Too Deep: The Rate of Inappropriate Deep Resections while Practicing a Single Stage Laser Cordectomy.

OBJECTIVE: Whenever a cortectomy is indicated, obviating preoperative biopsy and practicing a single-stage-laser-cordectomy (SSLC) may expedite treatment and preserve surgical planes. This may result in more superficial resections and improved vocal function. Yet, SSLC holds a risk for over-treating nonmalignant lesions. Our study aims to evaluate this risk. METHODS: A retrospective cohort of patients who underwent SSLC. Cordectomy types were compared with final pathology. Type-1 cordectomy was subcategorized into superficial-type-1 (superficial-lamina-propria preserved) and deep-type-1 (ligament exposed). Superficial-type-1 cordectomy was considered adequate for epithelial lesions not invading the basement membrane: nonmalignant, dysplasia, and carcinoma-in-situ (CIS). Deeper resections for these pathologies were considered inappropriately deep. All resections were considered appropriate for squamous cell carcinoma (SCC). RESULTS: Ninety-seven patients who underwent 139 SSLC were included. SCC was found in 30% (N = 42), CIS/severe-dysplasia in 15% (N = 21), mild/moderate-dysplasia in 23% (N = 32), nondysplastic lesions in 31% (N = 43), and lymphoma in 0.5% (N = 1). Superficial-type-1 cordectomy was performed in 64% (N = 89). Altogether, 15 lesions (11%) underwent inappropriately deep resections. Smoking history, current smoking status, prior glottic surgery, radiation or fungal infection, did not increase the rate of inappropriate deep resection. While the general rate of inappropriately deep resection is 11%, for deep-type-1 cordectomy or deeper the rate was 29.4%. The highest rate was associated with deep-type-1 cordectomy, reaching 52.9%. CONCLUSION: The general rate of inappropriately deep resection during a SSLC is low. However, when the depth of resection involves exposure of the vocal ligament or deeper, the rate increases. Hence, to avoid unnecessary morbidity, whenever a deep resection is considered, the authors recommend preceding a deeper resection with frozen section sampling.

Oncological outcomes and failure patterns of laser cordectomy in recurrent glottic cancer.

PURPOSE: Laser cordectomy is a widely accepted treatment modality for selected cases of early glottic cancers, but its role as a salvage treatment remains unclear. We aimed to investigate the oncological outcomes and failure patterns of salvage cordectomy. MATERIALS AND METHODS: This was a retrospective cohort study of patients who underwent cordectomy for early glottic cancer between 2013 and 2022 at a tertiary referral center. The main outcome measures were overall survival, larynx-preservation rate, tracheostomy dependency rate, and disease-free survival. RESULTS: A total of 142 patients (mean age: 63 years, interquartile range [IQR]: 45-72, 123[86.9 %] males) were analyzed. There were 38 (26.8 %) recurrences after a mean of 22 months (IQR: 17-26). Among them, 25 (17.6 %) underwent salvage cordectomy, while 13 (9.1 %) received other salvage treatments (11[7.7 %] (chemo)radiotherapy and 2[1.4 %] total laryngectomy). In comparison to the other salvage treatments, salvage cordectomy demonstrated lower tracheostomy rates (0 vs. 31 %, p = 0.05), comparable 5-year disease-free survival (62 % vs. 54 %, p = 0.4), higher 5-year larynx preservation rate (92 % vs. 54 %, p = 0.02), and improved 5-year overall survival rate (84 % vs. 62 %, p = 0.01). Factors associated with salvage cordectomy failure were age >60 years (odds ratio [OR]: 1.3, 95 % confidence interval [CI]: 1.15-1.53), smoking continuation (OR: 3.73, 95 % CI: 3.5-4.4), heavy smoking (OR: 1.24, 95 % CI:1.07-2.15), and pT1b + (OR: 2.26, 95 % CI: 2.1-2.9). CONCLUSIONS: Salvage cordectomy offers favorable larynx preservation rates and oncological outcomes for recurrent disease amenable to conservative surgery. Smoking, advanced age, and advanced tumor stages are associated with salvage cordectomy failure.

Long-term survival after cordectomy in a case of spinal cord diffuse midline glioma, H3K27-altered: illustrative case.

BACKGROUND: Spinal cord diffuse midline glioma, H3K27-altered, is an extremely rare entity with a poor prognosis. However, its optimal treatment remains poorly defined. Although cordectomy was introduced in the early 20th century, its efficacy has been questioned and shrouded behind the scenes. OBSERVATIONS: A 76-year-old male with recent-onset paraparesis of the lower extremities and paresthesia presented to our outpatient clinic. Magnetic resonance imaging revealed an intra-axial spinal cord tumor extending from T12 to L2. The patient underwent laminectomy and partial tumor resection, and the surgical specimen was histologically diagnosed as a diffuse midline glioma, H3K27-altered. Although standard chemoradiotherapy was implemented, the patient experienced local tumor recurrence 2 years later and underwent cordectomy at T9. The patient was alive at the 4-year follow-up after cordectomy without tumor recurrence. According to the literature, patients with lesions in the lower thoracic cord below T8 achieved a longer survival than those with lesions in the upper thoracic cord above T5. LESSONS: Cordectomy benefits selected cases of high-grade spinal cord gliomas. Maximal prevention of cerebrospinal fluid dissemination by tumor cells is indisputably important, and tumors located below the lower thoracic spine may be the key to success in establishing a long-term prognosis after cordectomy.

Endoscopic posterior ventricular cordectomy with contact diode laser: how I do it.

BACKGROUND: The treatment of bilateral vocal fold paralysis is mainly surgical and several procedures can be used to guarantee adequate breathing. Furthermore, other causes of the narrowing of the natural airways could coexist and the treatment should consider all of them. METHODS: A supraglottic extension of posterior cordectomy to the false homolateral chord is described, which provides a further widening of the airway while maintaining acceptable voice quality. CONCLUSION: Endoscopic posterior ventricular cordectomy performed by contact diode laser may be a viable and safe option, especially in those patients who present bilateral vocal fold paralysis associated with various degrees of laryngospasm.

Influence of age on voice quality after transoral CO2 laser microsurgery.

OBJECTIVE: To study the post-operative evolution of voice quality of patients treated by transoral CO2 laser microsurgery (TLM) according to the age. METHODS: Patients treated by type I to VI TLM and post-operative speech therapy were prospectively recruited from our hospital. The voice quality was assessed pre-, 1-, 3- 6- and 12-month posttreatment with voice handicap index (VHI), dysphonia, roughness, breathiness, asthenia, strain (GRBAS), maximal phonation time (MPT), F0, F0 standard deviation (STD), percent jitter, percent shimmer, noise-to-harmonic ratio (NHR), vocal fold vibration assessment and speech fluency. Evolution of voice outcomes was analyzed considering age of patients (< 60 vs. ≥ 60 years). RESULTS: Seventy-five patients completed the evaluations. Thirty-four and forty-one patients were < 60 or ≥ 60 yo, respectively. Subjective and objective voice parameters (VHI, G, R, B), jitter and fluency significantly improved from 1- to 6-month post-TLM in < 60 yo individuals. The voice parameters improved 12-month post-TLM in the ≥ 60 yo group at the exception of VHI that improved 3-month post-TLM. There were positive associations between age and 12-month NHR, G and A parameters. CONCLUSION: The post-operative evolution of voice quality parameters may vary between patients according to the age. Preoperative VHI is predictive of 12-month subjective and objective voice outcomes.

The Comparison of Electroacoustic and Subjective Voice Quality in Type 3 and 4 Transoral Laser Cordectomy for Early-Stage Glottic Carcinoma.

One of the main issues in early-stage glottic carcinoma management is the voice quality following different types of treatment modalities. In type 3 and 4 transoral laser cordectomies, the voice outcomes can show significant differences due to the extent of the vocal muscle resection. This study aims to compare the voice quality in patients who underwent type 3 and 4 laser cordectomy for early-stage glottic carcinoma. A total of 30 patients who underwent type 3 (15 patients) and type 4 (15 patients) laser cordectomy for T1a glottic carcinoma between May 2018 and 2020 were included in this retrospective comparative study. Electroacoustic voice analysis and Voice Handicap Index-10 were performed in the postoperative twelfth month and the outcomes were compared between two laser cordectomy groups. The mean age of all patients was 48.6 ± 4.2 years. Noise-to-harmonic ratio, jitter, shimmer, pitch perturbation quotient and amplitude perturbation quotient values were significantly different between two groups (p < 0.05). Fundamental frequency and Voice Handicap Index-10 scores showed no statistically significant difference (p > 0.05). This study reports significantly better results for type 3 against type 4 laser cordectomy by means of objective voice analysis outcomes, except fundamental frequency. On the other hand, self-reported subjective analysis showed very similar results for both groups. Further studies combining data with multiple objective and subjective analyses with larger patient series and longer follow-up are warranted.

Idiopathic bilateral abductor cord palsy-can it be the cause of obstructive sleep apnea?

We describe a case of 27 year old male who presented with history of breathing difficulty with episodes of apnea for 8 years. He was suspected to have obstructive sleep apnea and a nocturnal polysomnography showed Apnea-Hypopnea index of 34/hour and the lowest oxygen saturation of 78% and severe snoring in the night. Continuous positive airway pressure (CPAP) machine was advised from local hospital and he used for 2 month. Indirect laryngoscopy done showed bilateral abductor cord palsy. Contrast enhanced magnetic resonance imaging (CEMRI) of brain and contrast enhanced computed tomography (CECT) of chest and neck was normal study. Posterior cordotomy of left cord was done using coblation with resolution of symptoms of OSA. Repeat nocturnal polysomnography showed apnea/hypopnea index 5 and lowest oxygen saturation of 95%.

The Role of Robotic Surgery in Laryngeal Cancer.

Transoral robotic surgery (TORS) is a growing field in the treatment of head and neck cancers. Its benefits have been proven in the treatment of oropharynx HPV-positive squamous cell carcinoma, replacing chemoradiation as primary treatment of early-stage cancers or reducing the required radiation dosage, leading to improved functional outcomes without compromising oncological outcomes. There is also interest in the application of TORS for larynx cancer with the hope of achieving similar outcomes to replace open surgery or radiation treatments. Specifically, in the larynx, TORS can be used to resect supraglottic or glottic tumors.

Voice After Cordectomy Type I or Type II or Radiation Therapy for Large T1a Glottic Cancer.

OBJECTIVE: T1a glottic cancer can be treated with transoral laser microsurgery (TLM) or radiation therapy (RT). Dysphonia is the major disadvantage of TLM, and preservation of voice appears to be the best advantage of RT compared to TLM. Studies on voice outcomes of both options gave conflicting results, but there is a tendency toward better voice outcome after TLM compared to the past. STUDY DESIGN: Nonrandomized retrospective cohort study. SETTING: Tertiary referral center. METHODS: In total, 172 patients with a cancer lesion involving more than two-thirds of 1 membranous vocal fold underwent cordectomy type I (n = 56) (C1 group) or type II (n = 59) (C2 group) or RT (n = 57) (RT group). GRBASI (grade, roughness, breathiness, asthenia, strain, instability), videolaryngostroboscopy, Voice Handicap Index-30, acoustic analysis including F0, jitter, shimmer, noise to harmonic ratio, cepstral peak prominence, and cepstral spectral index of dysphonia using running speech, and aerodynamic analysis were performed before treatment and 6 and 24 months after treatment. RESULTS: Study groups did not differ significantly on pretreatment voice outcomes (P > .05). The RT group had significantly better voice outcomes at 6 months posttreatment compared to the C1 and C2 groups (P < .05). The C1 group had significantly better voice outcomes at 6 months posttreatment compared to the C2 group (P < .05). The C1 group had significantly better voice outcomes at 24 months posttreatment compared to the RT and C2 groups (P < .05). The RT and C2 groups did not differ significantly at 24 months posttreatment (P > .05). CONCLUSION: Voice outcomes after C2 are equal to RT. C1 has better voice outcomes than RT. C1 and C2 can be the treatment of choice for large T1a glottic cancers.

Medialization Laryngoplasty After Endoscopic Laser Cordectomy. Our Experience.

PURPOSE: Medialization laryngoplasty can be performed to treat glottic incompetence after endoscopic laser cordectomy. The aim of this study is to evaluate vocal outcome after this phonosurgical procedure and to analyze the critical aspects of the Montgomery and Gore-Tex laryngoplasty technique. METHODS: A retrospective observational study of patients with glottic incompetence after endoscopic laser cordectomy, underwent medialization laryngoplasty with Montgomery or Gore-Tex implant between January 2013 to December 2018 at the Bufalini Hospital of Cesena, Italy. The pre- and postphonosurgery evaluation included videolaryngostroboscopy, perceptual, evaluation of dysphonia with the GRBAS (grade, roughness, breathiness, asthenia, strain) scale, Voice Handicap Index-10, Maximum Phonation Time. The outcome was evaluated 6 months after the phonosurgical treatment. RESULTS: We treated 22 patients, 19 males and 3 females. Eight cases were treated with Montgomery implant and fourteen with Gore-Tex implant. The postphonosurgical videolaryngostroboscopy showed an improvement of the glottic closure in all patients; the scores of the Voice Handicap Index-10 and of the Maximum Phonation Time showed a statistically significant improvement after phonosurgery. The GRBAS scale scores showed a statistically significant improvement of Global Grade, Breathiness, and Asthenia; the parameter Strain remained unaltered both in pre- and postoperative evaluations, because the voice was never pressed due to glottic insufficiency, especially in preoperative observation. The parameter Roughness (R) did not show a significant difference between pre- and postoperative evaluation. CONCLUSION: Medialization laryngoplasty is an effective phonosurgical procedure to improve voice outcome, after extended endoscopic laser cordectomies, in patients with unacceptable results after voice therapy and injection laryngoplasty. In our experience the Gore-Tex implant allows the surgeon to perform a safer and more "tailored" phonosurgery in cases of cordectomies type IV and V, associated or not with radiotherapy and in revision surgery.

A Retrospective Study to Assess the Accuracy of Frozen Sections in Laser Laryngeal Surgery.

OBJECTIVE: The basis of good vocal outcomes following Transoral Laser Microlaryngeal Cordectomy (TLMC) is the narrow margin that is oncologically accepted for the glottis. Our objective is to evaluate the reliability of frozen section (FS) compared to paraffin section (PS) during TLMC and during laser laryngeal surgery when an incisonal or excisional biopsy is being performed. METHODS: Retrospectively, records of 159 sequential patients who underwent CO2 laser laryngeal surgery with intraoperative FS were reviewed along with the final PS. Group A patients were TLMC patients where FS was utilized for free margin confirmation (42 specimens) and Group B patients were those in whom FS was performed for primary diagnosis (122 specimens). RESULTS: A total of 164 samples were included where specimens submitted for FS were also processed for PS. Concordance was observed in 156 samples, discordance in 8, with 4 cases belonging to each group. FS was reported as false negative in 5 and false positive in 3 cases. In Group A where FS was utilized for free margin confirmation, the sensitivity was found to be 60%, specificity and positive predictive value (PPV) 100%, and negative predictive value (NPV) 88.9%. In Group B where FS was performed for primary diagnosis, the sensitivity was found to be 98.4%, specificity 95.1%, PPV 95.2%, and NPV 98.3%. CONCLUSION: A 100% PPV of FS in group A suggests that positive FS margins during TLMC may be safely relied upon in making decisions to upgrade the type of cordectomy being performed. A NPV of 88.9% in group A suggests that despite a clear frozen margin report during TLMC, 11.1% of patients would need further treatment. A PPV of 95.2% in group B suggests that although FS analysis is important for guiding further management, decisions regarding major laryngeal surgery should not be undertaken based solely on FS.

Oncological, Surgical and Functional Outcomes of Transoral Robotic Cordectomy for Early Glottic Carcinoma.

OBJECTIVE: To investigate oncological, surgical and functional outcomes of transoral robotic surgery cordectomy (TORS-Co). METHODS: A retrospective chart review of patients benefiting from TORS-Co for a cT1a vocal fold squamous cell carcinoma was conducted at a single academic medical center. TORS-Co was performed through da Vinci robot. The following outcomes were studied: preoperative and operative exposures; feasibility; conversion rate; average robotic set-up and operative times; margin status; postoperative complications; tracheotomy and feeding tube requirement. RESULTS: The medical record data of 12 patients were collected. Among them, two patients were excluded because the laryngeal exposition was not adequate. From the 10 included patients, TORS-Co was not performed in three patients. The tumor was not exposable regarding anatomical conditions in two patients, while the size of the robot arms did not allow an adequate exposure in another patient. TORS-Co was performed in the remaining seven patients without transient tracheotomy or feeding tube. The mean estimated blood loss was 20 mL. The average robotic set-up and operative times were 26 minutes and 30 minutes, respectively. The mean hospital stay was 2 days. The margins were not analyzable regarding the use of the monopolar. Two patients reported postoperative complications, while five required class 2 analgesics for postoperative pain. The mean duration of follow-up was 44 months (minimum duration of 36 months). One recurrence occurred 2 years post-surgery. The recurrence was successfully treated by transoral laser CO2 microsurgery. CONCLUSION: The exposure of the laryngeal surgical field is the primary limitation of TORS-Co. TORS-Co may not report better oncological and functional outcomes than transoral laser CO2 microsurgery, which remains the gold standard surgical approach for early glottic squamous cell carcinoma.

Long-Term Voice Outcomes After Type I, Type II, or Type V Cordectomy.

INTRODUCTION: We compare long-term voice outcomes in patients treated with European Laryngeal Society (ELS) classification Type I, Type II, or Type V cordectomy. The aim is to understand the impact of Type V cordectomy on voice outcomes in relation to Type I and Type II cordectomy. METHODS: A retrospective review of patients treated with Type I, Type II, or Type V cordectomy by a single surgeon over a 20-year period was performed. Voice Handicap Index-10 (VHI-10) scores, Cepstral Spectral Index of Dysphonia (CSID) measures from CAPE-V sentences, and two-rater GRBAS scores were analyzed. RESULTS: Sixty-two patients were identified with a mean follow-up of 52 months. Of these, there were 43 Type I and 19 Type II cordectomies, including 8 in each group with Type V resections. Significant differences in all parameters were noted between the Type I (VHI 5.7, CSID 20.6, Grade 1.3) and the Type II cohorts (VHI 12.6, CSID 36.3, Grade 1.8) who did not undergo Type V cordectomy. Patients undergoing Type V cordectomy demonstrated voice outcomes (VHI 9.4, CSID 35.6, Grade 1.7) which fell between those of Type I and Type II cordectomies. CONCLUSIONS: Better long-term subjective, objective, and computer-analyzed voice outcomes are noted for patients undergoing Type I rather than Type II cordectomy. When Type V cordectomy is performed, voice outcomes are comparable to those of both Type I and Type II cordectomy, a surprising finding given the expectation of worsened dysphonia in longer resections. Further work is needed to explain this finding and define voice outcomes after Type V cordectomy.

Voice Quality Outcomes After Transoral CO2 Laser Cordectomy: A Longitudinal Prospective Study.

OBJECTIVE: To evaluate the evolution of voice quality in patients after type I-VI transoral CO2 laser cordectomy (TLC) by using validated voice outcome measures over a 12-month period. STUDY DESIGN: Prospective uncontrolled study. SETTING: Monocenter study. METHODS: Patients with laryngeal carcinoma who were eligible for type I-IV TLC were prospectively recruited from a tertiary medical center. The following outcomes were assessed throughout the 12-month posttreatment period: Voice Handicap Index (VHI), GRBAS (grade of dysphonia, roughness, breathiness, asthenia, strain), maximal phonation time, fundamental frequency (F0), F0 standard deviation, percentage jitter, percentage shimmer, noise-to-harmonic ratio, and speech fluency. Analyses were performed considering 2 groups of cordectomies: type I-III vs IV-VI. RESULTS: A total of 131 patients completed the evaluations, totaling 76 type I-III and 55 type IV-VI cordectomies. In type IV-VI, breathiness and maximal phonation time significantly worsened from pretreatment to 1 month posttreatment (P < .05). In the type I-III cordectomy group, VHI, shimmer, roughness, breathiness, and strain significantly improved from pretreatment to 3 months posttreatment, while VHI, F0 standard deviation, shimmer, jitter, grade of dysphonia, roughness, breathiness, and strain improved from baseline to 6 months. Assessments at 12 months posttreatment revealed significant improvements for VHI, shimmer, jitter, noise-to-harmonic ratio, grade of dysphonia, roughness, breathiness, and strain. In the type IV-VI group, VHI significantly improved from baseline to 3, 6, and 12 months posttreatment. Strain improved at 6 and 12 months while roughness improved from baseline to 12 months. Maximal phonation time significantly worsened over the 12-month evaluation period. CONCLUSION: The effect of TLC on voice quality depends on its type. VHI was identified as the most indicative tool of voice changes irrespective of TLC type.

Transoral robotic cordectomy for glottic carcinoma: a rapid review.

OBJECTIVE: The objective of this study was to investigate feasibility, surgical, oncological, and functional outcomes of transoral robotic cordectomy (TORS-Co) and whether TORS-Co reported comparable outcomes of transoral laser microsurgery (TLM). METHODS: PubMed, Scopus, and Cochrane Library were searched by three laryngologists for studies investigating feasibility, surgical, oncological, and functional outcomes of patients benefiting from TORS-Co. The following outcomes were investigated according to the PRISMA statements: age; cT stage; types of cordectomy; surgical settings; complications; and functional and feasibility features. RESULTS: Nine studies published between 2009 and 2021 met our inclusion criteria, accounting for 114 patients. There was no controlled study. TORS-Co was performed in cT1 or cT2 glottic cancer through types II, III, IV, V, or VI cordectomies. The exposure was inadequate in 4% of cases, leading to conversion in transoral laser cordectomy. Margins were positive in 4.5% and local recurrence occurred in 10.7% (N = 8/75). Tracheotomy and feeding tube requirement varied across studies, depending on the types of TORS-Co. The mean duration of robot installation/vocal cord exposure and operative times ranged from 20 to 42 min and 10 to 40 min, respectively. The mean duration of hospital stay ranged from 2 to 7 days. Complications included dyspnea, bleeding, granuloma, synechia, and tongue hematoma and dysesthesia. CONCLUSION: The current robotic systems do not appear adequate for TORS-Co. TORS-Co was associated with higher rates of complications and tracheotomy than TLM.

Voice Outcome After Carbon Dioxide Transoral Laser Microsurgery for Glottic Cancer According to the European Laryngological Society Classification of Cordectomy Types - A Systematic Review.

BACKGROUND: Voice outcome after carbon dioxide transoral laser microsurgery (CO2TOLMS) for glottic cancer is of prime importance. However, a comprehensive overview according to the European Laryngological Society (ELS) classification of cordectomies is still lacking. The aim of this systematic review is to summarize data on voice outcome associated with individual types of ELS glottic cordectomy after CO2TOLMS. MATERIALS AND METHODS: A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The initial search identified 936 records of which 25 publications were then included. Voice outcome data (Voice Handicap Index [VHI] version 30, grade of dysphonia [G] and maximum phonation time [MPT]) were extracted per resection type. Weighted averages were calculated. RESULTS: Data show a gradual increase in the VHI scores although they were still similar for all cordectomy types (range 14.2 to 21.5). The grade of dysphonia showed a gradual increase with increasing resection depth (range 1.0 to 1.9). There was a gradual decrease in the MPT (range 15.2 to 7.2). CONCLUSION: Voice outcome is related to cordectomy type with mild dysphonia characterizing ELS type I, II and III cordectomies, while more extended cordectomies (ELS type IV, V and VI) result in moderate dysphonia and shortness of breath during phonation. The voice handicap experienced by patients is limited even in the more extended cordectomies.

Long-term Oncologic Results and Voice Outcomes in Patients With Glottic Cancer After Modified Type III Cordectomy.

OBJECTIVE: Transoral laser microsurgery and radiotherapy provide high and comparable cure rates for the treatment of early glottic cancer. However, the voice outcomes after treatment remain controversial. A modified type III cordectomy technique was proposed in 2006, and preliminary results showed it to be an oncologically safe method with satisfactory voice outcomes. This study aimed to evaluate oncologic and voice outcomes after long-term follow-up of these patients. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary care academic center. METHODS: Between 2006 and 2018, 42 patients with glottic cancer underwent a modified type III cordectomy. This technique resected the tumor and upper part of the vocal folds and preserved the lower part of the vocalis muscle as a scaffold to improve glottis closure. The oncologic results and voice outcomes were evaluated at a median follow-up of 68 months. RESULTS: The primary tumor stages included 13 T1 (31%), 26 T2 (64%), and 3 T3 (7%). Eight patients (19%) had local recurrence, and 6 underwent successful salvage with transoral laser microsurgery with or without postoperative radiotherapy with laryngeal preservation. The 5-year rate of local control was 80%; laryngeal preservation, 95%; overall survival, 89%; and disease-specific survival, 97%. The final laryngeal preservation rate was 95% (40/42). The voice outcomes were satisfactory and comparable to those of patients who underwent type I and II cordectomies. CONCLUSION: The modified type III cordectomy has been proven to be an oncologically safe method with satisfactory voice outcomes after long-term follow-up in selected cases of early glottic cancer.

Myelopexy: A novel technique in posttraumatic syringomyelia.

Posttraumatic syringomyelia (PTS) is a well-reported phenomenon that usually takes place in the long-term course of patients following spinal cord injury. Different surgical procedures have been described: spinal cordectomy is usually a last option technique, but might be an excellent choice in patients with severe spinal cord injuries. We present a young patient with complete spinal cord injury after spine trauma, who developed posttraumatic syringomyelia with progressive motor deterioration twelve years after fixation. We performed a novel surgical technique (myelopexy) with excellent resolution of syringomyelia, sparing the negative implications of complete cord transection. Some artistic illustrations made by one of the corresponding authors are included, to better understanding of operative details.

Assessment of Early Stage Glottic Cancer Depth of Resection After Transoral Laser Cordectomy.

OBJECTIVE: Surgeons generally determine depth of resection during transoral laser cordectomy by visual inspection of the surgical field. Our aim was to examine the correlation between early glottic cancer depth of resection as reported by surgeons in the operation report and depth of resection defined by pathology specimens, using various staining techniques intended to differentiate between the distinct vocal fold layers based on particular collagen deposition. STUDY DESIGN: Retrospective study. SETTING: A voice and swallowing clinic at a tertiary referral hospital. METHODS: We compared depth of cordectomy assessed intraoperatively by surgeons and by pathologists using Picrosirius red stain and collagen I immunohistochemistry stain in 32 patients who underwent transoral laser cordectomy for early glottic cancer. RESULTS: For type I, II, and III cordectomy, the respective proportions of patients were 14 (47%), 9 (30%), and 7 (23%) according to surgeons' estimations; 2 (6%), 17 (55%), and 12 (39%) according to Picrosirius red stain; and 3 (11%), 12 (44%), and 12 (45%) according to immunohistochemistry for collagen I. CONCLUSION: Surgeons' reported depth of resection did not correlate with depth of resection established by either staining technique. Determining depth of resection necessitates special stains, which should help in the clinical assessment of cordectomy type.

TREATMENT OF EARLY GLOTTIC CARCINOMA WITH TRANSORAL ENDOSCOPIC LASER SURGERY.

Laryngeal carcinoma is one of the most common tumors of the head and neck, just after skin cancer. Alongside open surgery, transoral endoscopic laser surgery (TOLS) has become widespread as a treatment method. Our aim was to assess the efficacy of transoral laser cordectomy in a group of patients with early glottic carcinoma. We retrospectively analyzed data on 131 patients who underwent TOLS in the 2017-2021 period. We divided patients into groups according to tumor stage and type of cordectomy performed, and compared outcomes between the groups. Our results revealed a higher number of patients in the group with Tis and T1a than in those with T1b and T2 who underwent type III cordectomy, and also a higher number of those for whom outpatient follow-ups were sufficient after surgery in the same group. We did not observe significant difference in outcomes according to cordectomy type except for type V (a-d), where a higher number of patients had to undergo radiotherapy. This study underlines the importance of careful patient selection for TOLS, as well as the need for close cooperation with pathology and radiology specialists to ensure optimal approach and extent of surgery for each individual patient. It also displayed TOLS as a sound therapeutic option for early stages of glottic carcinoma but also indicated the need for similar studies in a larger number of patients to elucidate the effectiveness in certain glottis areas.