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2018, Volume 12, Issue 3

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Frontiers of Medicine >> 2018, Volume 12, Issue 3 doi: 10.1007/s11684-017-0549-0

Prevention of laryngeal webs through endoscopic keel placement for bilateral vocal cord lesions

  1. Department of Otolaryngology–Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai 200031, China
  2. Department of Otology and Laryngology, Harvard Medical School, Boston, MA 02138, USA
  3. Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA 02138, USA

Available online: 2018-05-04
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Abstract

Transoral microresection for treatment of vocal cord lesions involving the anterior commissure may result in anterior glottic webs. In this study, we retrospectively reviewed 54 patients who underwent microsurgery for bilateral lesions involving the anterior commissure and categorized them into two groups. The keel placement and control groups received endoscopic keel placement and mitomycin C, respectively. During the follow-up of at least 1 year, the laryngeal web formation rate significantly decreased in the keel placement group compared with that in the control group (18.6% versus 54.5%, <0.05). Furthermore, the voice handicap index-10 scores for patients without web formation decreased in both the keel placement and control groups ( <0.0001 and <0.001, respectively). A pseudomembrane covering the vocal cords was detected in 16.3% (7 of 43) cases after keel removal. A total of 100% (7 of 7) of these cases and 2.8% (1 of 36) of the other cases formed laryngeal webs ( <0.0001). Endoscopic keel placement could be an effective method for preventing anterior glottic webs after surgery for bilateral vocal cord diseases involving the anterior commissure. The pseudomembrane observed at the time of keel removal may imply a high risk of web formation.

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