Single and double mucosal microflap CO2 laser “sliding” technique in the management of iatrogenic glottic web: anatomical and functional results
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).
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.
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.
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.
KeywordsAnterior glottic web Microflap Dysphonia Microlaryngoscopy CO2 laser
The authors would like to thank Mrs. Cristina Di Leo for assistance with the figures.
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.
The authors declare no funding.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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.
Informed consent was obtained from all individual participants included in the study.
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