The Anatomic Location and Distribution Pattern of Malignant and Premalignant Glottic Lesions

Abstract

Objectives: (1) Describe the anatomic location and distribution pattern of glottic dysplasia and early glottic cancer over the vocal folds. (2) Better understand the anatomic locations where glottic carcinogenesis initiates. Methods: A cohort reviewing glottic dysplasia or carcinoma patients, in a referral center, between 2008 and 2013. Lesions were described in terms of location and size, and a novel grid system was used to map their anatomic distribution. Results: A total of 167 patients were included; 78 with dysplasia and 89 with T1 early glottic carcinoma. The medial aspect was found to be more involved than the superior aspect, 95% versus 71%, respectively ( P < .001). Using the grid system, the most involved area was the midpoint of the membranous vocal fold at the transition between the superior and medial aspects. Ninety-seven percent of the lesions occupied this specific area, with no difference between smokers and nonsmokers. The vocal process mucosa was involved in 48 patients. Exclusive vocal process involvement was limited to 2 cases. All other 46 patients demonstrated extensive disease, encompassing more than half of the vocal fold’s length. Carcinoma in situ and invasive carcinoma lesions tended to be larger and to involve the superior aspect, otherwise all lesion types showed similar pattern of distribution. Conclusions: Premalignant and malignant glottic lesions tend to involve the medial aspect of the vocal fold, and the midpoint of the membranous part in particular. This might correlate with the anatomic origin of glottic carcinogenesis.