Steffen Maune, MD, PhD, Professor and Head of the Department of Otorhinolaryngology-Head and Neck Surgery at the Municipal Hospital in Cologne, Germany, emphasized the importance of diagnostic techniques before surgery is performed, including endoscopy and ultrasound of the neck.
Explore this issue:May 2009
He also drew attention to the use of the stepwise resection, removing a lesion through a series of cuts rather than one sweeping move. This allows microscopic control of the incision, better control over the deeper parts of the procedure, and identification of the relationship of the tumor to the cartilage, and means better observation of resection margins. In addition, he highlighted the need for carefully handling of the tumor to avoid the spread of metastases.
We are able to decide how much distance we want to have, he said. You need either R-0 resection, which is very important for the prognosis, or optimal postoperative function, which is part of the advantage of the laser. It lets you peel down to get to an R-0 situation correlated with optimal quality of life.
Steven M. Zeitels, MD, the Eugene B. Casey Professor of Laryngeal Surgery at Harvard Medical School and the Director of the Center for Laryngeal Surgery and Voice Rehabilitation at Massachusetts General Hospital in Boston, said there were exciting prospects for restoring voice through phonosurgical procedures.
In a case he presented, a woman who was nearly without a voice due to a T2b glottic cancer in which the dominant side of the cancer extended out to the thyroid lamina.
We decided to split the tumor, cut one side out conventionally, and treat the other side with an angiolytic laser to see if we could recover any epithelial superficial lamina propria, he said.
On the side in which the cancer was resected to the thyroid lamina, the vocal fold was reconstructed with a fat transplantation as well as a transcervical medialization laryngoplasty and anterior commissure thyroid lamina subluxation. Five years later, she had voice that wasn’t perfect, but functioned quite well. Her glottal valve was aerodynamically competent. This is a pretty reasonable voice for where she started, he said. She functions completely as a management professor by utilizing just one vocal fold to oscillate.
He then discussed the case of a prominent Israeli comedian who had voice problems. He’s a little hoarse, but when you see what was inside of him, it’s quite remarkable, Dr. Zeitels said. This was circumferential glottic and subglottic exophytic papillary cancer that had progressed all the way into the trachea.