Despite the dramatic reduction in the incidence of laryngeal tuberculosis after the 1950s, the topic has now gained new interest due to claims that the disease has changed its clinical pattern. In the past, the typical patient was 20-40 years old with ulcerated laryngeal lesions, perichondritis, and advanced cavitary lung disease. We studied nine cases of laryngeal tuberculosis confirmed by histological examination. The microlaryngoscopy revealed tumour-like lesions and/or chronic non-specific laryngitis. There were no significant ulcerations or signs of perichondritis. The patients' ages ranged from 48.5 years to 69.3 years (mean, 59.4 years). In three of our patients (33 per cent) we did not find any pulmonary involvement, thus suggesting primary laryngeal tuberculosis or haematogenous spread. In conclusion, the numerous physicians who deal with the various laryngeal symptoms and diseases should be aware of the existence of laryngeal tuberculosis and the changing patterns of the disease (at least in the developed countries).

The treatment of patients with vocal fold paralysis presents a challenge to the otolaryngologist-head and neck surgeon. Many techniques have been proposed to manage individuals with unilateral or bilateral vocal fold paralysis. We herein describe the experience of our department in dealing with bilateral vocal fold paralysis. At the University of Athens, patients presenting with symptomatic bilateral paralysis are treated with a posterior cordectomy by using the CO2 or KTP-532 laser. During the last 5 years, we have treated 20 patients (8 men and 12 women) presenting with symptomatic bilateral vocal fold paralysis. For augmentation of the glottic airway, a modification of Kashima's cordotomy was used, completing a partial posterior cordectomy of one or both true and false vocal folds with the CO2 laser (15 patients) and the KTP-532 laser (5 patients). An elective tracheotomy was done before the cordotomy. Complications, such as infection, stridor, or dyspnea, were minimal. Although no objective voice analysis was performed, all patients were able to communicate without any phonation device and were satisfied with the result of the surgery. When compared with other techniques, the advantages offered by the posterior cordectomy included rapidity and simplicity in concept, reliability of outcome, short hospitalization, low risk of complications, and the possibility for revision when necessary (posterior cordectomy). From the successful postsurgical results of this study, it can be concluded that the posterior cordectomy is a reliable treatment option for the management of patients with bilateral vocal fold paralysis.

Vertical laryngectomy was not associated with an increased complication rate. Morbidity in the horizontal-supraglottic laryngectomy group was higher, but a satisfactory functional outcome was obtained in all cases. Therefore, in early laryngeal cancer (glottic T1-T2, supraglottic T1) partial laryngectomy can be performed with good expectation of cure and satisfactory laryngeal function. In T2 supraglottic lesions, the oncologic results are less satisfactory; further research is required for developing more efficient complimentary or alternative treatments modalities.

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Aiming to improve voice quality and to facilitate swallowing rehabilitation, we modified the supracricoid partial laryngectomy with cricohyoidopexy by preserving the posterior segment of the true vocal cord on the less involved side of the larynx. Between 1983 and 1994, 13 patients with supraglottic cancer were treated with this modified procedure. The possibility of incomplete tumor excision was eliminated by careful patient selection and intraoperative reconfirmation of tumor extent with frozen sections. Our results have been promising, with a 76.9% 3-year survival rate and a 69.2% laryngeal preservation rate. There were 7 recurrences, 3 local (2 at the superior border of the cricoid and 1 at the cricoarytenoid region) and 4 nodal, in 5 patients. Distant metastases developed in another patient. Three patients, 2 with local and nodal recurrence and 1 with distant metastases, died of disease. Functional outcomes were also good, with all patients achieving normal swallowing by the end of the first year, although 5 patients required temporary gastrostomy for transient swallowing impairment. Early decannulation and satisfactory voice quality were achieved in all cases. We believe that with proper patient selection this modified procedure is effective both for tumor control and for preserving a more functional larynx.