Phonomicrosurgical treatment of early glottic cancer and carcinoma in situ

Abstract

In recent years, transoral resection of early glottic cancer has developed into a phonomicrosurgical approach that resulted from the convergence of microlaryngoscopic surgical technique theory with body cover mucosal wave theory of voice production. The vocal outcome from these procedures has improved by minimizing the deep resection margin and thereby maximizing the preservation of the vocal folds' normal layered microstructure (laminae propria and epithelium). Recurrence and cure rates from this narrow-margin approach were examined. The phonomicrosurgical resection approach is composed of four basic procedures in which there is an increasing depth of resection to accommodate a narrow-field deep cancer margin. This approach was employed to treat 13 T1 cancers and 7 with carcinoma in situ (CIS). No patients who underwent a cancer resection developed a recurrence. Minimum follow-up on these patients was 2 years and the mean follow-up was 42 months. In the group with CIS, 2 patients developed microinvasive carcinoma despite en bloc excision of the CIS. Both were successfully treated; 1 was resected transorally and the other underwent radiation therapy. This study indicates that the phonomicrosurgical approach, which incorporates a narrow deep cancer margin to enhance the postoperative vocal outcome, resulted in standard control and cure of early glottic neoplasia.