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Modified approach of the anterior commissure for transoral cordectomy in case of difficult exposure: a surgical innovation

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Abstract

Purpose

To propose, in patients presenting a difficult laryngeal exposure, a surgical innovation allowing to perform a transoral laser cordectomy for cancers reaching the anterior commissure or the anterior third of vocal folds (according to the European Laryngological Society classification of laryngeal endoscopic cordectomies).

Methods

Our surgical technique consisted of adding to conventional cordectomies a modified relaxation thyroplasty proposed by Isshiki (type III), also called relaxation thyroplasty by a medial approach in the European Laryngological Society classification system. The anterior commissure retrusion is usually employed in the management of high-pitched voice disorders, but can also allow a better exposure of the anterior commissure.

Results

We described here this surgical innovation through the example of our first two patients. For both patients, the definitive histologic analysis showed negative microscopic margins and there was no post-operative complication. There was no need for a tracheostomy. They were allowed to take a normal diet after 2 days and were discharged after 4 days. The voice was breathy and hoarse as expected in case of extended cordectomy.

Conclusions

This surgical innovation corresponding to the addition of an anterior commissure retrusion by a bilateral thyrotomy could be useful in the ELS classification of endoscopic cordectomies. It should allow surgeons to carry out a transoral CO2 laser cordectomy in patients with a T1 and sometimes T2 glottic carcinoma, even with a difficult laryngeal exposure.

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Authors and Affiliations

  1. Department of Oto-Rhino-Laryngology and Head and Neck Surgery, APHM, La Conception University Hospital, 147 bd baille, 13385, Cedex Marseille, France

    Alexia Mattei, Carole Boulze, Laure Santini, Matthieu Le Flem, Patrick Dessi, Nicolas Fakhry & Antoine Giovanni

  2. Aix Marseille Univ, CNRS, LPL, UMR 7309, Aix-en-Provence, France

    Alexia Mattei, Nicolas Fakhry & Antoine Giovanni

  3. Aix Marseille Univ, Marseille, France

    Carole Boulze & Matthieu Le Flem

  4. Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France

    Patrick Dessi

Authors
  1. Alexia Mattei
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  2. Carole Boulze
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  3. Laure Santini
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  4. Matthieu Le Flem
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  7. Antoine Giovanni
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Correspondence to Alexia Mattei.

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Online Resource 1 Patient 1’s voice 1 year after treatment: a hoarse and breathy but perfectly intelligible voice 1 (MP4 8568 kb)

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Mattei, A., Boulze, C., Santini, L. et al. Modified approach of the anterior commissure for transoral cordectomy in case of difficult exposure: a surgical innovation. Eur Arch Otorhinolaryngol 277, 301–306 (2020). https://doi.org/10.1007/s00405-019-05692-2

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  • DOI: https://doi.org/10.1007/s00405-019-05692-2

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