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

Abstract

Objectives/Hypothesis: To compare the 12-month evolution of voice quality outcomes in patients who benefited from types 1-2 transoral CO 2 laser cordectomy (TLC) for an early-stage vocal fold squamous cell carcinoma (VFSCC).Study Design: Prospective uncontrolled study.Methods: Sixty patients with cT1 VFSCC were consecutively recruited from a single medical center. Thirty patients benefited from type 1 TLC, while type 2 TCL was performed in 30 patients. The following voice quality outcomes were evaluated at baseline, 3-, 6-, and 12-month post-TLC: voice handicap index (VHI), GRBAS, speech rate, maximum phonation time (MPT), and acoustic parameters. Voice quality evolution was compared between type 1 and type 2 TLC.Results: Fifty-seven patients completed the evaluations. Type 1 TLC patients reported significant improvements of VHI, grade of dysphonia, and breathiness at 3-, 6-, and 12-month post-TLC. Speech rate and jitter values improved 6-and 12-month post-TLC. A few voice quality outcomes reported 3-or 6-month post-TLC improvements in type 2 TLC group, while VHI, grade of dysphonia improved at 6-and 12-month post-TLC. MPT significantly decreased at 6-and 12-month post-TLC, while there were no acoustic measurement changes in type 2 TLC.Conclusions: The effect of TLC on voice quality may depend on the type of TLC. Type 1 TLC was associated with faster voice quality improvements compared with type 2 TLC. VHI and dysphonia grade were identified as the most relevant tool of voice changes irrespective to the TLC type.

Application of Platysma Myocutaneous Flap in Surgical Repair after T2‐3 Glottic Carcinoma Resection

“…As transoral laser surgery has emerged, surgical trauma in the treatment of laryngeal cancer has decreased, and good vocal function can be achieved after surgery in patients with T1 glottic carcinoma. 3,4 Laser surgery has also been widely applied in patients with unilateral T2-3 glottic carcinoma. 5,6 However, these patients have poor closure of the glottis and unsatisfactory voice quality after surgery because the range of resection is wide; most or all of the vocal cords, or even other tissues (such as the ventricular band and laryngeal ventricle), must be resected for some patients with T2 disease and most patients with T3 disease without performing intraoperative repair, which results in large glottic defects.…”

“…The 3‐year survival rate of patients with T2‐3 glottic carcinoma is 80.6%–91.0%, 1,2 and increased emphasis should be placed on posttreatment vocal and swallowing function. As transoral laser surgery has emerged, surgical trauma in the treatment of laryngeal cancer has decreased, and good vocal function can be achieved after surgery in patients with T1 glottic carcinoma 3,4 . Laser surgery has also been widely applied in patients with unilateral T2‐3 glottic carcinoma 5,6 .…”

The Same–Up–Down Staging System for Recurrent Early Glottic Cancer

“…Exclusive radiotherapy (RT) or surgery, mostly in the form of transoral laser microsurgery (TLM), are the two main primary treatment options, with comparable results in terms of survival even in the most recent series [1,5]. With the ultimate aim of optimizing the functional outcomes, TLM is performed in the most conservative way, because tumor-free margins of one millimeter are usually sufficient and lead to the voice recovering faster [6,7]. On the other hand, new RT techniques are being investigated, such as single vocal cord irradiation (with apparently good results) [8] or the use of stereotactic RT, which is still in its preliminary phase [9,10].…”

Voice quality after transoral CO2 laser microsurgery (TOLMS): systematic review of literature

“…In literature the oncological outcomes of TOLMS have been extensively investigated by systematic reviews and meta-analysis. In fact, is clear that TOLMS and radiotherapy for early stage of LSCC are similar for overall survival [ 4 ], but TOLMS is favored due to lower costs and fewer post-treatment adverse events [ 5 ].…”