Top

European Archives of Oto-Rhino-Laryngology

Published in:

01-01-2020 | Laser | Short Communication

Modified approach of the anterior commissure for transoral cordectomy in case of difficult exposure: a surgical innovation

Authors: Alexia Mattei, Carole Boulze, Laure Santini, Matthieu Le Flem, Patrick Dessi, Nicolas Fakhry, Antoine Giovanni

Published in: European Archives of Oto-Rhino-Laryngology | Issue 1/2020

Abstract

Purpose

To propose, in patients presenting a difficult laryngeal exposure, a surgical innovation allowing to perform a transoral laser cordectomy for cancers reaching the anterior commissure or the anterior third of vocal folds (according to the European Laryngological Society classification of laryngeal endoscopic cordectomies).

Methods

Our surgical technique consisted of adding to conventional cordectomies a modified relaxation thyroplasty proposed by Isshiki (type III), also called relaxation thyroplasty by a medial approach in the European Laryngological Society classification system. The anterior commissure retrusion is usually employed in the management of high-pitched voice disorders, but can also allow a better exposure of the anterior commissure.

Results

We described here this surgical innovation through the example of our first two patients. For both patients, the definitive histologic analysis showed negative microscopic margins and there was no post-operative complication. There was no need for a tracheostomy. They were allowed to take a normal diet after 2 days and were discharged after 4 days. The voice was breathy and hoarse as expected in case of extended cordectomy.

Conclusions

This surgical innovation corresponding to the addition of an anterior commissure retrusion by a bilateral thyrotomy could be useful in the ELS classification of endoscopic cordectomies. It should allow surgeons to carry out a transoral CO₂ laser cordectomy in patients with a T1 and sometimes T2 glottic carcinoma, even with a difficult laryngeal exposure.

Available only for authorised users

Remacle M, Eckel HE, Antonelli A, Brasnu D, Chevalier D, Friedrich G, Olofsson J, Rudert HH, Thumfart W, de Vincentiis M, Wustrow TP (2000) Endoscopic cordectomy. A proposal for a classification by the Working Committee, European Laryngological Society. Eur Arch Otorhinolaryngol 257(4):227–231CrossRef

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 (2007) Proposal for revision of the European Laryngological Society classification of endoscopic cordectomies. Eur Arch Otorhinolaryngol 264:499–504. https://doi.org/10.1007/s00405-007-0279-z CrossRefPubMed

Eckel HE, Thumfart WF (1992) Laser surgery for the treatment of larynx carcinomas: indications, techniques and preliminary results. Ann Otol Rhinol Laryngol 101(2Pt1):113–118CrossRef

Kirschner JA (1984) Invasion of the framework by laryngeal cancer. Surgical and radiological implications. Acta Otolaryngol (Stockh) 97(5–6):392–397CrossRef

Hochman II, Zeitels SM, Heaton JT (1999) Analysis of the forces and position required for direct laryngoscopic exposure of the anterior vocal folds. Ann Otol Rhinol Laryngol. août 108(8):715–724CrossRef

Kitamura Y, Isono S, Suzuki N, Sato Y, Nishino T (2007) Dynamic interaction of craniofacial structures during head positioning and direct laryngoscopy in anesthetized patients with and without difficult laryngoscopy. Anesthesiology. déc 107(6):875–883CrossRef

Isshiki N (1989) Phonosurgery. Theory and practice. Springer-Verlag, Tokyo, TokyoCrossRef

Isshiki N, Taira T, Tanabe M (1988) Surgical treatment for vocal pitch disorders. In: Fujimura O (ed) Vocal physiology: voice productions, mechanisms and functions. Raven Press, New York, pp 449–458

Remacle M, Matar N, Verduyckt I, Lawson G (2010) Relaxation thyroplasty for mutational falsetto treatment. Ann Otol Rhinol Laryngol 119(2):105–109. https://doi.org/10.1177/000348941011900207 CrossRefPubMed

10.

Conticello S, Biondi S, Ferlito S (1999) Indications and results of fronto-lateral laryngectomy using a combined endolaryngeal and external approach. Eur Arch Otorhinolaryngol 256(8):373–377CrossRef

11.

Eckel HE (2001) Local recurrences following transoral laser surgery for early glottic carcinoma: frequency, management and outcome. Ann Otol Rhinol Laryngol 110:7–15CrossRef

12.

Hoffmann C, Hans S, Sadoughi B, Brasnu D (2016) Identifying outcome predictors of transoral laser cordectomy for early glottic cancer. Head Neck 38(Suppl 1):E406–E411. https://doi.org/10.1002/hed.24007 CrossRefPubMed

13.

Sprinzl GM, Eckel HE, Sittel C, Potoschnig C, Koebke J (1999) Morphometric measurements of the cartilaginous larynx: an anatomic correlate of laryngeal surgery. Head Neck 21:743–750CrossRef

14.

Mahieu HF, Patel P, Annyas AA, van der Laan T (1994) Carbon dioxide laser vaporization in early glottic carcinoma. Arch Otolaryngol Head Neck Surg 120(4):383–387CrossRef

15.

Bertino G, Degiorgi G, Tinelli C, Cacciola S, Occhini A, Benazzo M (2015) CO₂ laser cordectomy for T1–T2 glottic cancer: oncological and functional long-term results. Eur Arch Otorhinolaryngol 272(9):2389–2395. https://doi.org/10.1007/s00405-015-3629-2 CrossRefPubMed

16.

Charbonnier Q, Thisse AS, Sleghem L, Mouawad F, Chevalier D, Page C, Mortuaire G (2016) Oncologic outcomes of patients with positive margins after laser cordectomy for T1 and T2 glottic squamous cell carcinoma. Head Neck 38(12):1804–1809. https://doi.org/10.1002/hed.24518 CrossRefPubMed

17.

Peretti G, Piazza C, Cocco D et al (2010) Transoral CO₂ laser treatment for Tis-T3 glottic cancer: the University of Brescia experience on 595 patients. Head Neck 32:977–983CrossRef

18.

Michel J, Fakhry N, Duflo S, Lagier A, Mancini J, Dessi P, Giovanni A (2011) Prognostic value of the status of resection margins after endoscopic laser cordectomy for T1a glottic carcinoma. Eur Ann Otorhinolaryngol Head Neck Dis. 128(6):297–300. https://doi.org/10.1016/j.anorl.2011.05.006 CrossRefPubMed

19.

Jackel MC, Ambrosch P, Martin A, Steiner W (2007) Impact of re-resection for inadequate margins on the prognosis of upper aerodigestive tract cancer treated by laser microsurgery. Laryngoscope 117:350–356CrossRef

20.

Landolfo V, Gervasio CF, Riva G, Garzaro M, Audisio R, Pecorari G, Albera R (2018) Prognostic role of margin status in open and CO₂ laser cordectomy for T1a–T1b glottic cancer. Braz J Otorhinolaryngol 84(1):74–81. https://doi.org/10.1016/j.bjorl.2016.11.006 CrossRef

21.

Lachowska M, Osuch-Wójcikiewicz E, Bruzgielewicz A (2011) Voice evaluation following endoscopic laser CO(2) cordectomy and conventional cordectomy. Arch Med Sci 7(1):143–153. https://doi.org/10.5114/aoms.2011.20621 CrossRefPubMedPubMedCentral

22.

Brandenburg JH (2001) Laser cordotomy versus radiotherapy: an objective cost analysis. Ann Otol Rhinol Laryngol 110:312–318CrossRef

23.

Diaz-de-Cerio P, Preciado J, Santaolalla F, Sanchez-del-Rey A (2013) Cost-minimisation and cost-effectiveness analysis comparing transoral CO₂ laser cordectomy, laryngofissure cordectomy and radiotherapy for the treatment of T1–2, N0, M0 glottic carcinoma Eur Arch Otorhinolaryngol 270:1181–1188. https://doi.org/10.1007/s00405-012-2139-8 CrossRef

24.

Remacle M, Arens C, Eldin MB, Campos G, Estomba CC, Dulguerov P, et al. Laser-assisted surgery of the upper aero-digestive tract: a clarification of nomenclature. A consensus statement of the European Laryngological Society. Eur Arch Otorhinolaryngol. 2017;274(10):3723‑7CrossRef

25.

Succo G, Peretti G, Piazza C, Remacle M, Eckel HE, Chevalier D, Simo R, Hantzakos AG, Rizzotto G, Lucioni M, Crosetti E, Antonelli AR (2014) Open partial horizontal laryngectomies: a proposal for classification by the working committee on nomenclature of the European Laryngological Society. Eur Arch Otorhinolaryngol 271(9):2489–2496CrossRef

Title: Modified approach of the anterior commissure for transoral cordectomy in case of difficult exposure: a surgical innovation
Authors: Alexia Mattei
Carole Boulze
Laure Santini
Matthieu Le Flem
Patrick Dessi
Nicolas Fakhry
Antoine Giovanni
Publication date: 01-01-2020
Publisher: Springer Berlin Heidelberg
Keyword: Laser
Published in: European Archives of Oto-Rhino-Laryngology / Issue 1/2020
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-019-05692-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Modified approach of the anterior commissure for transoral cordectomy in case of difficult exposure: a surgical innovation

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2020

Dynamic imaging in suspected Eagle syndrome

The relationship between the findings of vestibular evoked myogenic potentials and severity of obstructive sleep apnea syndrome

Correction to: Voice rehabilitation for laryngeal cancer after radiotherapy: a systematic review and meta-analysis

The use of structured reporting of head and neck ultrasound ensures time-efficiency and report quality during residency

Comparing local anesthetic infiltration of the peritonsillar region and glossotonsillar sulcus for post-tonsillectomy pain management

Disease course after the first recurrence of head and neck squamous cell carcinoma following (chemo)radiation