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

Alexia Mattei (1) , Carole Boulze (1) , Laure Santini (1) , Matthieu Le Flem (1) , Patrick Dessi (2) , Nicolas Fakhry (3) , Antoine Giovanni (1)

1 LA CONCEPTION - Hôpital de la Conception [CHU - APHM]
2 ADES - Anthropologie bio-culturelle, Droit, Ethique et Santé
3 LPL - Laboratoire Parole et Langage

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.

Mots clés: glottoplasty; laser; thyroplasty; glottic cancer; Cordectomy; difficult exposure

Domaines: Chirurgie; Cancer

Alexia Mattei, Carole Boulze, Laure Santini, Matthieu Le Flem, Patrick Dessi, et al.. Modified approach of the anterior commissure for transoral cordectomy in case of difficult exposure: a surgical innovation. European Archives of Oto-Rhino-Laryngology, 2020, 277, pp.301-306. ⟨10.1007/s00405-019-05692-2⟩. ⟨hal-02476110⟩