Vocal Cord Leukoplakia Management Trends Include Advanced Surgical Techniques, Voice Preservation

by Linda Kossoff •

What can a detailed literature review related to the epidemiology, diagnosis, and management of vocal cord leukoplakia reveal about oncologic outcomes, voice preservation, current and emerging diagnosis, and management techniques?

BOTTOM LINE

There have been shifts away from “vocal cord stripping” procedures; improvements in surgical techniques and instruments, grading systems, and biomarker classification; and increased examinations of endoscopic imaging and contact endoscopy improvements.

BACKGROUND: Vocal fold leukoplakia is a descriptive term for white plaque on the vocal fold. Managing the problem is challenging due to its corresponding variety of pathologies and the imperative to assess the degree of dysplasia, provide a prognosis, and balance the patient’s voice preservation with surgical excision of the disease.

COMMENT: This provides a comprehensive review of the current state of diagnosis and treatment of laryngeal leukoplakia with excellent clinical photos. This serves as a valuable update for general otolaryngologists who encounter these lesions frequently. —Cristina Cabrera-Muffly, MD

STUDY DESIGN: Literature review.

SETTING: Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.

SYNOPSIS: Researchers conducted a literature search for vocal cord and laryngeal leukoplakia, dysplasia, hyperkeratosis, leukoplakia endoscopy, and leukoplakia management. Researchers found that vocal fold leukoplakia incidence and keratosis has a predilection of 10.2 per 100,000 in males and 2.1 in females. Median patient age is 61.7 to 63 years. Cigarette smoking is the major risk factor for laryngeal squamous intraepithelial lesion development and laryngeal malignancy. Benign and dysplastic leukoplakia lesions carry some risk of malignant transformation. Laryngoscopy remains the workhorse for otolaryngology recognition of a leukoplakic lesion. Lesions at the medial border of the vocal folds are better visualized using stroboscopy, and blue-light wavelength filtering allows for identification of neoplastic lesions. In vivo contact endoscopy for potential early diagnosis is gaining interest. Microflap techniques with preservation of superficial lamina propria are preferred to vocal cord stripping. Angiolytic lasers are well designed for superficial epithelial disease treatment. Continued study of chemoprevention agents in conjunction with biomarkers and genetic discovery holds promise. Authors say future research should aim to measure the benefits of voice preservation methods.

CITATION: Park JC, Altman KW, Prasad VMN, et al. Laryngeal leukoplakia: state of the art review. Otolaryngol Head Neck Surg. 2021;164:1153-1159.