title: Laryngeal Framework Surgery in the Irradiated Neck: A Retrospective Matched Cohort Study.
abstract: BACKGROUND
  Laryngeal framework surgery (LFS) remains a cornerstone treatment in the management of glottic insufficiency. Traditionally, a history of radiation to the neck has been considered a relative contraindication to LFS.
  
  
  METHODS
  A retrospective matched cohort study was performed to study LFS outcomes in patients with and without a history of radiation. Variables studied included radiation specifics, surgical time, operative difficulty, complications, need for revision surgery, and Voice Handicap Index-10 (VHI-10) scores.
  
  
  RESULTS
  A total of 298 patients were studied. Fourteen patients with a history of neck irradiation were matched with 14 nonirradiated controls. No complications were encountered in the nonirradiated cohort. In the irradiated cohort, there were 2 minor wound complications and 1 admission for stridor treated medically. No cases of implant extrusion were observed. The VHI-10 scores were improved in both cohorts relative to preoperative baseline (P = .001). Posttreatment VHI-10 scores were better in the nonirradiated cohort (P = .03). There was no difference between cohorts with respect to complication rates, surgical time, surgical difficulty, length of stay, use of a surgical drain, or need for revision surgery.
  
  
  CONCLUSIONS
  Laryngeal framework surgery is safe and associated with improved voice outcomes in patients with a history of neck irradiation.
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania, USA kubikmw@upmc.edu.
authors.forename: Mark
authors.initials: M
authors.lastname: Kubik
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Clark
authors.initials: C
authors.lastname: Rosen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D055154:Dysphonia / Q000601:surgery*; D005260:Female; D005931:Glottis / Q000601:surgery*; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D058753:Laryngoplasty; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures; D011878:Radiotherapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000601:surgery*; D014833:Voice Quality
keywords: dysphonia; head and neck cancer; laryngology; laryngoplastic phonsurgery; otolaryngology; radiotherapy; vocal fold paralysis