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. 2013 Oct 23:2:Doc14.
doi: 10.3205/iprs000034. eCollection 2013.

A modified false vocal fold flap for functional reconstruction after frontolateral partial laryngectomy: a comparison with conventional open resection and laser cordectomy

Kai J Lorenz  1 , Roland Kohnle  1 , Heinz Maier  1
Affiliations

A modified false vocal fold flap for functional reconstruction after frontolateral partial laryngectomy: a comparison with conventional open resection and laser cordectomy

Kai J Lorenz et al. GMS Interdiscip Plast Reconstr Surg DGPW. .

Abstract
in English, German

Objective: To describe a modified flap technique (MFT) involving the use of a false vocal fold flap for glottic reconstruction and the removal of arytenoid cartilage and to compare it with conventional frontolateral partial laryngectomy (FLPL) and laser cordectomy (LC).

Methods: Twenty-eight MFT, 13 FLPL and 12 LC patients completed a standardised questionnaire for assessing aspiration, respiration, quality of life, and subjective voice quality. We analysed vocal function in terms of roughness, breathiness and hoarseness, measured voice range profiles, and performed videoendoscopy.

Results: No patient reported respiratory problems. Aspiration occurred in 33.3% (MFT), 41.6% (FLPL) and 16.6% (LC). Voice quality was rated as good/satisfactory by 17 MFT patients (62%), satisfactory/sufficient by 69% of FLKT patients, and sufficient/poor by 75% of LC patients.

Conclusions: The modified false vocal fold flap effectively covers defects and creates a neocord that ensures good phonatory rehabilitation and has positive effects on postoperative quality of life.

Hintergrund: Vergleich einer neuen Technik zur Rekonstruktion der Neoglottis mit Aryknorpel-Resektion (mTBP) im Vergleich zur konventionellen Teilresektion (FLKT) und Laserchordektomie.Material/Methoden: 28 Patienten (mTBP), 13 Patienten (FLKT) und 12 Patienten (Laser) wurden mittels eines standardisierten Fragebogens zu Aspirationsproblematik, Atmungsbeschwerden, peri- und postoperativer Lebensqualität sowie subjektiver Stimmqualität befragt. Ferner erfolgten eine Analyse der Stimmfunktion nach dem RBH-Schema, eine Stimmfelduntersuchung und eine Videoendoskopie.Ergebnisse: Keine Beschwerden bezüglich der Atmung. Hinsichtlich der Atmung wurden in keiner Gruppe postoperative Beschwerden angegeben. Aspiration bei 33,3% (mTBP), 41,6% (FLKT), 16,6% (Laser). Stimmqualität: mTBP 17 Patienten (62%) gut bis befriedigend, FLKT 69% befriedigend bis ausreichend, Laser 75% ausreichend bis schlecht.Schlussfolgerung: Die erweiterte Taschenbandplastik zur Glottisrekonstruktion nach frontolateraler Kehlkopfteilresektion ermöglicht neben einer guten Defektdeckung, die Ausbildung eines suffizienten Ersatzstimmbandes mit einer guten phonatorischen Rehabilitation, die sich auch positiv auf die postoperative Lebensqualität auswirkt.

Keywords: laser cordectomy; partial laryngectomy; quality of life; voice quality.

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Figures

Table 1
Table 1. Patient characteristics
Table 2
Table 2. Types of phonation as assessed by endoscopy (Type I = vocal folds, Type II = vocal fold against scar, Type III = false vocal folds, Type IV = arytenoid cartilage against epiglottis)
Table 3
Table 3. Expert (phoniatrist) assessment of voice quality in terms of roughness, breathiness and hoarseness (LC = laser cordectomy, FLPL = frontolateral partial laryngectomy, MFT = modified flap technique, SD = standard deviation)
Table 4
Table 4. Maximum phonation times in seconds. Patients were asked to phonate the vowel “a” three times. The averaged results are presented in the table. (LC = laser cordectomy, FLPL = frontolateral partial laryngectomy, MFT = modified flap technique, SD = standard deviation)
Table 5
Table 5. Voice range profiles (SD = standard deviation, LC = laser cordectomy, FLPL = frontolateral partial laryngectomy, MFT = modified flap technique)
Table 6
Table 6. Assessment of voice quality by patients using a standardised questionnaire (LC = laser cordectomy, FLPL = frontolateral partial laryngectomy, MFT = modified flap technique)
Table 7
Table 7. Assessment of voice quality by family and friends using a standardised questionnaire (LC = laser cordectomy, FLPL = frontolateral partial laryngectomy, MFT = modified flap technique)
Table 8
Table 8. a: Assessment of quality of life by patients after laryngeal surgery (LC = laser cordectomy, FLPL = frontolateral partial laryngectomy, MFT = modified flap technique)
b: Subjective assessment of the degree of distress caused by the surgical procedure (LC = laser cordectomy, FLPL = frontolateral partial laryngectomy, MFT = modified flap technique)
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