Vestibular fold flap for post-cordectomy laryngeal reconstruction.
OBJECTIVE
The development of techniques causing fewer sequelae without compromising oncologic control has led to better phonation, breathing, and postoperative swallowing in patients submitted to cordectomy. The objective of the present study was to describe post-cordectomy laryngeal reconstruction with a vestibular fold flap and to analyze the resulting laryngeal functions.


METHODS
Prospective study.


METHODS
Ten patients, 9 males and 1 female, aged 45 to 75 years (mean, 64.5 years), were evaluated. The patients had squamous cell carcinomas in the glottic region and were treated surgically by laryngofissure and cordectomy with the use of a vestibular fold flap for laryngeal reconstruction. The patients were followed up for functional laryngeal analysis that consisted of videolaryngostroboscopy, endoscopic evaluation of swallowing, and voice recording for perceptive auditory analysis, and for computing purposes.


RESULTS
No patients depended on tracheostomy during the late postoperative period. No stenosis, anterior synechia, granuloma, or laryngocele were detected, although 1 patient developed immobility in the median position of the operated hemilarynx, which, however, was not sufficient to impair the respiratory function. No alterations in the pharyngeal phase of swallowing were observed by endoscopic evaluation. Using the GRBAS scale, we observed moderate (30%) and severe (20%) dysphonia in 50% of the patients and grade 1 dysphonia (40%) or normal (10%) dysphonia in the remaining ones. Computing analysis revealed the following mean values: fundamental frequency of 177.5 Hz, jitter 1.11%, and shimmer 7.04%.


CONCLUSIONS
We conclude that reconstruction with a vestibular fold flap permitted the maintenance of the laryngeal functions of breathing and airway protection during swallowing, as well as the maintenance of phonation function, providing perfect voice emission according to perceptive auditory or acoustic analysis in 1 patient and moderate or severe dysphonia in one half of the cases when technical faults occurred.
Martins Mamede
Rui Celso
RC
Division of Head and Neck Surgery, University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
Ricz
Hilton Marcos Alves
HM
Aguiar-Ricz
Lílian Neto
LN
de Mello-Filho
Francisco Veríssimo
FV
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013524:Surgical Flaps; D014827:Vocal Cords / Q000601:surgery*