Endolaryngeal Surgery Research Articles

The effect of surgical access on functional and oncological results of resections in laryngeal cancer T2N0M0

Introduction. Laryngeal cancer is the most common malignant neoplasm of the ENT organs. The preferred and primary therapy for this pathology is surgical intervention. The search for highly effective organ-saving methods of surgical treatment aimed at minimization of resection volume and preservation of functioning of the larynx continues. Current endolaryngeal surgery allows to improve functional results and is the most modern and advanced method.Aim. To compare functional and oncological results of surgical treatment of patients with laryngeal squamous cell carcinoma Т2N0M0 performed through transcervical and endolaryngeal accesses.Materials and methods. The results of surgical treatment of patients with squamous cell carcinoma of the vocal folds part of the larynx T2N0M0 performed between 2015 and 2020 at the Oncological Division of Head and Neck Tumors of the The National Medical Research Center for Otorhinolaryngology of the Federal Medico-Biological Agency of Russia were analyzed. The study included 49 men aged 52–72 years; the diagnosis was confirmed by histological examination. All patients underwent standard exams which led to diagnosis per the Tumor, Nodus and Metastasis international system.Results. Three-year recurrence-free survival after endolaryngeal resection of cancer of the vocal folds part of the larynx Т2N0M0 was 88.47 %, after transcervical resections it was 91.31 %. Analysis of functional and surgical results showed that compared to patients who underwent surgery through external access, in patients who underwent surgery with endolaryngeal access the rate of complications associated with the surgical wound in the early postoperative period was 13.04 % lower, frequency of cicatricial stenoses of the larynx was 20.06 % lower, and abnormalities of separating function of the larynx were 49.33 % rarer.Conclusion. In patients who underwent endolaryngeal resection of the larynx, better functional and surgical results were achieved compared to patients who underwent surgery through external access. Moreover, there was no statistically significant difference in oncological results between the study groups. This allows to conclude that minimally invasive endolaryngeal approaches are highly effective and functional in organ-saving surgeries for patients with squamous cell carcinoma of the vocal fold part of the larynx T2N0M0.

Airway management during unusual tracheal stenosis: A clinical feasibility trial.

Prolonged intubation is a known risk factor of LTS. LTS related to COVID-19 may result in a different phenotype: pronation affects the location of stenosis and COVID-19 pneumonia can decline lung mechanics. Therefore, airway management in these patients may carry unique challenges for both anesthesiologists and surgeons.This prospective observational feasibility trial aims to evaluate the use of a novel thin, cuffed, endotracheal tube (Tritube) in combination with flow-controlled ventilation (FCV) in the management of patients with COVID-19-related LTS undergoing laryngeal surgery. 20 patients suffering from COVID-19-related LTS, as diagnosed by CT, requiring endolaryngeal surgery, with or without CO2 laser, were included. Ultrathin endotracheal tube Tritube, together with FCV was used for airway management and ventilation. Feasibility, ventilation efficiency, and surgical exposure were evaluated. Median duration of mechanical ventilation during their ICU stay was 17 days, (range, 7-27), and all patients had been pronated. In 18/20 patients, endoscopic diagnosis confirmed the initial CT diagnosis: posterior subglottic stenosis. Surgeons' satisfaction on the view was rated 9 out of 10 (range 7-10), where 0 was the worst view and 10 was the best view. Hemodynamic and respiratory variables were within the normal clinical range during the surgical procedure. One patient that had a SpO2 of 90% before induction of anesthesia, a temporal drop to 89%, caused meeting the predefined requirement of "respiratory complication." This study demonstrates the feasibility of using Tritube with FCV in patients with relatively unusual subglottic posterior location tracheal stenosis, undergoing laryngotracheal surgery. Tritube provides a good surgical field and FCV provides highly adequate ventilation especially in patients with compromised lung mechanics. IV, non-comparitive prospective clinical trial with 20 patients.

Assessment of Preoperative Predictors for Difficult Laryngeal Exposure in Endolaryngeal Surgery.

The proper visualisation of the larynx is required for the diagnostic assessment and therapeutic intervention. The most significant challenges for surgeon is to visualise the anterior commissure of the glottis region. The aim of this study is to record the preoperative laryngoscore in patients posted for endolaryngeal surgery and to assess preoperative predictors for intraoperative difficult laryngeal exposure by correlating with preoperative laryngoscore. Prospective, Cross-sectional, Observational study. Department of Otorhinolaryngology in a tertiary care teaching facility. 150 patients were included with an endolaryngeal disease who were planned for surgery with age > 18yrs. In 150 subjects preoperative laryngoscore was calculated, which comprised 11 parameters including thyromental distance, mandibular prognathism, macroglossia, micrognathia, trismus, inter incisor gap, degree of neck flexion-extension, history of prior open-neck surgery or radiotherapy, upper jaw dental status, modified Mallampati score and body mass index in order to produce a total score out of a possible maximum score of 17. According to the anterior commissure visualisation all patients were categorised into five classes, ranging from class 0 to class IV during surgery. The laryngoscore parameters were assessed and compared statistically with five classes of intraoperative anterior commissure visualisation. Out of 150 patients 70 (46.6%) were having 3-4 laryngoscore, followed by 45 (30%) patients with 5-6 laryngoscore. Total 123 (82%) patient had class 0,1 and 2 intraoperative anterior commissure visualisation while 27 (18%) had class 3 and 4 visualisation. If laryngoscore was either less or equal to 5, 90% of the patients had excellent laryngeal exposure whereas only 10% of the patients had challenging laryngeal exposure. At univariate analysis, thyromental distance, degree of neck flexion/extension, and modified Mallampati classification were found statistically significant for difficulty of anterior commissure visualisation independently. A sound, easy and valid preoperative laryngoscore may be significantly helpful in identifying intraoperative difficult laryngeal exposure. This may prevent inadequacy of surgery, abandon of surgery, intra operative complication, and medico-legal cases for laryngologist.

Evolution of anaesthesia technique for endolaryngeal surgery through and post-COVID-19 pandemic: An experience from a tertiary referral centre for airway surgery.

Anaesthesia for endolaryngeal surgery is specialised to provide almost a tubeless surgical field. During the coronavirus disease-19 pandemic, when most of the surgeries were staggered, we being in a tertiary referral centre for airway surgery had to modify our existing techniques and observed an evolution in the anaesthesia management which we could continue even in the postpandemic period. Hence, we conducted this retrospective study to analyse the reliability of our locally developed apnoeic high-flow oxygenation technique (AHFO) for endolaryngeal procedures. We conducted this single-centric retrospective study from January 2020 to August 2021 to observe the choice of airway management techniques in endolaryngeal surgery and assess the feasibility and safety of AHFO. We also intend to propose an algorithm for airway management. We calculated the percentages of all necessary parameters to denote the trend in change of practices roughly classifying the study period as prepandemic, pandemic and postpandemic. A total of 413 patients were analysed in our study. The changing trend over preference of AHFO from prepandemic (72%) and dominance of AHFO (92.5%) in the postpandemic period are the most significant observations of our study with 17% patients needing conversion to tube in-tube out technique due to desaturation which is comparable to 14% in prepandemic period. The tubeless field provided by AHFO replaced the conventional airway management techniques. Our study demonstrates the safety and feasibility of AHFO for endolaryngeal surgeries. We also propose an algorithm for anaesthetists involved in laryngology unit.

Deep Neuromuscular Block for Endolaryngeal Surgery: A Systematic Review and Meta-Analysis.

To determine the safety and efficacy of deep neuromuscular block (NMB) for endolaryngeal surgery. PubMed, Web of Science, Cochrane Library, Ovid Medline, Embase, China National Knowledge Infrastructure, Wanfang, VIP databases, and trial registry database. Inclusion criteria followed the PICOS principles: Participants, adults undergoing endolaryngeal surgery; Intervention, deep NMB performed during the surgery; Control, no-deep NMB performed; Outcomes, primary outcome: the incidence of clinically acceptable surgical conditions. the incidence of intraoperative complications (including vocal fold movement and coughing) and total incidence of postoperative complications [including postoperative residual curarization (PORC), postoperative sore throat (POST), and postoperative nausea and vomiting (PONV)]. Study design, randomized controlled trials (RCTs). Duplicate publications, editorials, letters, abstracts, and reviews were excluded. Four articles with 242 patients were identified for analysis. The results indicated that compared with no-deep NMB, deep NMB provides a higher incidence of clinically acceptable surgical conditions (98.36% vs. 76.67%; relative ratio [RR]=1.29, 95% CI: 1.07-1.56), a lower incidence of intraoperative complications (10.83% versus 37.16%; RR=0.32; 95% CI: 0.21-0.49) (lower incidence of vocal fold movement [1.85% vs. 34%; RR=0.08, 95% CI: 0.02-0.41] and coughing [15.53% vs. 38.78%; RR=0.42, 95% CI: 0.27-0.66]). There were no differences in the overall incidence of postoperative complications (RR=2.10, 95% CI: 0.12-36.40). Based on current published evidence, deep NMB provides better surgical conditions with a higher incidence of clinically acceptable surgical conditions and a lower incidence of intraoperative complications (lower incidence of vocal fold movement and coughing) without increasing the overall incidence of postoperative complications. 1 Laryngoscope, 133:2055-2065, 2023.

Primary Laryngeal Aspergillosis - Case Series, Reported in a Tertiary Care Hospital, Bhubaneswar, Odisha, India.

We report 2 vocal fold aspergillosis cases from Otolaryngology department of a tertiary hospital, Bhubaneswar. A 26years old female visited the OPD with chief complaint of progressive hoarseness and pain while talking since 6months. While another 29years old female complained of having progressive hoarseness since 4months preceded by an episode of sore throat. Both cases had microlaryngeal surgery/ endo laryngeal surgery followed by excisional biopsy.

Endolaryngeal surgery of benign vocal fold lesions with a 445 nm semiconductor laser: postoperative management

Introduction. Today the high prevalence of benign vocal fold lesions is shown (up to 55-70%). The possibilities of surgical management of this pathology are very extensive. Laser technologies are becoming more and more popular among high-tech treatment methods. However the comprehensive postoperative management of these patients is equally important.The aim of the study was to assess the features of the postoperative period in patients undergoing the endolaryngeal surgery using a semiconductor laser with a wavelength of 445 nm.Material and methods. On the basis of Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech from February to June 2021 20 patients with benign vocal fold lesions 6 women and 14 men from 24 to 67 years old were examined and treated. All the patients underwent endolaryngeal surgery with direct microlaryngoscopy using a new semiconductor 445 nm laser in an inert gas atmosphere (intraoperative helium supply). After surgical treatment, the patients observed vocal rest, received antiinflammatory, antibacterial therapy, inhalations, as well as the drug Homeovox® according to the standard scheme.Conclusion. Endolaryngeal surgery with the removing of benign vocal fold lesions using a semiconductor laser with a wavelength of 445 nm has been proven to be safe and effective. According to the results of video laryngostroboscopy, acoustic analysis of the voice (the questionnaire “Voice handicap index-30”) it was noted that the laryngeal functions were restored in a short time. The inclusion of Homeovox® in the complex postoperative treatment had a favorable effect on the restoration of the phonatory function.

Vocal outcomes after video assisted cold knife endolaryngeal phonosurgery of benign vocal fold lesions

<p class="abstract"><strong>Background:</strong> This study focuses on therapeutic possibilities in managing benign superficial vocal fold lesions with video assisted cold knife endolaryngeal phonosurgery.</p><p class="abstract"><strong>Methods: </strong>Fifty patients with benign vocal fold lesions presented to us between September 2013 and October 2015 who failed conservative therapy were subjected to video assisted cold knife endolaryngeal phonosurgery. The pre and postoperative results were evaluated based on voice rating by visual analogue scale and GRBAS scale.</p><p class="abstract"><strong>Results</strong>: Encouraging results were achieved with cold knife endolaryngeal surgery as 96.3% of patients were symptom free without any recurrence after single operation. Most of them have achieved >90% of voice outcome by 1 month postoperatively based on voice assessment and laryngoscopic evaluation.</p><p class="abstract"><strong>Conclusions:</strong> Using a telescope with high definition video system for performing phonosurgery is economic, enables the surgeon to acquire static images and video sequences. Cold knife endoscopic laryngeal surgery is possibly a better option for addressing BVFLs.</p>

Consistent Technique Limits Suspension Laryngoscopy Complications.

Introduction Suspension laryngoscopy (SL) is a commonly performed procedure among otolaryngologists. Several studies have shown that adverse effects occur regularly with SL. Objective To evaluate the postoperative complications of SL, and to determine if protecting the dentition and the oral mucosa and limiting suspension times decrease the overall incidence of oral cavity and pharyngeal complications of SL. Methods All of the cases of SL performed by 1 surgeon from November 2008 through September 2014 were retrospectively reviewed. A consistent technique for dental and mucosal protection was utilized, and suspension times were strictly limited to 30 consecutive minutes. The incidence of postoperative complications was calculated and analyzed with respect to gender, smoking status, dentition, laryngoscope type, and suspension system. Results A total of 213 consecutive SL cases were reviewed, including 174 patients (94 male, 80 female). The overall postoperative complication rate was of 3.8%. Four patients experienced tongue-related complications, two experienced oral mucosal alterations, one had a dental injury, and one experienced a minor facial burn. The complication incidence was greater with the Zeitels system (12.5%) compared with the Lewy suspension system (3.3%), although it was not significant ( p = 0.4). Likewise, the association of complications with other patient factors was not statistically significant. Conclusion Only 8 out of 213 cases in the present series experienced complications, which is significantly less than the complication rates observed in other reports. Consistent and conscientious protection of the dentition and of the oral mucosa and limiting suspension times to 30 minutes are factors unique to our series that appear to reduce complications in endolaryngeal surgery.

Deep neuromuscular blockade for endolaryngeal procedures: A multicenter randomized study

The aim of the present study was to compare the surgical condition between deep neuromuscular blockade (NMB) and moderate NMB. Multicenter, randomized, parallel intervention trial. One hundred two patients underwent microscopic endolaryngeal surgery at four university hospitals. The patients were randomized into moderate NMB (train-of-four 1-2) (M group) or deep NMB (post-tetanic count 1-2) (D group) with moderate or high doses of rocuronium, respectively. Surgical rating conditions (SRCs) were evaluated during the surgery. Sugammadex was given to the M group at 2 mg/kg and the D group at 4 mg/kg. Perioperative clinical signs and conditions were recorded until discharge from the postanesthesia care unit. Clinically acceptable SRC was observed in 49 patients (100%) in the D group and 43 patients (89.6%) in the M group (P = .027). The frequency of notable vocal fold movement in the M group was significantly higher than the D group (70.8% vs. 32.7%). The patients in the M group required more additional doses of rocuronium (47.9%) than the D group (20.4%) to maintain full relaxation (P = .005). The median time (interquartile range) from administration of sugammadex to train-of-four ratio 0.9 in the D group was shorter than the M group (120 [109-180 minutes] vs. 180 minutes [120-240 minutes], P = .034). Deep NMB with high doses of rocuronium combined with 4 mg/kg of sugammadex for reversal during endolaryngeal surgery provided better SRC and anesthetic conditions than moderate NMB of rocuronium with 2 mg/kg of sugammadex. 1b Laryngoscope, 130:437-441, 2020.

A Comprehensive Voice Analysis in Benign Vocal Fold Lesions Treated by Cold Knife Endolaryngeal Surgery Using Subjective, Objective and Video-Stroboscopic Parameters.

In the era of globalisation, numerous technical methods have emerged in the management of benign laryngeal lesions. Still cold knife endolaryngeal surgery holds the basic and effective position in providing excellent voice outcome. The aim of this study is to assess the cold knife as a tool for excision of benign laryngeal lesions by protocol of voice assessment. Fifty-five patients with benign vocal fold lesions were included (26 women and 29 men), with age ranging from 22 to 56years. Each patient was subjected to endoscopic microlaryngeal surgery with cold instruments. Voice assessment was done preoperatively and 3weeks postoperatively and 3month post-operatively. The patients were assessed subjectively by Voice Problem Self-Assessment Scale and objectively by laryngoscopy, stroboscopy, and acoustic analysis. Outcome was measured by comparing preoperative and postoperative groups. Significant improvement (< 0.05) was observed in the voice handicap index, acoustic parameters and video stroboscopy parameters between the preoperative and the postoperative groups. The cold knife endo-laryngoscopic surgery still stands out to be a simple, cost effective yet efficient way in treating majority of benign vocal fold lesions causing hoarseness of voice.

Glottik Transoral Robotic Cerrahi Sonrası Nükslerde Suprakrikoid Parsiyel Larinjektominin Yeri

Objective: Organ preservation strategy in laryngeal carcinoma is now the fundamental treatment choice in laryngeal carcinoma. Endolaryngeal surgery (ELS) is one of the successful treatment modalities for organ preservation. With the introduction of transoral robotic surgery (TORS) into glottic laryngeal cancer treatmet options, TORS failure patient management became more important for surgeons interested in head and neck surgery. The aim of this study was to evaluate the functional results, local control, and survival rates in a series of 7 patients who were consecutively managed with Supracricoid Partial Laryngectomy (SCPL) for persistent and recurrence tumors after TORS cordectomy. Material and Methods: Patients who underwent SCPL after failed TORS cordectomy over a seven-year period were enrolled in the study. The patients' age, sex, previous cordectomy type, tumor stage, recurrence interval, recurrence stage, neck dissection adjuvant therapy, decannulation time, and start to oral feeding type were recorded. Results: After salvage surgery, the mean decannulation time was 17.4±3.49 days in 5 patients who could be decannulated. The mean oral intake time was 26.57±23.66 days. The recurrence rate was 14.28% (1/7). The local control rate and organ preservation rate was 85.72%. The functional preservation rate was 71.42%. All patients are feeding orally (100%). Conclusion: With suitable oncologic and functional rates, SCPL is a feasible surgical choice after TORS failure.

The functional outcomes of open vertical resections of the larynx

The early diagnostics of the malignant tumours of the larynx provides a basis for the timely beginning of their conservative treatment and endolaryngeal surgical interventions. However, neither the conservative treatment nor endolaryngeal surgery ensures the sufficiently efficient treatment when the tumour spreads over the anterior commissure, subglottic space, and/or laryngeal ventricles. The open surgical resection of the larynx is indicated for the management of the patients presenting with this condition. Our experience is based on the performance of vertical resection of the larynx in 98 patients including the fronto-lateral and extended fronto-lateral interventions in 63 and 35 of them, respectively. The formation of the malignant tumour is known to result in the alteration of the acoustic characteristics of the patient's voice as compared to the initially normal ones in the preceding period. Specifically, the mean values of the fundamental tone frequency increases, the intensity of the sound signal decreases, and the amplitudes of the fundamental tone harmonics tend to be reduced. At the same time, both the dispersion and the variability of the acoustic characteristics being studied undergo an enhancement in comparison with the normal values. Open resection of the larynx with its simultaneous endoscopic correction made it possible to restore the respiratory and vocal functions in 90.8% and 92.1% of the treated patients respectively.

Использование СО2-лазера в эндоларингеальной хирургии постинтубационных стенозов гортани у детей

Использование СО2-лазера в эндоларингеальной хирургии постинтубационных стенозов гортани у детей

A case report of subglottic haemangioma

&lt;p class="abstract"&gt;We report a case of 18 year old female who presented with hoarseness of voice and hemoptysis for 6 months eventually diagnosed as subglottic haemangioma through video laryngoscopy, CT imaging and histopathological examination of excision biopsy. The tumor excision was done by endolaryngeal surgery with tracheostomy under general anesthesia. The diagnosis of subglottic haemangioma, its management and prognosis were discussed.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Transtracheal high-frequency jet ventilation in a patient with limited mouth opening for endolaryngeal surgery: A case report

Transtracheal high-frequency jet ventilation in a patient with limited mouth opening for endolaryngeal surgery: A case report

New Metal Shield for the Endotracheal Tube during Laser Endolaryngeal Surgery

To present and assess a newly designed autoclavable, reusable tube shield for an endotracheal tube (ETT) during laser laryngeal surgery. This study included patients scheduled for endolaryngeal laser surgery. A carbonated stainless-steel hemisphere shield (~1.5×0.6 mm) connected to a silk thread passing through a hole in its middle near upper edge was used. Under general anesthesia, patients were intubated orally using a small cuffed polyvinyl ETT, filling the cuff with saline. When the laser was used, the shield was applied either to the side of the tube or anterior to it, depending on the site of the laser procedure. The shield could easily be repositioned when needed during surgery. In 25 cases (six cordectomy for glottic carcinomas and 19 posterior cordotomy for bilateral vocal cord paralysis), application of the shield over the ETT was easy and the shield could be easily and simply fitted in all cases, with change in position achieved easily during the work as required. The shield over the ETT could not be penetrated by the laser, regardless of the gas composition or laser energy. No intraoperative complications were encountered in any of our cases. Recovery was event-free in all patients without the need for admission to an intensive care unit. The newly designed autoclavable reusable stainless-steel shield designed for an ETT could be safely, easily, and effectively used during laser laryngeal surgery with low cost and easy availability. However, comparative and multicenter studies are still needed.

A Comprehensive Analysis of Benign Vocal Fold Lesions Causing Hoarseness of Voice and Our Experience with Cold Knife Endolaryngeal Surgery in a Tertiary Healthcare Centre.

Benign vocal fold lesions (BVFL) frequently affect the general population and cause significant hoarseness by interfering with daily communication. Healthcare for low income groups in India is all about affordability and availability without giving up on quality and providing maximum satisfaction. (1) To analyse over a period of 4years, the demographics, clinical profile, diagnostics and management options of BVFL. (2) To assess the diagnostic potential of rigid laryngoscopy in diagnosing these lesions. (3) Cold knife endolaryngeal surgery as a cost effective, satisfactory and efficient treatment modality to tackle majority of these BVFL. A prospective cross sectional study over a period of 4years from 2013 to 2017. 114 patients presenting with hoarseness of voice were evaluated by indirect laryngoscopy followed by video laryngoscopy and stroboscopy in the department of ENT, MYH Hospital Indore (M.P.). Male:female ratio of 1.59:1 with male predominance (61.4%) and maximum incidence in the third decade (32%). All cases presented with hoarseness (100%) while vocal fatigue (63%) was the most common associated complaint followed by foreign body sensation (60%). Housewives (32%) were most commonly involved non professional group while teachers (13%) constituted the most common group of professionals. Laryngitis (26%) involving bilateral vocal folds diffusely was the most common finding followed by vocal fold sulcus (18%) and vocal fold cysts (14%). The duration of symptom was 6months to 1year in 52% patients. The positive predictive value for rigid laryngoscopy was 100% for vocal nodules, arytenoid granulomas and anterior glottis web. Out of 114 patients, 66 patients improved on conservative management while 48 patients underwent cold knife endolaryngeal surgery. As per the GRBAS scale to assess the post therapeutic prognosis, all had good outcome of voice with only two recurrences due to patient non compliance. In this rapidly evolving era of sophisticated lasers which is a costly affair that requires skilled personnel and safety precautions, the prime goal in a government run setup has always been to provide affordable and quality healthcare to the common man. Cold knife endolaryngeal surgery is a simple, cost effective and efficient way to tackle most of these lesions and hence helps in achieving this goal.

High frequency jet ventilation during endolaryngeal surgery: Risk factors for complications

Microlaryngeal surgery requires teamwork between surgeons and anesthesiologists. High-frequency jet ventilation (HFJV) is an artificial breathing technique, preferred during endolaryngeal interventions, which offers a good solution for the requirements. Most studies investigating independent risk factors for intraoperative complications during HFJV in endolaryngeal surgery (ELS) has been retrospective and not standardized and the anesthetic approach has not been standardized. This prospective cohort study aimed to identify risk factors of complications related to HFJV in ELS under a standardized anesthesia regimen. 243 patients who underwent ELS with infraglottic HFJV were investigated. Infraglottic jet ventilation catheter was placed and anesthesia was standardized. Demographic and operative data were noted. Hemodynamics, SpO2 and end-tidal CO2 were recorded at regular intervals. Complications such as hemodynamic disturbances, respiratory problems, barotrauma, equipment failure and requirement for conventional ventilation were also documented. 222 patients were included. Hypoxia, hypercapnia and the need for intubation were observed in 20(9%), 4(1.8%), 10(4.5%) patients. Bradycardia, hypotension and arrhythmia were observed in six (2.7%), 24(10.8%), and four (1.8%) patients respectively. Respiratory complications were associated with body mass index (BMI) (p < 0.001, OR: 1.57, 95%CI: 1.31–1.88) and previous major airway surgery (p < 0.001, OR: 34.0, 95%CI:3.52–328.24), whereas hemodynamic complications were associated with duration of the operation (p = 0.034, OR:1.04, 95%CI:1.0–1.09) and history of previous major airway surgery (p = 0.005, OR:9.57, 95%CI:1.97–46.49). Infraglottic HFJV can be evaluated as an alternative breathing technique to conventional ventilation during endolaryngeal interventions. However, longer operation and previous laryngeal surgeries can increase the incidence of respiratory complications.

Transoral surgery vs intensity-modulated radiotherapy for early supraglottic cancer: a systematic review.

To provide clinicians with a critical review of outcomes for endolaryngeal surgery and intensity-modulated radiation therapy (IMRT) for early-stage supraglottic cancer. A total of 971 potential articles were reviewed, with inclusion of 14 studies comparing IMRT with transoral surgery. One study analyzed IMRT, one transoral robotic surgery, and the remaining were transoral laser microsurgery studies. A weighted average and 95% confidence interval of all surgery patients showed a local control of 90.36 ± 1.14% (n = 118) for T1 lesions, 83.09 ± 1.36% (n = 232) for T2 lesions, and 86.38 ± 0.82% (n = 429) overall. The one study examining IMRT outcomes reported a local control of 70 ± 10.07% and overall survival of 63% over 5 years for T2 lesions (n = 78), with no reported T1 data or secondary outcomes. Endolaryngeal surgery as definitive therapy for T1 and T2 supraglottic cancer has excellent local control. Although endolaryngeal surgery performed better than IMRT, the data are limited, and a definitive comparison with surgery cannot be made. Additional studies are required.