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Single and double mucosal microflap CO2 laser “sliding” technique in the management of iatrogenic glottic web: anatomical and functional results

  • Laryngology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

An anterior glottic web consists of the formation of a bridge of scar tissue covered by epithelium between the anterior free edges of the true vocal cords and represents one of the most common complications of laryngeal endoscopic surgery for tumors involving the anterior commissure. Endoscopic surgery is the therapy of choice, but simple section of the web is burdened by a high recurrence rate. Topical application of mitomycin C, intracordal stents, and the use of mucosal microflaps have been proposed to improve outcomes. We report our experience with the use of single and double mucosal microflaps (sliding technique) during the management of iatrogenic anterior glottic web (IAGW).

Methods

From November 2010 to December 2018, 30 patients (29 males, 1 female, mean age 65 years, range 47–87 years) were observed for IAGW, and 11 of these patients (36.7%) required surgical treatment. The Voice Handicap Index (VHI) and the GRBAS were used for the perceptive evaluation of pre- and post-operative voice quality.

Results

A reduction of the web length was observed in all cases, and we did not observe any residual web at the mid-third of the glottis. The mean post-operative VHI score decreased from 45 to 24, and the mean post-operative GRBAS values were reduced from 2.8, 2.4, 2.3, 2.1, and 1.1 to 1.9, 1.4, 1.3, 1.1, and 0, respectively.

Conclusions

The microflap technique represents an effective and reproducible one-step procedure that, in expert hands, allows to obtain good anatomical and functional results in a high percentage of cases.

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References

  1. Deganello A, Gallo O, Gitti G, de'Campora E, Mahieu H (2010) New surgical technique for endoscopic management of anterior glottic web. B-ENT 6:261–264

    CAS  PubMed  Google Scholar 

  2. Cao Y, Sun G (2018) Surgical treatment modalities for iatrogenic anterior glottic stenosis. Ann Otol Rhinol Laryngol 127:946–952. https://doi.org/10.1177/0003489418803651

    Article  PubMed  Google Scholar 

  3. Garrel R, Amy de La Breteque B, Canitrot L, Frery A, Guerrier B (2012) One-step microsurgery for acquired anterior glottic web. Eur Ann Otorhinolaryngol Head Neck Dis 129:61–63. https://doi.org/10.1016/j.anorl.2011.10.004

    Article  CAS  PubMed  Google Scholar 

  4. McGuirt WF, Salmon J, Blalock D (1984) Normal speech for patients with laryngeal webs. Laryngoscope 94:1176–1179. https://doi.org/10.1288/00005537-198409000-00009

    Article  CAS  PubMed  Google Scholar 

  5. Puxeddu R, Sionis S, Gerosa C, Carta F (2015) Enhanced contact endoscopy for the detection of neoangiogenesis in tumors of the larynx and hypopharynx. Laryngoscope 125:1600–1606. https://doi.org/10.1002/lary.25124

    Article  PubMed  Google Scholar 

  6. Cohen SR (1985) Congenital glottic webs in children. A retrospective review of 51 patients. Ann Otol Rhinol Laryngol 121:2–16

    Article  CAS  Google Scholar 

  7. Koltai PJ, Mouzakes J (1999) The surgical management of anterior glottic webs. Oper Tech Otolayngol Head Neck Surg 10:325–330. https://doi.org/10.1016/s1043-1810(99)80017-7

    Article  Google Scholar 

  8. Remacle M, Eckel HE, Antonelli A, Brasnu D, Chevalier D, Friedrich G, Olofsson J, Rudert HH, Thumfart W, de Vincentiis M, Wustrow TPU (2000) Endoscopic cordectomy. A proposal for a classification by the Working Committee. Eur Laryngol Soc Eur Arch Otorhinolaryngol 257:227–231. https://doi.org/10.1007/s004050050228

    Article  CAS  Google Scholar 

  9. Remacle M, Van Haverbeke C, Eckel H, Bradley P, Chevalier D, Djukic V, de Vicentiis M, Friedrich G, Olofsson J, Peretti G, Quer M, Werner J (2007) Proposal for revision of the European laryngological society classification of endoscopic cordectomies. Eur Arch Otorhinolaryngol 264:499–504. https://doi.org/10.1007/s00405-007-0279-z

    Article  PubMed  Google Scholar 

  10. Carta F, Bandino F, Olla AM, Chuchueva N, Gerosa C, Puxeddu R (2018) Prognostic value of age, subglottic, and anterior commissure involvement for early glottic carcinoma treated with CO2 laser transoral microsurgery: a retrospective, single-center cohort study of 261 patients. Eur Arch Otorhinolaryngol 275:1199–1210. https://doi.org/10.1007/s00405-018-4890-y

    Article  PubMed  Google Scholar 

  11. Edwards J, Tanna N, Bielamowicz SA (2007) Endoscopic lysis of anterior glottic webs and silicone keel placement. Ann Otol Rhinol Laryngol 116:211–216. https://doi.org/10.1177/000348940711600309

    Article  PubMed  Google Scholar 

  12. Lahav Y, Shoffel-Havakuk H, Halperin D (2015) Acquired glottic stenosis-the ongoing challenge: a review of etiology, pathogenesis, and surgical management. J Voice 29:646 e641–646 e610. https://doi.org/10.1016/j.jvoice.2014.10.012

    Article  Google Scholar 

  13. Chen J, Shi F, Chen M, Yang Y, Cheng L, Wu H (2017) Web thickness determines the therapeutic effect of endoscopic keel placement on anterior glottic web. Eur Arch Otorhinolaryngol 274:3697–3702. https://doi.org/10.1007/s00405-017-4689-2

    Article  PubMed  Google Scholar 

  14. Xiao Y, Wang J, Han D, Ma L, Ye J, Xu W (2014) Vocal cord mucosal flap for the treatment of acquired anterior laryngeal web. Chin Med J 127:1294–1297

    PubMed  Google Scholar 

  15. Benmansour N, Remacle M, Matar N, Lawson G, Bachy V, Van Der Vorst S (2012) Endoscopic treatment of anterior glottic webs according to Lichtenberger technique and results on 18 patients. Eur Arch Otorhinolaryngol 269:2075–2080. https://doi.org/10.1007/s00405-012-2001-z

    Article  CAS  PubMed  Google Scholar 

  16. Roh JL, Yoon YH (2005) Prevention of anterior glottic stenosis after transoral microresection of glottic lesions involving the anterior commissure with mitomycin C. Laryngoscope 115:1055–1059. https://doi.org/10.1097/01.MLG.0000163341.67553.B9

    Article  CAS  PubMed  Google Scholar 

  17. Yilmaz T (2019) Surgical treatment of glottic web using butterfly mucosal flap technique: experience on 12 patients. Laryngoscope 129:1423–1427. https://doi.org/10.10022/lary.27531

    Article  PubMed  Google Scholar 

  18. Jackson C, Coates GM (1929) The nose, throat and ear and their disease. WB Saunders, Philadelphia, pp 166–168

    Google Scholar 

  19. Stasney CR (1995) Laryngeal webs: a new treatment for an old problem. J Voice 9:106–109. https://doi.org/10.1016/s0892-1997(05)80228-0

    Article  CAS  PubMed  Google Scholar 

  20. McNaught R (1950) Surgical correction of anterior web of the larynx. Trans Am Laryngol Rhinol Otol Soc 54th Meeting, pp 232–242. https://doi.org/10.1288/00005537-195003000-00004

    Article  Google Scholar 

  21. Paniello RC, Desai SC, Allen CT, Khosla SM (2013) Endoscopic keel placement to treat and prevent anterior glottic webs. Ann Otol Rhinol Laryngol 122:672–678. https://doi.org/10.1177/000348941312201102

    Article  PubMed  Google Scholar 

  22. Veen EJ, Dikkers FG (2010) Topical use of MMC in the upper aerodigestive tract: a review on the side effects. Eur Arch Otorhinolaryngol 267:327–334. https://doi.org/10.1007/s00405-009-1151-0

    Article  PubMed  Google Scholar 

  23. Hirshoren N, Eliashar R (2009) Wound-healing modulation in upper airway stenosis-myths and facts. Head Neck 31:111–126. https://doi.org/10.1002/hed.20925

    Article  PubMed  Google Scholar 

  24. Schweinfurth J (2002) Single-stage, stentless endoscopic repair of anterior glottic webs. Laryngoscope 112:933–935. https://doi.org/10.1097/00005537-200205000-00029

    Article  PubMed  Google Scholar 

  25. Isshiki N, Taira T, Nose K, Kojima H (1991) Surgical treatment of laryngeal web with mucosa graft. Ann Otol Rhinol Laryngol 100:95–100. https://doi.org/10.1177/000348949110000203

    Article  CAS  PubMed  Google Scholar 

  26. Remacle M, Lawson G, Degols JC, Evrard I, Jamart J (2000) Microsurgery of sulcus vergeture with carbon dioxide laser and injectable collagen. Ann Otol Rhinol Laryngol 109:141–148. https://doi.org/10.1177/000348940010900206

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Mrs. Cristina Di Leo for assistance with the figures.

Funding

The authors declare no funding.

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Author notes

  1. Filippo Carta and Cinzia Mariani have contributed equally to the manuscript.

Authors and Affiliations

  1. Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria Di Cagliari, University of Cagliari, Cagliari, Italy

    Filippo Carta, Cinzia Mariani, Daniela Quartu, Edoardo Gioia & Roberto Puxeddu

  2. I.M. Sechenov First Moscow State Medical University, Moscow, Russia

    Natalia Chuchueva

Authors
  1. Filippo Carta
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  2. Cinzia Mariani
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  6. Roberto Puxeddu
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Contributions

FC, CM, and RP wrote the manuscript. DQ and EG contributed to the collection and analysis of the clinical data. NC provided final editing and review of the manuscript. All of the authors reviewed and contributed to the present form of the manuscript.

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Correspondence to Cinzia Mariani.

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The research described herein did not involve any animal models. The research involved human participants and was conducted in accordance with the ethical standards adopted by the institutional and national research committees and with the principles set forth in the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Carta, F., Mariani, C., Quartu, D. et al. Single and double mucosal microflap CO2 laser “sliding” technique in the management of iatrogenic glottic web: anatomical and functional results. Eur Arch Otorhinolaryngol 276, 3405–3412 (2019). https://doi.org/10.1007/s00405-019-05632-0

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