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Current Practice and Future Perspectives in Laryngeal Surgery
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Current Practice and Future Perspectives in Laryngeal Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Otolaryngology".

Deadline for manuscript submissions: closed (28 February 2025) | Viewed by 4656

Special Issue Editor

Dr. Eugenia Allegra

E-Mail Website
Guest Editor
Department of Health Science, Otolaryngology, University of Catanzaro, 88100 Catanzaro, Italy
Interests: laryngeal disorders; laryngeal surgery; microsurgery; endoscopic surgery; open surgery; laser surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Laryngeal surgery is a specialized field of surgery that deals with the diagnosis and treatment of laryngeal disorders. The current practice of laryngeal surgery involves a multidisciplinary approach that includes otolaryngologists, speech-language pathologists, and anesthesiologists. The most common indications for laryngeal surgery are vocal fold nodules, polyps, and cysts, benign and malignant lesions of the larynx, and airway obstruction due to various causes.

The current surgical techniques used in laryngeal surgery include microsurgery, endoscopic surgery, open surgery, and laser surgery. Microsurgery is a minimally invasive technique that uses specialized instruments and magnification to visualize and manipulate the laryngeal structures. Endoscopic surgery involves the use of a flexible or rigid endoscope to access the larynx through the mouth or nose. Open surgery involves making an incision in the neck to access the larynx directly. Laser surgery is a newer technique that uses a laser to vaporize or cut the laryngeal tissues.

In conclusion, laryngeal surgery is an important field of clinical medicine that continues to evolve with ongoing research and technological advancements. Current practice involves a multidisciplinary approach and the use of various surgical techniques, while future perspectives hold promise for further improvements in surgical outcomes and the understanding and management of laryngeal disorders.

Prof. Dr. Eugenia Allegra
Guest Editor

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Keywords

  • laryngeal disorders
  • laryngeal surgery
  • microsurgery
  • endoscopic surgery
  • open surgery
  • laser surgery

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Published Papers (4 papers)

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Research

11 pages, 2796 KiB  
Article
Trends in Treatment Choice for Early Glottic Cancer
by Emily Y. Huang, Henry H. Joo, Sarek A. Shen, Matthew R. Naunheim, Ved Tanavde and Lee M. Akst
J. Clin. Med. 2025, 14(9), 3095; https://doi.org/10.3390/jcm14093095 - 30 Apr 2025
Viewed by 243
Abstract
Background/Objective: Systemic investigation into treatment for early-stage glottic cancer (EGC) has demonstrated similar functional and oncologic outcomes between transoral laser microsurgery (TLM) and external beam radiotherapy (XRT). In this study, we aim to identify longitudinal trends in treatment decisions and patient demographics. Methods: [...] Read more.
Background/Objective: Systemic investigation into treatment for early-stage glottic cancer (EGC) has demonstrated similar functional and oncologic outcomes between transoral laser microsurgery (TLM) and external beam radiotherapy (XRT). In this study, we aim to identify longitudinal trends in treatment decisions and patient demographics. Methods: This is a retrospective longitudinal study on all cases of T1-2N0M0 glottic carcinoma queried from the NCDB between 2004 and 2017. The ratio of TLM to XRT (TLM/XRT) performed per year was calculated and further stratified by insurance status, education, income, and treatment facility location. Univariable and multivariable linear regressions were used to assess the trend of TLM/XRT over time and evaluate the effect of demographic characteristics on the TLM/XRT ratio. Results: A total of 38,428 EGC patients were analyzed: 2169 (5.6%) received TLM; 36,259 (94.4%) underwent XRT. The overall ratio of TLM/XRT increased over time from 0.04 in 2004 to 0.08 in 2017. Significant increases were observed in the higher-income quartiles (Q4: p < 0.001, Q3: p = 0.02, Q2 < 0.001) and among patients with private (p < 0.02) or public (p = 0.003) insurance. TLM/XRT rose significantly over time in the highest (Q4), third (Q3), and lowest (Q1) education quartiles but not in the second (Q2). Regionally, increases were observed in the Northeast (p < 0.001) and West (p = 0.008), with no significant change in the South or Midwest. By T stage, only T1 tumors showed a significant increase in TLM/XRT over time (p < 0.001). Conclusions: While the majority of patients receive XRT as the initial treatment for EGC, the proportion of TLM has been slowly increasing over time. Patient insurance status, education, income, facility geography, and T stage are correlated with increasing use of TLM. Full article
(This article belongs to the Special Issue Current Practice and Future Perspectives in Laryngeal Surgery)
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12 pages, 244 KiB  
Article
Analysis of Tracheoesophageal Voice after Total Laryngectomy: A Single Center Experience
by Andrea Migliorelli, Erennio Natale, Marianna Manuelli, Andrea Ciorba, Chiara Bianchini, Stefano Pelucchi and Francesco Stomeo
J. Clin. Med. 2024, 13(15), 4392; https://doi.org/10.3390/jcm13154392 - 27 Jul 2024
Viewed by 971
Abstract
Background/Objectives: Tracheoesophageal voice is the most commonly used voice rehabilitation technique after a total laryngectomy. The placement of the tracheoesophageal prosthesis can be performed at the same time as the total laryngectomy (primary placement) or in a second procedure after surgery (secondary [...] Read more.
Background/Objectives: Tracheoesophageal voice is the most commonly used voice rehabilitation technique after a total laryngectomy. The placement of the tracheoesophageal prosthesis can be performed at the same time as the total laryngectomy (primary placement) or in a second procedure after surgery (secondary placement). The purpose of this study is to analyze the substitution voice in patients with a tracheoesophageal prosthesis, considering the influence of radiotherapy and timing of prosthesis placement (primary or secondary) on voice quality. Methods: A retrospective analysis was conducted of all patients who received a tracheoesophageal phonatory prosthesis after a total laryngectomy was performed. We assessed whether patients received radiotherapy and whether they had a primary or secondary tracheoesophageal prosthesis. For the voice analysis, maximum phonation time (MPT), INFVo, SECEL, AVQI, CPPS, harmonic to noise ratio (HNR), unvoiced fraction (UVF), and number of voice breaks (NVB) were evaluated. Results: A total of 15 patients (14 males and 1 female) with a mean age of 71.8 years (SD ± 7.5) were enrolled. Eight had a primary prosthesis placement and five did not receive radiotherapy. INFVo parameters I and Vo were higher in patients with a primary placement of the phonatory prosthesis (p = 0.046 and p = 0.047). Patients who received the prosthesis secondarily had a higher mean CPPS and lower mean AVQI. Conclusions: A secondary placement of the prostheses seems to result in a minimal advantage in voice quality compared to a primary placement. Radiation therapy, on the other hand, has no effect on voice quality, according to these preliminary data. Full article
(This article belongs to the Special Issue Current Practice and Future Perspectives in Laryngeal Surgery)
11 pages, 2467 KiB  
Article
Surgical and Functional Outcomes of Posterior Cordotomy and Partial Arytenoidectomy with CO2 LASER in the Treatment of Bilateral Vocal Cord Immobility: A Single Institution Experience
by Virginia Fancello, Andrea Migliorelli, Isotta Campomagnani, Federica Morolli, Francesco Stomeo, Andrea Ricci-Maccarini, Massimo Magnani and Marco Stacchini
J. Clin. Med. 2024, 13(13), 3670; https://doi.org/10.3390/jcm13133670 - 24 Jun 2024
Viewed by 1546
Abstract
Background/Objectives: The purpose of this study is to investigate surgical and functional outcomes of patients affected by bilateral vocal cord immobility (BVCI) and treated with posterior cordotomy and partial arytenoidectomy. Methods: We performed a retrospective analysis on pre- and postoperative findings [...] Read more.
Background/Objectives: The purpose of this study is to investigate surgical and functional outcomes of patients affected by bilateral vocal cord immobility (BVCI) and treated with posterior cordotomy and partial arytenoidectomy. Methods: We performed a retrospective analysis on pre- and postoperative findings on a series of 27 patients affected by BVCI and treated with posterior cordotomy and partial arytenoidectomy from January 2017 to January 2022. Perceptual voice evaluations were performed using the GRBAS scale. The patients were requested to estimate the level of voice handicap experienced in their life using the Italian version of Voice Handicap Index 10 (VHI 10) questionnaire, while swallowing difficulties were self-evaluated through the Italian version of the Eating Assessment Tool (EAT-10) questionnaire. Results: Respiratory distress was evaluated according to the American Medical Research Council Dyspnoea Scale (MRC_DS) before and 1 year after the surgery. The mean of the preoperative values was 3.86 (±0.4), while 1 year after the procedure, we witnessed a significant (p ≤ 0.001) improvement, with a mean value of 1.09 (±0.9). After surgery, an overall worsening in voice quality was perceived, with a worsening in the GRBAS score. In contrast, the VHI10 does not show a statistically significant worsening. EAT 10 did not demonstrated worse scores after the surgery; rather, it showed a trend of improvement (preoperative EAT10 5.5 ± 5.8, postoperative 3.3 ± 2.9, p = 0.064). Conclusions: According to our results, posterior cordotomy plus partial arytenoidectomy is an effective procedure that provides stable and rapid respiratory improvement whilst preserving swallowing and the self-perception of voice quality. Full article
(This article belongs to the Special Issue Current Practice and Future Perspectives in Laryngeal Surgery)
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9 pages, 215 KiB  
Article
Long-Term Complications of Tracheoesophageal Voice Prosthesis
by Maria Rita Bianco, Vincenzo Saita, Federico Occhiuzzi, Domenico Michele Modica, Daniele Latella, Alfio Azzolina, Mario Galfano and Eugenia Allegra
J. Clin. Med. 2024, 13(7), 1912; https://doi.org/10.3390/jcm13071912 - 26 Mar 2024
Cited by 2 | Viewed by 1432
Abstract
Background: The aim of our multicenter retrospective study was to evaluate the long-term complications associated with primary and secondary tracheoesophageal puncture (TEP) in patients who underwent total laryngectomy (TL) for laryngeal cancer and were subsequently rehabilitated to phonatory function with tracheoesophageal speech [...] Read more.
Background: The aim of our multicenter retrospective study was to evaluate the long-term complications associated with primary and secondary tracheoesophageal puncture (TEP) in patients who underwent total laryngectomy (TL) for laryngeal cancer and were subsequently rehabilitated to phonatory function with tracheoesophageal speech (TES). Materials and Methods: To evaluate the long-term outcomes and complications of TEP, the following data were collected: mean time of prosthesis replacement, mean time of onset of complications, type of complications, and type of failure. Results: Complications occurred in 18 out of 46 patients (39.2%) with primary TEP and in 10 out of 30 patients (33.4%) with secondary TEP, out of a total of 76 enrolled patients. Common complications included prosthesis leakage, fistula leakage, granulation, and prosthesis extrusion. Prosthesis replacement due to fistula leakage or prosthesis extrusion was observed exclusively in the group of patients with primary TEP. Among the 28 patients (35.7%) who experienced complications, rehabilitation with TEP failed in 10 cases, primarily due to abandonment and spontaneous fistula closure. Conclusions: TEP, both primary and secondary, represents a valid option for vocal rehabilitation in patients undergoing TL. However, identifying prognostic factors that could influence the success of TEP would be beneficial to allow a targeted rehabilitation process. Full article
(This article belongs to the Special Issue Current Practice and Future Perspectives in Laryngeal Surgery)
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