The European Laryngological Society is proposing a classification of different laryngeal endoscopic cordectomies in order to ensure better definitions of post-operative results. We chose to keep the word "cordectomy" even for partial resections because it is the term most often used in the surgical literature. The classification comprises eight types of cordectomies: a subepithelial cordectomy (type I), which is resection of the epithelium; a subligamental cordectomy (type II), which is a resection of the epithelium, Reinke's space and vocal ligament; transmuscular cordectomy (type III), which proceeds through the vocalis muscle; total cordectomy (type IV); extended cordectomy, which encompasses the contralateral vocal fold and the anterior commissure (type Va); extended cordectomy, which includes the arytenoid (type Vb); extended cordectomy, which encompasses the subglottis (type Vc); and extended cordectomy, which includes the ventricle (type Vd). Indications for performing those cordectomies may vary from surgeon to surgeon. The operations are classified according to the surgical approach used and the degree of resection in order to facilitate use of the classification in daily practice. Each surgical procedure ensures that a specimen is available for histopathological examination.

Botulinum toxin is known as a relatively safe and efficacious agent for the treatment of various neurologic and ophthalmologic disorders. Since dysphagia and deglutition problems combined with aspiration are often caused by spasticity, hypertonus, or delayed relaxation of the upper esophageal sphincter (UES), conventional treatment including lateral cricopharyngotomy was replaced by localized injections of botulinum toxin into the cricopharyngeal muscle (CM) in a series of 7 patients. The study comprised patients with slight dysphagia caused by isolated hypertonus of the UES, as well as patients with severe deglutition disorders, complete inability to swallow, and aspiration problems. Preoperative diagnostic evaluation included careful history-taking, physical examination, cineradiography, and esophageal manometry to exclude other causes of dysphagia. For precise localization, injections were performed under general anesthesia after location of the CM by direct esophagoscopy and electromyographic guidance. Injections were administered into the dorsomedial part and on both sides into the ventrolateral parts of the muscle. Depending on the severity of symptoms and the intraluminal pressure of the UES, the dose varied between 80 and 120 units (botulinum toxin A from Dysport). The treatment outcome was evaluated by a disability rating score: patients' complaints were scored by subjective and objective parameters before and after injection. All but 2 patients experienced complete relief or marked improvement of their complaints. There were no severe side effects or postoperative complications. Local botulinum toxin injection proved to be an effective alternative treatment to invasive procedures for patients with isolated dysfunction of the UES, and also for patients with more complex deglutition problems combined with aspiration.

The detection of neural degeneration by laryngeal electromyography allows the prediction of poor functional outcome with sufficient reliability in an early phase of the disease process. Conversely, the absence of signs of degeneration does not imply that complete recovery is to be expected.

The surgical approach should be determined by tumor location, tumor size, and effectiveness of tumor embolization. For patients with JNA with tumor extension involving the nasopharynx, the nasal cavity, the paranasal sinuses, and the pterygopalatine fossa, the transnasal endoscopic technique offers a minimally invasive resection of the entire tumor mass with minimal morphological disturbance.

The authors have developed four different types of endolaryngeal laser resections for the treatment of larynx carcinomas. These new techniques are based on traditional concepts employed in partial larynx resections. From 1986 onward, 110 patients with laryngeal cancers were treated by endoscopic laser surgery. One hundred six patients were operated on for cure and 4 for palliation. In 9 cases of T3 tumor, complete removal of the tumor was not possible, requiring total laryngectomy. In all T2 cancers of the glottis and subglottis (n = 36), a total resection was possible. Additional staged neck dissection was performed in 16 cases, and postoperative radiotherapy in 10 cases. Follow-up investigations of the patients treated for cure (n = 106) cover a period of 3 to 42 months (mean, 22 months). These revealed 6 recurrences in the larynx, which were treated by laryngectomy. Recurrences in the cervical nodes were seen in 2 patients following resection of a supraglottic tumor and a subglottic tumor, respectively. Seven patients could not be followed up, 4 patients died of intercurrent disease, and 87 patients are alive and free of tumor. At present the number of recurrences and the rate of survival show no significant difference from those previously reported after conventional surgery. The phonatory function is not always predictable and still remains to be investigated. The authors believe that laser surgery may obviate the need for total laryngectomies in selected cases of laryngeal cancer, especially in T2 tumors. However, T3 tumors should not be treated by endolaryngeal laser surgery.