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REVIEW ARTICLE
Year : 2011  |  Volume : 1  |  Issue : 1  |  Page : 6-11

Voice outcomes after laser cordectomy


Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain

Correspondence Address:
Faustino Nunez-Batalla
c/Las Mazas #40-6, 33191, Oviedo
Spain
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-9748.76130

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Early glottic carcinoma can be treated using endoscopic surgery, radiotherapy, or partial open surgery. Lesions limited to the vocal fold are normally treated with endoscopic surgery or partial open surgery, with local control results between 80% and 90%. The choice of one treatment over another should contemplate the cure rate, larynx preservation rate, post-treatment voice quality, morbidity, and treatment cost. Although both external beam radiotherapy and endoscopic carbon dioxide laser excision of early glottic cancer will affect voice quality, it is difficult to compare them. A complete voice assessment including perceptual, objective, and subjective evaluation is mandatory whenever a meaningful analysis of the pathological voice is to be accomplished. Meta-analyses of the results of voice treatments are generally limited and may even be impossible owing to the major diversity in the ways functional outcomes are assessed. The postsurgical voice outcome depends upon having a straight postoperative vocal fold for glottic closure and intact vibration from the contralateral vocal fold. Subepithelial and subligamental cordectomies are oncologically safe resections and have a quality of voice comparable to that of controls. By contrast, with wider resections (types III-V cordectomies), a concave neocord may form resulting in an aerodynamic glottic incompetence. In order to select the most appropriate treatment modality according to the patient's age, gender, compliance, and professional activity, a detailed preoperative counseling concerning vocal outcome is recommended. After phonosurgical resection, patients who have lost paraglottic musculature may benefit from medialization and augmentation procedures to re-establish glottic competence.


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