Phonosurgery after Laser Cordectomy

So, Yoon-Kyung; Son, Young-Ik

J Korean Soc Laryngol Phoniatr Logop > Volume 19(1); 2008 > Article

Journal of The Korean Society of Laryngology, Phoniatrics and Logopedics 2008;19(1): 11-15.

레이저 성문절제술 후의 음성수술

소윤경, 손영익

성균관대학교 의과대학 삼성서울병원 이비인후과학교실

Phonosurgery after Laser Cordectomy

Yoon-Kyung So, Young-Ik Son

Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center

ABSTRACT

Endoscopic laser cordectomy is known as an oncologically sound procedure for T1 and selected T2 glottic carcinoma ; it has comparable local control rate and better long-term laryngeal preservation rate when compared with those of radiotherapy. Even if results of the reported voice outcome studies after surgery or radiotherapy are diverse and controversial, resection deeper than the body layer of the vocal fold (type III, IV, V cordectomy) usually leads to aerodynamic insufficiency during phonation and results in poor voice quality. A keyhole defect or development of synechiae at the anterior commissure after type VI cordecomy may also result in unsatisfactory vocal outcome. However, many advances in phonosurgical techniques are reported to be successfully applied in the reconstruction of glottal defect that is subsequent to endoscopic laser cordectomy. In case of glottal insufficiency, voice restoration can be achieved by means of augmentation of the paraglottic space or medialization of the excavated vocal fold. Injection laryngoplasty with synthetic materials or autologous fat is gaining its popularity for restoring minor glottal volume defect because of its convenience. Laryngeal framework surgery, especially type I thyroplasty with premade implant systems or Gore-Tex, is most frequently used to correct larger glottic volume defect. In case of anterior commissural keyhole defect, additional procedure including laryngofissure may be required. For anterior commissural synechiae, laryngeal keel may be inserted for several weeks or mitomycin-C may be repeatedly applied after the division of adhesive scar to prevent restenosis. In this paper, current concepts and the authors' experiences of phonosurgical reconstruction of vocal function after endoscopic cordectomy will be introduced.

KEY WORDS： Laryngeal neoplasm;Glottis;Voice;Reconstruction;

중심 단어： 후두암;성대;음성;재건;