Alexia Mattei1,2, Carole Boulze3,4, Laure Santini3, Matthieu Le Flem3,4, Patrick Dessi3,5, Nicolas Fakhry3,6, Antoine Giovanni3,6. 1. Department of Oto-Rhino-Laryngology and Head and Neck Surgery, APHM, La Conception University Hospital, 147 bd baille, 13385, Cedex Marseille, France. alexia.mattei@laposte.net. 2. Aix Marseille Univ, CNRS, LPL, UMR 7309, Aix-en-Provence, France. alexia.mattei@laposte.net. 3. Department of Oto-Rhino-Laryngology and Head and Neck Surgery, APHM, La Conception University Hospital, 147 bd baille, 13385, Cedex Marseille, France. 4. Aix Marseille Univ, Marseille, France. 5. Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France. 6. Aix Marseille Univ, CNRS, LPL, UMR 7309, Aix-en-Provence, France.
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.
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.
Authors: M Remacle; H E Eckel; A Antonelli; D Brasnu; D Chevalier; G Friedrich; J Olofsson; H H Rudert; W Thumfart; M de Vincentiis; T P Wustrow Journal: Eur Arch Otorhinolaryngol Date: 2000 Impact factor: 2.503
Authors: Marc Remacle; Christophe Van Haverbeke; Hans Eckel; Patrick Bradley; Dominique Chevalier; Votko Djukic; Marco de Vicentiis; Gerhard Friedrich; Jan Olofsson; Giorgio Peretti; Miquel Quer; Jochen Werner Journal: Eur Arch Otorhinolaryngol Date: 2007-03-22 Impact factor: 3.236