Endoscopic laser anterior commissurotomy for anterior glottic web: one-stage procedure.
OBJECTIVE
The conventional method for preventing web formation after anterior glottic web surgery is keel insertion. However, this presents risks of airway compromise and granulation tissue formation, which could necessitate tracheotomy in addition to a secondary procedure for keel removal. We introduce a novel, 1-stage endoscopic laser anterior commissurotomy for preventing anterior glottic web re-formation.


METHODS
Twenty patients with glottic webs involving the anterior commissure were studied. The lesions were removed by transoral carbon dioxide laser microsurgery. In all patients, the anterior glottic web was vaporized along with the inner perichondrium of the thyroid cartilage over the anterior commissure area, creating a raw vertical break "alley" between the anterior vocal folds that measured between 0.3 and 0.5 cm in width and between 0.8 and 2 cm in length. The preoperative and postoperative vocal folds and voice quality were evaluated by videostrobolaryngoscopy and voice recordings.


RESULTS
All 20 patients had anterior glottic webs ranging from 11% to 64% of the length from the anterior commissure to the vocal process. None of the patients developed restenosis at the anterior commissure of a severity similar to that of the initial lesion during follow-up (mean, 13 months; range, 3 to 44 months).All patients except 1 reported satisfaction with their voice improvement. Outcome analysis revealed that partial re-formation of the web was noted in 4 patients.


CONCLUSIONS
One-stage, endoscopic laser anterior commissurotomy was effective and relatively safe for removing glottic webs, for preventing anterior glottic web re-formation, and for improving vocal fold performance among our patients.
Chang Gung Memorial Hospital-Kaohsiung Medical Center, Department of Otolaryngology, Chang Gung University College of Medicine, Kaohsiung.
Chih-Ying
CY
Su
Jamil N
JN
Alswiahb
Chung-Feng
CF
Hwang
Cheng-Ming
CM
Hsu
Pei-Yin
PY
Wu
Hsun-Hsien
HH
Huang
D000293:Adolescent; D000328:Adult; D000368:Aged; D004724:Endoscopy; D005260:Female; D005931:Glottis / Q000002:abnormalities; D006801:Humans; D007818:Laryngeal Diseases / Q000601:surgery; D007828:Laryngoscopy; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D049489:Stroboscopy; D016896:Treatment Outcome; D014827:Vocal Cords / Q000601:surgery; D014833:Voice Quality