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

  • Filippo Carta
  • Cinzia MarianiEmail author
  • Daniela Quartu
  • Edoardo Gioia
  • Natalia Chuchueva
  • Roberto Puxeddu



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.


Anterior glottic web Microflap Dysphonia Microlaryngoscopy CO2 laser 



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

Author 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.


The authors declare no funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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

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

Supplementary material

405_2019_5632_MOESM1_ESM.xlsx (36 kb)
Supplementary file1 (XLSX 36 kb)


  1. 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 6:261–264Google Scholar
  2. 2.
    Cao Y, Sun G (2018) Surgical treatment modalities for iatrogenic anterior glottic stenosis. Ann Otol Rhinol Laryngol 127:946–952. CrossRefGoogle Scholar
  3. 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. CrossRefGoogle Scholar
  4. 4.
    McGuirt WF, Salmon J, Blalock D (1984) Normal speech for patients with laryngeal webs. Laryngoscope 94:1176–1179. Google Scholar
  5. 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. CrossRefGoogle Scholar
  6. 6.
    Cohen SR (1985) Congenital glottic webs in children. A retrospective review of 51 patients. Ann Otol Rhinol Laryngol 121:2–16CrossRefGoogle Scholar
  7. 7.
    Koltai PJ, Mouzakes J (1999) The surgical management of anterior glottic webs. Oper Tech Otolayngol Head Neck Surg 10:325–330. CrossRefGoogle Scholar
  8. 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. CrossRefGoogle Scholar
  9. 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. CrossRefGoogle Scholar
  10. 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. CrossRefGoogle Scholar
  11. 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. CrossRefGoogle Scholar
  12. 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. CrossRefGoogle Scholar
  13. 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. CrossRefGoogle Scholar
  14. 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 127:1294–1297Google Scholar
  15. 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. CrossRefGoogle Scholar
  16. 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. CrossRefGoogle Scholar
  17. 17.
    Yilmaz T (2019) Surgical treatment of glottic web using butterfly mucosal flap technique: experience on 12 patients. Laryngoscope 129:1423–1427. CrossRefGoogle Scholar
  18. 18.
    Jackson C, Coates GM (1929) The nose, throat and ear and their disease. WB Saunders, Philadelphia, pp 166–168Google Scholar
  19. 19.
    Stasney CR (1995) Laryngeal webs: a new treatment for an old problem. J Voice 9:106–109. CrossRefGoogle Scholar
  20. 20.
    McNaught R (1950) Surgical correction of anterior web of the larynx. Trans Am Laryngol Rhinol Otol Soc 54th Meeting, pp 232–242.
  21. 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. CrossRefGoogle Scholar
  22. 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. CrossRefGoogle Scholar
  23. 23.
    Hirshoren N, Eliashar R (2009) Wound-healing modulation in upper airway stenosis-myths and facts. Head Neck 31:111–126. CrossRefGoogle Scholar
  24. 24.
    Schweinfurth J (2002) Single-stage, stentless endoscopic repair of anterior glottic webs. Laryngoscope 112:933–935. CrossRefGoogle Scholar
  25. 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. CrossRefGoogle Scholar
  26. 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. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Unit of Otorhinolaryngology, Department of SurgeryAzienda Ospedaliero-Universitaria Di Cagliari, University of CagliariCagliariItaly
  2. 2.I.M. Sechenov First Moscow State Medical UniversityMoscowRussia

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