Evolution of voice after transoral laser cordectomy for precancerous lesions and early glottic cancer

Abstract

Purpose To evaluate voice quality evolution after a transoral laser cordectomy (TLC) for precancerous lesions and early glottic cancer. Methods This prospective study enrolled 18 patients scheduled for TLC for high-grade dysplasia, Tis, T1, and T2 glottic squamous cell cancers, from May 2017 to March 2020. Patients were grouped according to the extent of TLC: Group I (n = 11, 61.1%): unilateral subepithelial or subligamental cordectomy; Group II (n = 7, 38.9%): unilateral transmuscular, total, or extended cordectomy. Voice quality parameters, including dysphonia grade (G), roughness (R), breathiness (B), maximal phonation time (MPT), jitter, and shimmer, were evaluated before, and at 6 weeks and 6 months after the TLC. Results In Group I, the degree of G and R items remained without substantial improvement 6 weeks after surgery; however, improved above the pre-surgery level up to 6 months after surgery. The MPT, jitter, and shimmer did not change significantly at 6 weeks or 6 months post-TLC. In Group II, G, R, and B remained significantly impaired even 6 months post-surgery. Jitter, and shimmer worsened at 6 weeks, but reached preoperative levels at 6 months post-surgery. MPT was significantly worse at 6 weeks and remained deteriorated at 6 months post-surgery. All measured parameters were significantly worse in Group II than in Group I at 6 weeks and 6 months post-surgery. No patient required a phonosurgical procedure. Conclusion After a TLC, voice quality evolution depended on the extent of surgery. It did not improve at 6 weeks post-surgery. Improvements in less extent cordectomies occurred between 6 weeks and 6 months post-surgery. Understanding voice development over time is important for counseling patients when considering phonosurgical procedures.

Evolution of Voice Quality in Type 1–2 Transoral CO2 Laser Cordectomy: A Prospective Comparative Study

“…To date, few studies investigated postoperative voice quality outcomes in types 1-2 TLC through subjective and objective voice evaluations. 6,[10][11][12][13] The primary finding of the present study reported that postoperative voice quality outcomes did not substantially differ among TLC groups. At most, we observed that patients with type 1 TLC showed an earlier overall subjective and objective voice quality improvements (6 months) compared to patients who benefited from type 2 TLC (12 months).…”

“…These results did not confirm the initial findings of Hillel et al, 6 and the theoretical model of Mau et al 7 The impact of TLC and, therefore, the extent of vocal cord surgery on voice quality outcomes were studied by Ledda et al 11 In a retrospective chart review, Ledda et al did not find significant differences in GRBAS scale, MPT, and acoustic measurements (i.e., F0, Jitt, Shim, NHR) between type 1 and 2 CO 2 TLCs (median follow‐up of 2 years), 11 which corroborates our findings. The better postoperative voice quality outcomes of type 1 over type 2 TLC were supported in a recent prospective study where authors observed faster voice recovery in type 1 (6‐month post‐TLC) versus type 2 (>6‐month post‐TLC) TLC according to perceptual voice quality evaluations 12 . In the same study, authors suggested that the voice quality evolution may depend on the extent of surgery.…”

“…19 The primary limitation of this study was the low number of patients in both groups. However, in comparison with other publications, 12,13,16 the current study is one of the largest focusing on type 1-2 CO 2 TLCs. The lack of consideration of gender differences is an additional limitation of the study because gender remains important in the analysis of voice quality evaluations regarding the gender-related vocal fold anatomical and histological differences, 20 as well as differences in the postoperative inflammatory and healing processes.…”

“…The better postoperative voice quality outcomes of type 1 over type 2 TLC were supported in a recent prospective study where authors observed faster voice recovery in type 1 (6-month post-TLC) versus type 2 (>6-month post-TLC) TLC according to perceptual voice quality evaluations. 12 In the same study, authors suggested that the voice quality evolution may depend on the extent of surgery.…”

“…Voice quality is one of the most important outcomes in patients who benefited from TLC for early stage VFSCC. To date, few studies investigated postoperative voice quality outcomes in types 1–2 TLC through subjective and objective voice evaluations 6,10–13 …”