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KMID : 1037020120010010021
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Medical Lasers; Engineering, Basic Research, and Clinical Application
2012 Volume.1 No. 1 p.21 ~ p.27
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CO2 Laser in the Diagnosis and Treatment of Early Cancer of the Vocal Fold
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Cho Jae-Gu
Park Min-Woo
Baek Seung-Kuk
Kwon Soon-Young
Jung Kwang-Yoon
Woo Jeong-Soo
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Abstract
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Background and Objectives: We report on our experiences with the CO2 laser in the diagnosis and treatment of early cancer of the vocal fold, as well as the voice quality produced after this type of treatment.
Materials and Methods: A total of 74 patients underwent cordectomy using a CO2 laser for either diagnosis or treatment of an early cancer of the vocal fold. Type I cordectomy consisted of the resection of the entire epithelium, while leaving the vocal ligament intact. Type II cordectomy involved removal of the vocal fold from the vocal process to the anterior commissure and passing through the inferior thyroarytenoid muscle. Type IIIA required vocal fold resection along the internal side of the thyroid ala, while type IIIB included removal of the anterior commissure.
Results: Type I cordectomies were performed using an Acuspot micromanipulator, which provided a 250-gm-diameter beam for a working distance of 400 mm, and in the shot-by-shot cutting mode with 3 W power superpulse. This cordectomy was performed in 39 patients and a dysplasia or an early carcinoma was detected in 45.9% of cases. Type II and type III procedures were performed using the Microslad micromanipulator having a 700 micrometer-diameter beam in the continuous cutting mode, with 7 W power superpulse. Fifteen cases were treated with type II cordectomy; of these, three patients with T1aN0M0 tumors underwent postoperative radiotherapy due to insufficient resection and two patients with T1aN0M0 tumors later underwent reconstructive laryngectomy. A type III cordectomy was performed in 14 patients with T1aN0M0 carcinomas and three patients with severe dysplasia. The margins of resection were found to be positive histologically in 23.5% of these cases, making frozen section examinations mandatory at the time of surgery.
Conclusion: Results of all procedures showed that voice was best after a type I cordectomy where only the epithelium was resected. In type II and type III cordectomies, the quality of voice depended on development of a fibrous fold and the absence of anterior synechia in the healed larynx.
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KEYWORD
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Glottic carcinoma, Laser cordectomy, Quality of voice, Acoustic voice analysis
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