Neck Cancer Center Research Articles

The use and results of bony composite reconstructions in a tertiary Head and Neck Cancer Centre

Bony reconstruction is challenging in the head and neck, especially in patients who have received or will receive radiotherapy. 4 types of bony flaps are commonly used in the head and neck region. The unique features of each flap have been well described in the literature. As a result, it is recognised that a single bony flap cannot treat all the variety of defects. A suitable flap should thus be selected according to the type of bony and soft tissue defect.

Pseudocyst of the Vocal Fold: Distinct Disease Entity or Not?

Hyunchung Chung, Youngtae Yoo, Min Woo Park, Woo-Jin Jeong, Hee Young Son, Myung-Whun Sung, Kwang Hyun Kim and Tack-Kyun Kwon Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul; and Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul; and Department of Otolaryngology-Head and Neck Surgery, Bundang Seoul National University Hospital, Seoul; and Department of Otolaryngology-Head and Neck Surgery, Thyroid/Head & Neck Cancer Center of The Dongnam Institute of Radiological & Medical Sciences (DIRAMS), Busan, Korea

Complementary medicine use in patients with head and neck cancer in Ireland

The objectives of the study were: first, to determine the prevalence of traditional medicine (TM) and complementary and alternative medicine (CAM) use in head and neck cancer patients in Ireland; second, to educate ourselves on the plethora of CAM/TM options available to patients outside the dominion of conventional medicine. The study design consisted of a cross-sectional survey carried out in three head and neck cancer centres. Self-administered questionnaires were distributed to 110 head and neck cancer patients attending the three cancer centres and data were collected for statistical analysis. A total of 106 patients completed the questionnaire; 21.7% of the participants used CAM/TM since their diagnosis with head and neck cancer. CAM/TM usage was higher in female (34.3%) than in male patients (16.2%). CAM/TM use was more common in the 41-50-year age group, in patients with higher educational levels and those holding strong religious beliefs, and also in married than single patients. The most common types of CAM/TM used were spiritual and laying on of hands. The most common reasons reported for using CAM/TM were to counteract the ill effects of treatment and increase the body's ability to fight cancer. Sources of information on CAM/TM were friends (65%), family (48%) and media (21%). This survey reveals a high prevalence of CAM/TM use in head and neck cancer patients, hence emphasising the need for otolaryngologists to educate themselves on the various therapies available to be able to provide informative advice. There is an urgent need for evidence-based investigation of various CAM/TM therapies currently offered to patients.

Prevention of thrombosis after microvascular tissue transfer in the head and neck. A review of the literature and the state of affairs in Dutch Head and Neck Cancer Centers

Free vascularized graft or free-flap reconstruction is frequently used in the reconstruction of defects in head and neck oncology patients. A common complication in free-flap surgery is thrombosis. Thrombosis occurs in 8-14% of cases and often leads to flap failure. A review of the literature on this subject was carried out and Dutch head and neck cancer centres were asked to share their guidelines concerning the prevention of thrombosis after free vascularized graft surgery. No consensus in the literature was found on how thrombosis could best be prevented. The Dutch Head and Neck Cancer Centers use routine deep venous thrombosis prophylaxis to prevent thrombosis in the anastomosis. It was also concluded that non-pharmacologic measures for preventing thrombosis, such as meticulous microvascular surgery and smoking cessation prior to the operation, are thought to play an important role in the prevention of thrombosis in microvascular free-flap reconstructions. It has not been determined which pre- and postoperative pharmacologic measure can prevent thrombosis most effectively. A pharmacologic regimen to prevent thrombosis that is customized to the patient is suggested. This should be based on an individual risk profile for the development of thrombosis.

Cystic masses of the supraclavicular fossa: clinical features and diagnostic strategies

Purpose Cystic masses of the supraclavicular fossa (SCF) are uncommon. The diverse anatomical structures within the SCF create an extended differential diagnosis for any mass arising in the SCF. This study describes the presenting symptoms, radiologic findings, medical and surgical management, and posttreatment outcomes of various cystic mass presenting in the SCF. A review of the literature and diagnostic and therapeutic algorithms are also provided. Methods A retrospective study of an academic tertiary care head and neck cancer center was done. Seven cases of treated cystic masses of the SCF were identified. Diagnostic and therapeutic interventions are described. Results Cross-sectional imaging and needle aspiration or biopsy were obtained in all 7 cases. Aspirates accurately differentiated benign from malignant lesions in 6 cases, identified the offending pathology in 3 cases, and provided inoculum for culture-directed antibiotic therapy in 1 case. Surgical intervention was used for definitive therapy in 6 cases. All patients achieved complete resolution of signs and symptoms of the mass. Conclusions Effective evaluation of a cystic lesion within the SCF mandates a thorough understanding of the anatomy and differential diagnosis. A well-defined algorithm allows successful management of benign and malignant lesions in the SCF.

The Voice Handicap Index with post‐laryngectomy male voices

Surgical treatment for advanced laryngeal cancer involves complete removal of the larynx ('laryngectomy') and initial total loss of voice. Post-laryngectomy rehabilitation involves implementation of different means of 'voicing' for these patients wherever possible. There is little information about laryngectomees' perception of their changed voice quality and communication status. Surgical voice restoration (SVR) has become the 'gold standard' rehabilitation, but there continue to be patients who use other methods of communication. There is no clear evidence comparing patients' perception of their voice handicap across different types of alaryngeal communication. To compare the self-assessed vocal handicap of laryngectomees using SVR with those using non-SVR methods of post-laryngectomy communication. Potential participants were identified from one Head and Neck cancer centre in South Wales. They included both male and female participants using all methods of post-laryngectomy communication. Each patient's Voice Handicap Index (VHI) score, sub-set scores, and group means were calculated. Two major confounding factors: age and time since surgery, and communication method (SVR/non-SVR), were considered to identify factors, other than method of communication, which may influence rehabilitation outcomes. A total of 71 questionnaires were sent out and 62 (82%) were returned from 35 patients who had undergone SVR and 27 patients who used non-SVR methods of communication. Of the non-SVR group, twelve used oesophageal voice, eleven an electrolarynx, two writing and two mouthing for communication. The gender ratio (53:9), age (43-90 years) and time since surgery (1-40 years) were broadly representative of this population, but because of the small number of females, we excluded the women from further analysis. Individual VHI scores ranged from 4 to 106. Both the SVR and non-SVR group mean scores: 44.7 and 50.9, were within the range of moderately severe voice handicap. There was no significant difference between the groups for total VHI scores or two of the three sub-domains, nor any significant effect on voice handicap due to the confounding factors assessed: age or time since surgery. The total VHI score was better by 6.5 ( - 4.9 to 17.9) points in the SVR group (p = 0.3), probably reflecting the literature reporting superior voice in SVR. The data suggest that where patient-assessed quality of life is concerned, SVR and non-SVR outcomes are comparable. This is an important consideration when planning and carrying out treatment recommendations. The study has clear clinical implications; understanding the potential of all methods of post-laryngectomy communication is essential for holistic patient management.

Indications and extent of elective neck dissection in patients with early stage oral and oropharyngeal carcinoma: nationwide survey in The Netherlands

Different strategies are available for the management of patients with early (i.e. tumour stage one or two) oral or oropharyngeal carcinoma and a clinically negative neck. In 2006, a questionnaire was sent to the eight head and neck cancer centres of the Dutch Head and Neck Oncology Cooperative Group. This questionnaire covered: the factors influencing the decision to perform an elective neck dissection; the neck staging procedure; and the types of neck dissection undertaken. All eight questionnaires were returned completed. Respondents indicated that the site (n = 6), size (n = 7) and thickness (n = 6) of the primary tumour were important in decisions regarding elective neck dissection. Ultrasound-guided fine needle aspiration cytology was the most frequently used diagnostic technique (n = 7). Depending on the site and stage of the primary tumour presented, in the different cases 3-7 of the centres would perform an elective neck dissection. Selective neck dissections (i.e. levels I to III/IV) were more frequently performed than modified radical neck dissections. There was no uniformity regarding management of the clinically negative neck in patients with early stage oral and oropharyngeal carcinoma, within The Netherlands.

Integrated media presentation in multidisciplinary head and neck oncology meetings

Multidisciplinary meetings (MDMs) are an essential part of the management of head and neck cancer. Practice care guidance set up by the British Association of Head and Neck Oncologists has recommended that MDMs should have appropriate projection equipment for computer-generated images so that all members of group have access to the same information. The aim of this paper is to review our experience with the integrated visual presentation of head and neck oncology patients and to demonstrate its advantages over conventional approaches. Digital photographs are taken of patients and of their index tumour at presentation or at the time of diagnostic endoscopy. All relevant pre-treatment digitised images from tumour sites and radiological images and histological slides are incorporated into a single presentation using Microsoft PowerPoint software. During the past 2 years, on-line radiological scans have also become accessible for the meeting to aid treatment planning. Subsequently, all peri-operative pictures and post-surgical macroscopic and microscopic histopathological images are added to each patient's presentation, which is then hyperlinked into the agenda. The Guy's and St Thomas' Head and Neck Cancer Centre treats over 400 patients a year, and since 2002, all new cancer diagnoses have been discussed in the weekly MDM as described above. A total of 1,638 presentations have been incorporated in a centralized database that is updated in the event of recurrence, further primary tumours or other clinical developments. Satisfactory documentation and staging of head and neck tumours must include a verbal description, accurate measurement, diagrammatic representation, photographic recording and appropriate radiological imaging. Integrated presentation at MDM collates all relevant findings for clinical management decisions on patients with head and neck cancer. This approach is also an extremely valuable adjunct to long-term clinical monitoring.

Fine‐needle aspiration cytology in a regional head and neck cancer center: Comparison with a systematic review and meta‐analysis

Fine-needle aspiration cytology (FNAC) is used to diagnose masses presenting in the head and neck region. No systematic review of FNAC in this group has yet been performed. A systematic review of the published literature and meta-analysis of data extracted from the included studies were compared with a 10-year review of head and neck FNAC from our institution. Systematic review identified 30 studies; 3459 FNAC aspirates from all head and neck sites were included. Overall results were as follows: sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were 89.6%, 96.5%, 93.1%, 96.2%, and 90.3%, respectively. Two thousand seven hundred two head and neck aspirates were included in our institutional review. Sensitivity, specificity, PPV, NPV, and accuracy were 89.5%, 98.5%, 97.3%, 94.0%, and 95.1%, respectively. Meta-analysis and comparative systematic review confirm that FNAC is highly effective in the diagnosis of head and neck masses, with some limitations.

A new indicator-guided percutaneous emergency cricothyrotomy device: in vivo study in man

There is presently no ideal method of securing an airway during acute upper airway obstruction. A new cricothyrotomy device has been developed, which has theoretical advantages. The goal of this clinical study in a head and neck cancer centre was to assess the safety of the device in man. Patients undergoing laryngectomy/laryngopharyngectomy for carcinoma were recruited. The outcome measures were as follows: time for completion, cardio-respiratory measurements and complications. Four experiments were performed. Two were performed by doctors trained in the technique and it proceeded smoothly, and ventilation was achieved in 110 and 84 s. Examination of excised larynges revealed minimal, but a short linear abrasion on the posterior wall. Two were performed by doctors who had received a limited explanation of the technique and it did not achieve a secure airway. With adequate prior training, this new cricothyrotomy procedure achieves a secure airway quickly with little trauma. This study supports the use of the new cricothyrotomy device by trained staff, but prospective audit of its application in real trauma settings is required.

Multicenter Validation of Recursive Partitioning Analysis Classification for Patients With Squamous Cell Head and Neck Carcinoma Treated With Surgery and Postoperative Radiotherapy

To validate the recursive partitioning analysis (RPA) classification system for squamous cell head and neck cancer as recently reported by the VU University Medical Center. In eight Dutch head and neck cancer centers, data necessary to classify patients according to the RPA system were retrospectively collected from the charts of a group of 780 patients treated between 1989 and 2003. The patients in this validation group were classified according to the RPA classification system. For each endpoint, the 5-year values and hazard ratios were calculated and compared with the results of the VU University Medical Center. The RPA classification system was considered valid if the hazard ratio of the validation population was within the 95% confidence interval of the VU University Medical Center study population. The locoregional control rate was 82%, 75%, and 63% at 5 years for those with class I, II, and III, respectively (p < 0.0001). The hazard ratio for the locoregional control rate relative to class I was 1.44 (95% confidence interval, 0.97-2.16) for class II and 2.37 (95% confidence interval, 1.57-3.57) for class III. Similar results were found for the distant metastasis, overall survival, and disease-free survival rates. The RPA classification system for head and neck squamous cell carcinoma in the postoperative setting, which was originally designed at one center, proved to be valid in a multicenter setting among patients included in a national multicenter study. This validated RPA classification scheme can be used to assess standard treatment strategies for head and neck squamous cell carcinoma in the postoperative setting, as well as in the design of future prospective studies.

A randomized trial of PET scanning to improve diagnostic yield of direct laryngoscopy in patients with suspicion of recurrent laryngeal carcinoma after radiotherapy

The RELAPS study (REcurrent LAryngeal carcinoma PET Study) was designed to determine whether FDG–PET is of value in the selection of patients for direct laryngoscopy under general anesthesia in patients with suspicion of recurrent laryngeal carcinoma after radiotherapy. In a randomized controlled clinical trial the current diagnostic practice, i.e. all patients undergo direct laryngoscopy, will be compared to a strategy in which FDG–PET selects the patients for laryngoscopy. All eight head and neck cancer centers of the Dutch Head and Neck Oncology Cooperative Group NWHHT will participate in this multicenter trial. The study population consists of patients with clinical suspicion of recurrent T2–T4 laryngeal carcinoma after radiotherapy (without obvious signs of tumor) in whom a direct laryngoscopy under general anesthesia with taking of biopsies is indicated by the local physician. The primary efficacy endpoint is the difference in the number of futile indications for direct laryngoscopy between the conventional diagnostic arm and the FDG–PET based diagnostic arm. An indication for laryngoscopy is classified as futile if this laryngoscopy was negative and no recurrence was diagnosed within 6 months follow-up (gold standard). The FDG–PET based strategy may increase the risk of missing recurrent tumor compared to current practice. Safety endpoints include survival and morbidity due to laryngoscopy with taking of biopsies. Survival rates of both groups will have to be collected outside the time frame of the funded trial. Resectability of recurrent tumor and tumor negative surgical margins after total laryngectomy will be used as proxy endpoints. The trial will also compare quality of life and direct medical costs between both arms.

Patients’ views on the utility of quality of life questionnaires in head and neck cancer: a randomised trial

(i) To evaluate head and neck cancer patient perspectives regarding the usefulness of quality of life questionnaires in communicating their health problems to clinicians and (ii) to identify the quality of life questionnaire that head and neck cancer patients find most useful. Randomised questionnaire study. Patients completed all four validated head and neck cancer quality of life questionnaires - European Organisation for Research and Treatment of Cancer (EORTC), Functional Assessment of Cancer Therapy Scale (FACT) HN35, Washington quality of life questionnaire, Auckland quality of life questionnaire. Order of questionnaire presentation was randomised to counterbalance order effects. Tertiary referral head and neck cancer centre. Eighty patients diagnosed and treated for head and neck cancer. blindness, learning difficulties or inability to understand or read English. Patient ratings of perceived usefulness and preferences of studied questionnaires. Patients reported high relevance to their problems and high ease of understanding of all questionnaires, with FACT scoring highest (79% and 89%, respectively); 58% of participants (67% respondents) would like to complete a questionnaire in clinic, as it would help them describe their health problems to their doctors; 28% of participants did not. Almost half preferred a particular quality of life questionnaire, FACT being most preferred. Length of questionnaire did not affect reported usefulness, but most would prefer a short questionnaire (<20 items). Patients report that head and neck cancer quality of life questionnaires effectively describe their health concerns. Most are in favour of completing quality of life questionnaires in clinic, as an aid for describing health problems to clinicians. There appears to be a difference between clinicians and patients regarding the perceived usefulness of quality of life questionnaires in the clinic setting, which needs to be highlighted to clinicians.

Deterioration in quality‐of‐life of late (10‐year) survivors of head and neck cancer

To determine 10-year quality-of-life (QOL) in head and neck cancer patients and to examine the potential predictors of late QOL. Prospective 10-year (QOL) assessment in a cohort of head and neck cancer patients. Tertiary referral head and neck cancer centre in Auckland, New Zealand. Two hundred patients diagnosed and were treated for head and neck cancer. Exclusion criteria were blindness, learning difficulties or inability to understand or read English. Quality-of-life at 10 years measured by Auckland QOL questionnaire, and analysed for associations with the following co-variates: age, gender; co-morbidities (alcohol intake and smoking), type and stage of disease; treatment modality; and QOL measures. At 10 years following diagnosis, overall QOL (life satisfaction), decreased significantly by an average of 11% (95% CI: -5, -17) compared with before treatment, and by 15% when compared with years 1 and 2. Pre-treatment QOL significantly predicted late QOL, whilst QOL 1 year after treatment did not. None of the socio-demographic, disease- or treatment-related factors predicted long-term QOL on univariate analysis, but this may be due to the small sample size. This observed, late drop in the QOL of head and neck cancer patients requires further corroboration and investigation. Due to small sample sizes associated with long-term studies in head and neck cancer cohorts, studies of predictors of long-term QOL will only be likely to succeed if done as multi-centre studies. As there is some evidence to suggest that psychosocial interventions improve the QOL of head and neck cancer patients, it may be appropriate to consider screening for risk of a late deterioration in QOL in order to plan appropriate psycho-social intervention.

Cervicofacial and cervicothoracic rotation flaps in head and neck reconstruction

Compound cervicofacial and cervicothoracic rotation flaps are highly versatile flaps that may be applied to a variety of defects of the cheek, orbit, periauricular region, and neck. These rotation advancement flaps should be a staple of the head and neck surgeon's reconstructive armamentarium. This is a retrospective review of medical records at a university-based head and neck cancer center. Thirty-three patients were identified, with a mean age of 66 years. Primary or recurrent skin neoplasms made up the most common indication for surgery, followed by primary parotid tumors and cervical lymphatic metastases from upper aerodigestive tract malignancies. Defects of the cheek, orbit, periauricular region, and neck were reconstructed with cervicofacial or cervicothoracic flaps, with larger wounds requiring variable extension of the incision onto the chest wall. Other reconstructive modalities were used in 18 cases to increase tissue bulk or provide internal lining. Minor wound complications occurred in 13 patients. There was no statistically significant association between wound complications and smoking or previous radiation therapy. Compound cervicofacial and cervicothoracic rotation flaps provide a straightforward, reliable, and efficient means to reconstruct complex defects of the face, lateral skull base, and neck, with the potential for excellent cosmetic results.

Accuracy of magnetic resonance imaging in predicting absence of fixation of head and neck cancer to the prevertebral space

The purpose of this study was to determine the preoperative accuracy of preservation of the retropharyngeal fat plane on magnetic resonance (MR) images in predicting the absence of fixation or extension of head and neck carcinomas to the prevertebral space. The MR images of 75 patients with T3 or T4 primary pharyngeal or laryngeal cancers seen over a 5-year period and treated at our Head and Neck Cancer Center were retrospectively reviewed. The MR images were independently and blindly evaluated by two head and neck radiologists for preservation of the retropharyngeal fat plane between the tumor and prevertebral musculature. In cases in which the fat was preserved, the prevertebral muscle complex was assessed for the presence of T2 hyperintensity and enhancement. All patients underwent panendoscopy, surgery, or both. Forty of 75 patients had preservation of the retropharyngeal fat plane between the tumor and the prevertebral compartment on T1-weighted images. In all 40 cases, the prevertebral muscles had a normal appearance on T2-weighted and enhanced MR images. Intraoperative assessment revealed absence of fixation of tumor to the prevertebral fascia in 39 of 40 cases, and these tumors were resectable. In patients with advanced head and neck carcinomas, preservation of the fat between the tumor and the prevertebral musculature on unenhanced T1-weighted images reliably predicts absence of prevertebral space fixation.

Squamous cell carcinoma of the buccal mucosa: A retrospective analysis

Objectives: To review our institution’s experience with 23 previously untreated patients with buccal squamous cell carcinoma and describe its clinical course, treatment, outcomes, and prognosis. Methods: Retrospective chart review of 60 patients seen at the University of California, San Francisco (UCSF) Head and Neck Cancer Center identified using the UCSF tumor registry database from 1972 to 2003. Of these, 23 patients were initially treated exclusively at UCSF. Patients who were previously treated elsewhere or whose lesions initially arose in other oral cavity sites and secondarily involved the buccal mucosa were excluded. Results: Patients of all T stages had an almost 34% locoregional recurrence rate (T1 25%, T2 37.5%, T3 33%, T4 40%). Five-year survival rates were as follows: T1 100%, T2 75%, T3 40%, and T4 75%. Eight patients were treated with surgical excision and postoperative radiation therapy, 6 patients with primary radiation therapy, and 9 patients underwent surgical excision alone. The locoregional recurrence rates were 0%, 83%, and 33%, respectively. The 5-year survival rates were 88%, 67%, and 89%, respectively. Perineural invasion was also associated with locoregional recurrence. Follow-up was an average of 4.1 years. Conclusions: Buccal squamous cell carcinoma is an aggressive oral cavity cancer with a historically high rate of locoregional recurrence and poor survival. For all stages, locoregional control and survival rates may be improved with surgical excision followed by radiation therapy rather than by treatment with either radiation or surgical therapy alone.

Palatal reconstruction with the palatal island flap.

The management of palatal defects resulting from the extirpation of benign and malignant lesions uses a variety of methods, with the optimal techniques allowing maximal postoperative function with minimal morbidity. The palatal island flap is an effective, reliable technique for reconstructing postablative oral cavity defects. All patients who underwent palatal resections for benign or malignant lesions at a tertiary care, referral-based head and neck cancer center since 1995 were eligible. Ten patients were identified whose surgical defects were reconstructed with palatal island flaps. The cases were reviewed for the symptomatology, tumor features, defect size, perioperative and postoperative management, complications, and impact on palatal function. Ten patients ranging in age from 18 to 81 years underwent palatal island mucoperiosteal flaps after resection of a variety of benign and malignant tumors, most arising from minor salivary glands. The defects ranged in size from 5 to 15 cm2, with extension into the floor of the nose in four cases and to the skull base in two. Nine patients were discharged on a regimen of oral diet, and no patient manifested permanent velopharyngeal insufficiency, speech impairment, or airway compromise. Follow-up ranged from 3 months to 6 years, with an average follow-up of 18.5 months. Delayed donor site re-epithelialization required debridement in one case, and two patients required obturation of small oronasal fistulae. The palatal island mucoperiosteal flap provides an effective means of reconstructing hard and soft palate defects with few complications and low morbidity.

Rehabilitation after laryngectomy: a practical approach and guidelines for patients.

Laryngectomy causes irreversible loss or distortion in basic human habits, such as speech, swallowing, smelling, tasting, coughing and kissing. Rehabilitation can help a patient to reach the maximal potential within the context of his or her social milieu. Learning and adapting the lifestyle of living after laryngectomy is a challenge that faces the patient and the doctor. The authors' Head and Neck Cancer Center treated more than 100 laryngeal carcinomas with laryngectomy during a five-year period. A multidisciplinary group was established for the education and rehabilitation of laryngectomized patients in order to provide them with the best possible overall quality of life. The group's rehabilitation program is described.

Phonatory results after laser surgery for glottic carcinoma

OBJECTIVE: To identify the influence of type and extent of surgery on postoperative voice parameters after endoscopic laser resection for glottic carcinoma. SETTING AND DESIGN: A multidisciplinary university-based head and neck cancer center. Objective and subjective measures of voice were correlated with type and extent of surgery following a standardized classification in a prospective study including 80 patients. SUBJECTS AND METHOD: The postoperative mechanism of phonation was assessed by videostroboscopy 6 months after surgery at the earliest. A phonetogram was produced, and its area was calculated (relative phonetogram [RP]) in relation to a gender-different normal phonetogram. Two speech therapists (ST) and a trained otolaryngologist (TO) rated each voice independently for communication ability in a grade from 1 (poor) to 5 (near normal). RESULTS: After simple cordectomy the means were as follows: RP = 24.8%, TO = 3.26, and ST = 3.33. When the anterior commissure was completely preserved, mean results were better (RP = 34%, TO = 3.92, ST = 3.83). Results were worse after extended cordectomy (RP = 14.7%, TO = 2.82, ST = 3.00) and transglottic resection (RP = 13.7%, TO = 2.30, ST = 2.86) but were similar within these two groups. The parameters RP, TO, and ST do not differ significantly between the group who had speech therapy after surgery ( n = 33) and the group who did not ( n = 47). Voice production at glottic level yields better results for every parameter than supraglottic substitute phonation. The amount of tissue removed was less significant. CONCLUSION: Postoperative phonatory results correlate with the postoperative mechanism of phonation. There is no linear correlation with the amount of tissue removed. Comparison of similar types of resection preservation of the anterior commissure plays a key role. From the data in this study, there is no evidence for a significant benefit from speech therapy. The parameter RP is an effective and relatively simple parameter to complete auditory voice assessment. (Otolaryngol Head Neck Surg 1998;119:418-24.)