of poor retention of the paste in the scarred vocal fold remnant.
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Affiliation(s)
- M. Boyd Gillespie
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Thomas S. Dozier
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Terry A. Day
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Bonnie Martin-Harris
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Shaun A. Nguyen
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Chung D, Tsuji DH, Sennes LU, Imamura R. Upper Displacement of the Anterior Commissure: Experimental Study of a New Phonosurgical Approach to Raising Vocal Pitch. Ann Otol Rhinol Laryngol 2016; 116:462-70. [PMID: 17672250 DOI: 10.1177/000348940711600612] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The present study assessed the effects of a unique pitch-raising surgical technique designated upper displacement of the anterior commissure (UDAC), comparing the results with those obtained through cricothyroid approximation (CTA). Methods: Vocal fold vibration was artificially evoked in 20 excised human larynges through tracheal injection of compressed air. Vocal fold length, fundamental frequency, and videokymography parameters were determined preoperatively, post-CTA, and post-UDAC. In UDAC, a bilateral incision was made between the middle and anterior thirds of the thyroid cartilage. The inferiormost portion of the anterior thyroid cartilage (anterior to the cartilaginous incision) was sutured to the superiormost portion of the posterior thyroid cartilage (posterior to the cartilaginous incision). The anterior commissure was thus moved upward and forward, ensuring increased vocal fold tension. Results: The mean vocal fold length was 16.88 mm preoperatively, 20.02 mm post-CTA, and 18.67 mm post-UDAC (p < .05). The mean fundamental frequency was 151.60 Hz preoperatively, 271.10 Hz post-CTA, and 239.30 Hz post-UDAC (p < .05). The post-CTA and post-UDAC vibration amplitudes were significantly lower than the preoperative values (p < .05). Conclusions: Vocal fold length and fundamental frequency increased significantly after UDAC (p < .05), although to a lesser degree than after CTA.
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Affiliation(s)
- Daniel Chung
- Department of Clinical Otorhinolaryngology, University of Sao Paulo School of Medicine, Hospital das Clinicas, Sao Paulo, Brazil
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Prasad VM, Remacle M. Voice Rehabilitation After Transoral Laser Microsurgery of the Larynx. Otolaryngol Clin North Am 2015; 48:639-53. [DOI: 10.1016/j.otc.2015.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Goessler UR. Traditional transcutaneous approaches in head and neck surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 11:Doc06. [PMID: 23320058 PMCID: PMC3544212 DOI: 10.3205/cto000088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The treatment of laryngeal and hypopharyngeal malignancies remains a challenging task for the head and neck surgeon as the chosen treatment modality often has to bridge the gap between oncologically sound radicality and preservation of function. Due to the increase in transoral laser surgery in early tumor stages and chemoradiation in advanced stages, the usage of traditional transcutaneous approaches has decreased over the recent past. In addition, the need for a function-sparing surgical approach as well as highest possible quality of life has become evident. In view of these facts, rationale and importance of traditional transcutaneous approaches to the treatment of laryngeal and hypopharyngeal malignancies are discussed in a contemporary background. The transcutaneous open partial laryngectomies remain a valuable tool in the surgeon's armamentarium for the treatment of early and advanced laryngeal carcinomas, especially in cases of impossible laryngeal overview using the rigid laryngoscope. Open partial laryngetomies offer superior overview and oncologic safety at the anterior commissure, especially in recurrencies. In select advanced cases and salvage settings, the supracricoid laryngectomy offers a valuable tool for function-preserving but oncologically safe surgical therapy at the cost of high postoperative morbidity and a very demanding rehabilitation of swallowing.In hypopharyngeal malignancies, the increasing use of transoral laser surgery has led to a decline in transcutaneous resections via partial pharyngectomy with partial laryngectomy in early tumor stages. In advanced stages of tumors of the piriform sinus and the postcricoid area with involvement of the larynx, total laryngectomy with partial pharyngectomy is an oncologically safe approach. The radical surgical approach using circumferent laryngopharyngectomy with/without esophagectomy is indicated in salvage cases with advanced recurrences or as a primary surgical approach in patients where chemoradiation does not offer sufficient oncologic control or preservation of function. In cases with impending reconstruction, fasciocutaneous free flaps (anterolateral thigh flap, radial forearm flap) seem to offer superior results to enteric flaps in cases where the cervical esophagus is not involved leading to better voice rehabilitation with fewer complications and postoperative morbidity. In salvage situations, the Gastroomental Free Flap has proven to be a valuable tool.In conclusion, the choice of a surgical treatment modality is influenced by the patient's anatomy, tumor size and location as well as the surgeon's personal expertise.
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Chu PY, Hsu YB, Lee TL, Fu S, Wang LM, Kao YC. Longitudinal analysis of voice quality in patients with early glottic cancer after transoral laser microsurgery. Head Neck 2011; 34:1294-8. [PMID: 22084017 DOI: 10.1002/hed.21914] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2011] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND We conducted longitudinal voice evaluations in patients with early glottic cancer who underwent transoral laser microsurgery (TLM) to determine the time to stability. METHODS Twenty-five patients underwent TLM, including 13 limited cordectomies (type I and type II) and 12 extended cordectomies (type III to type IV). Multidimensional voice evaluations were performed before treatment and at 1, 3, 6, and 12 months after treatment. RESULTS Voice parameters of asthenicity, strain, mean airflow rate (MFR), voice handicap index (VHI)-functional, VHI-physical, and VHI-total scores improved in all patients. Most patients had improved 6 months after TLM. Patients with extended cordectomy showed higher breathiness, MFR, VHI-functional, and VHI-total scores. Healing was complete in all cases by 6 months and in a majority of cases (76%) by 3 months. CONCLUSIONS Voice quality achieved stability 6 months after TLM. Comparing treatment outcomes and surgical intervention are not recommended within 6 months of surgery.
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Affiliation(s)
- Pen-Yuan Chu
- Department of Otolaryngology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan.
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Cavanagh JP, Hart RD, Brown T, Trites JRB, Brake M, Taylor SM. Laryngeal reconstruction following CO2laser surgery for glottic cancer. Head Neck 2009; 31:1369-76. [PMID: 19455696 DOI: 10.1002/hed.21154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Marsupialisation and strap muscle transposition laryngoplasty for vocal cysts with vocal fold atrophy. The Journal of Laryngology & Otology 2009; 123:1131-6. [DOI: 10.1017/s0022215109990673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectives:Vocal cysts with fold atrophy often result in more severe glottal incompetence than vocal cysts along during phonation. Although total excision or marsupialisation are reliable treatments for vocal fold cysts, any post-operative vocal deficit with significant glottal gap will need further treatment. This study aimed to evaluate the efficacy of combined treatment consisting of marsupialisation of the cyst immediately followed by strap muscle transposition laryngoplasty.Method:Under direct laryngomicroscopy, microscissors were used to make a disc-shaped incision encircling the equator of the cyst. After marsupialisation of the cyst, a simultaneous medialisation laryngoplasty with strap muscle transposition was performed.Results:Seven patients with vocal cysts and marked vocal fold atrophy were included in the study. After surgery, subjective improvement in voice quality was reported by all patients. Patients' glottal incompetence and vocal performance were markedly improved.Conclusion:Marsupialisation is a simple and effective surgical technique for vocal fold cysts. For cases of vocal cysts with marked vocal fold atrophy, marsupialisation followed by medialisation laryngoplasty with strap muscle transposition may be considered.
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Hsu CM, Armas GL, Su CY. Marsupialization of Vocal Fold Retention Cysts: Voice Assessment and Surgical Outcomes. Ann Otol Rhinol Laryngol 2009; 118:270-5. [DOI: 10.1177/000348940911800406] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Although total excision remains the standard treatment for vocal fold retention cysts, postoperative deficits and damage to the vocal folds still occur. Marsupialization is a more conservative technique and can prevent these complications. Methods: In this prospective clinical series, 25 patients underwent the marsupialization procedure. Under a direct laryngomicroscope, the cystic wall margin was retracted medially with microforceps. An incision was made with microscissors encircling the equator of the cyst. The cyst contents drained from the cystic cavity when the capsule was sectioned. For 7 patients with concomitant marked vocal fold atrophy, strap muscle transposition laryngoplasty was simultaneously performed. Results: All patients had complete preoperative and postoperative voice parameter analyses. A subjective improvement in voice quality was reported by 23 of the 25 patients (92%). A small recurrent vocal fold cyst was detected in 1 patient. Small vocal fold deficits and sulcus vocalis were detected in 2 and 4 patients, respectively. Only 1 patient described a worse voice after operation. No other complications were noted. Conclusions: Marsupialization of vocal fold retention cysts is a simple, relatively safe, and effective surgical treatment. Voice improvement, a low incidence of recurrence, and minimal vocal fold deficits demonstrate the validity of this technique. Marked preoperative vocal fold atrophy or postoperative glottal gap can be managed with medialization laryngoplasty.
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Roh JL, Kim DH, Kim SY, Park CI. Quality of life and voice in patients after laser cordectomy for TIS and T1 glottic carcinomas. Head Neck 2007; 29:1010-6. [PMID: 17510971 DOI: 10.1002/hed.20625] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Laser cordectomy is gaining popularity for treatment of early glottic carcinoma, but little is known about vocal and quality of life (QOL) outcomes as a function of extent of resection. We prospectively examined QOL and vocal function of patients with carcinoma in situ (Tis) or T1 glottic carcinomas after laser cordectomy. METHODS Patients (n = 75) were grouped into those who underwent unilateral subepithelial or subligamental resection (group A, n = 45); those who underwent unilateral transmuscular or total cordectomy (group B, n = 17); and those who underwent extended or bilateral cordectomy including the anterior commissure (group C, n = 19). The European Organization for Research and Treatment of Cancer head and neck cancer specific module (QLQ-H&N35), voice handicap index (VHI), and objective vocal function were examined before and 1 year after cordectomy and compared among the groups. RESULTS No major complications were encountered, but local recurrence occurred in 10 patients, with group C showing the highest rate (6/19, 31.6%). Patient-reported speech and social contact scores of QOL questionnaire and VHI scores after surgery were higher in groups B and C than in group A (p < .05). The scores and perceptual and acoustic data were generally improved in all groups after surgery, but were statistically significant only in group A (p < .03). CONCLUSION Our data suggest that early glottic cancers with a limited extent and infiltration depth have improved outcomes, both oncologically and functionally, compared to those lesions requiring extensive laser resection.
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Affiliation(s)
- Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Remacle M, Van Haverbeke C, Eckel H, Bradley P, Chevalier D, Djukic V, de Vicentiis M, Friedrich G, Olofsson J, Peretti G, Quer M, Werner J. Proposal for revision of the European Laryngological Society classification of endoscopic cordectomies. Eur Arch Otorhinolaryngol 2007; 264:499-504. [PMID: 17377801 DOI: 10.1007/s00405-007-0279-z] [Citation(s) in RCA: 216] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Accepted: 12/11/2006] [Indexed: 11/29/2022]
Abstract
A classification of laryngeal endoscopic cordectomies, which included eight different types, was first proposed by the European Laryngological Society in 2000. The purpose of this proposal of classification was an attempt to reach better consensus amongst clinicians and agree on uniformity in reporting the extent and depth of resection of cordectomy procedures, to allow relevant comparisons within the literature when presenting/publishing the results of surgery, and to recommend the use of guidelines to allow for reproducibility amongst practicing laryngologists. A total of 24 article citations of this classification have been found through the science citation index, as well as 3 book chapters on larynx cancer surgery, confirming its acceptance. However, on reflection, and with the passage of time, lesions originating at the anterior commissure have not been clearly described and, for that reason, a new endoscopic cordectomy (type VI) for cancers of the anterior commissure, which have extended or not to one or both of the vocal folds, without infiltration of the thyroid cartilage is now being proposed by the European Laryngological Society Committee on Nomenclature to revise and complete the initially reported classification.
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Affiliation(s)
- Marc Remacle
- Department of Oto-rhino-laryngology, University Hospital of Louvain at Mont-Godinne, Yvoir, Belgium.
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Remacle M, Lawson G, Morsomme D, Jamart J. Reconstruction of glottic defects after endoscopic cordectomy: voice outcome. Otolaryngol Clin North Am 2006; 39:191-204. [PMID: 16469663 DOI: 10.1016/j.otc.2005.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Marc Remacle
- University Hospital of Louvain at Mont-Godinne, Therasse Avenue 1, 5530 Yvoir, Belgium.
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Su CY, Tsai SS, Chuang HC, Chiu JF. Functional Significance of Arytenoid Adduction with the Suture Attaching to Cricoid Cartilage versus to Thyroid Cartilage for Unilateral Paralytic Dysphonia. Laryngoscope 2005; 115:1752-9. [PMID: 16222189 DOI: 10.1097/01.mlg.0000172203.28583.63] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In the treatment of unilateral paralytic dysphonia, traditional arytenoid adduction is designed to place suture through the muscular process of the arytenoid attaching anteriorly to the thyroid ala. In contrast with the suture direction of this technique, a new paramedian approach to arytenoid adduction anchors anteroinferiorly to the cricoid cartilage, mimicking the force action of the lateral cricoarytenoid muscle (the major adductor of the larynx). This study investigated the influence of these changes in suture direction on the vocal fold level as well as the vocal outcomes in these two techniques of arytenoid adduction. STUDY DESIGN A prospective clinical series. METHODS Thirty patients with unilateral paralytic dysphonia underwent medialization laryngoplasty with arytenoid adduction and strap muscle transposition. Under local anesthesia, the thyroid lamina on the involved side was paramedially separated. The inner perichondrium was carefully elevated away from the overlying thyroid cartilage, carrying the dissection posteriorly to the level of the superior and inferior cornua. The lamina was retracted laterally, the inner perichondrium was opened near the midpoint, and the lateral cricoarytenoid muscle identified. Tracing the muscle fibers posterosuperiorly, the muscular process of the arytenoid was identified. A 2-0 Prolene suture was placed through the muscular process and temporarily tied to the anterolateral aspect of the thyroid ala (AA-thyroid suture). Intraoperative acoustic and perceptual assessments were performed. After releasing the tie, the suture was anchored to the cricoid cartilage at the origin of the lateral cricoarytenoid muscle (AA-cricoid suture). Voice assessments were repeated, and the outcomes of the two tests were compared. The choice of the type of arytenoid adduction suture was made intraoperatively according to which condition provided better vocal performance. After securing the suture, a bipedicled strap muscle flap was transposed into the space between the lamina and inner perichondrium and the thyroid cartilages sutured back into place. RESULTS The intraoperative acoustic and perceptual assessments revealed the vocal performance was significantly better with AA-cricoid suture than the AA-thyroid suture in this series. No major complications occurred in the study. CONCLUSION This study suggests that arytenoid adduction with suture attachment along the longitudinal axis of the lateral cricoarytenoid muscle to the cricoid cartilage is more physiologic and effective than that attaching the suture to the thyroid ala. A paramedian approach to arytenoid adduction with or without strap muscle transposition is a safe and effective method for treatment of unilateral paralytic dysphonia.
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Affiliation(s)
- Chih-Ying Su
- Department of Otolaryngology and voice center, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan.
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