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

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%, P<0.05). Furthermore, the voice handicap index-10 scores for patients without web formation decreased in both the keel placement and control groups (P<0.0001 and P<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 (P<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.

Keywords

glottic stenosis / glottic web / laryngeal keel / silastic sheets / anterior commissure

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Acknowledgements

This work was funded by grants from the Science and Technology Commission of Shanghai Municipality, China (Nos. 15401971600 and 16411960600).

Compliance with ethics guidelines

Jian Chen, Yilai Shu, Matthew R. Naunheim, Min Chen, Lei Cheng, and Haitao Wu declare no conflict of interest with regard to this work. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.

Electronic Supplementary Material Supplementary material is available in the online version of this article at http://dx.doi.org/10.1007/s11684-017-0549-0 and is accessible for authorized users.

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