Study on the prevention of vocal cord adhesion after operation of T1b glottic carcinoma by repairing the wound with transposition of ventricular mucosal flap

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Objective: To explore the feasibility of one-stage repair and reconstruction of glottic area wounds with the ventricular mucosal flap to prevent postoperative vocal cord adhesion in patients with T1b glottic laryngeal cancer. Methods: This case series study involved the research and analysis of clinical data of 12 patients with T1b glottic laryngeal cancer treated in the Department of Otorhinolaryngology, the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2021 to June 2023. All patients were male, aged 50-85 years (median age 64.5 years), and underwent CO2 laser vocal cord resection under oral support laryngoscopy, followed by one-stage reconstruction of the glottic wound using a ventricular mucosal flap transfer. Postoperative observation indicators included oncological efficacy, surgical complications, degree of vocal cord adhesion, and vocal function, with routine follow-up conducted. The preoperative and postoperative Voice Handicap Index (VHI) scores were compared using a paired-sample Wilcoxon signed-rank test. Results: All 12 patients were followed up for more than 1 year, with follow-up periods ranging from 12 to 37 months and a median follow-up period of 19.5 months. During the follow-up period, no tumor recurrence was observed in any of the patients. One patient experienced suture detachment and displacement of the ventricular mucosal flap postoperatively, and no patient reported respiratory distress symptoms after surgery. 6 patients had no postoperative vocal cord adhesion, and the vocal cord length ratio in 12 patients was (0.80±0.23). The maximum glottic opening angle after surgery was (46.5±7.7) degrees. Voice function was evaluated before surgery and in six months postoperatively, when the laryngeal mucosa was on the stable phase. The median VHI-10 score for the 12 patients was 20 preoperatively and 10 postoperatively, the difference was statistically significant (Z=-2.827,P<0.05). Conclusions: The application of ventricular mucosal flap repair and reconstruction for glottic wound following laser resection of T1b laryngeal cancer effectively prevents postoperative vocal cord adhesion. The postoperative recovery of vocal function in these patients is favorable.