A Comparative Study of the Vocal Outcomes Following Type 1 Versus Type 2 Transoral Laser Micro Laryngeal Cordectomy
摘要
To evaluate vocal fold pliability, phonatory gap and voice outcomes in patients who have undergone Type 1 (subepithelial) cordectomy versus Type 2 (subligamentous) cordectomy for early glottic precancerous and cancerous lesions.
Materials and MethodsWe retrospectively reviewed the records of patients diagnosed as unilateral glottic precancerous lesions as well as Early Glottic Cancer (EGC) who underwent Type 1 or Type 2 cordectomy at our center from June 2023 to January 2024. Our patients were divided into 2 groups; Group A who underwent Type 1 cordectomy and Group B who underwent Type 2 cordectomy. From the voice clinic records, the data of age, gender, histopathology, 6 months post-operative Maximum Phonation Time (MPT), glottic closure, mucosal wave amplitude, supra glottic squeeze and Voice Handicap Index (VHI) were noted.
ResultsA total of 23 patients who met the criteria were included in the study, where 8 patients had undergone a Type 1 cordectomy and 15 had undergone a Type 2 cordectomy. The average post-operative MPT in Type 1 cordectomy was 18 s. The mucosal wave amplitude was bilaterally poor in 2 out of 8 patients and glottic closure was present in 6 out of 8 patients with an average VHI of 5.38 ± 2.95 at 6months postoperatively. The average post-operative MPT in Type 2 cordectomy patients was 13 s. Mucosal wave amplitude was bilaterally poor in 6 out of 15 patients, glottic closure was present in 9 out of 15 patients and an average VHI of 9.71 ± 1.60 noted 6months postoperatively.
ConclusionVocal outcomes depend on the type of Trans-Oral Laser Micro laryngeal Cordectomy (TLMC) done. In our study Type 1 TLMC was associated with a better voice quality as compared to Type 2 TLMC. The patients of Type 1 TLMC at 6 months had a better subjective as well as objective vocal outcome as compared to Type 2 TLMC. This suggests that increasing depth of excision in TLMC is directly related to decreasing vocal outcomes.