Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Cordectomy With Imbrication Laryngoplasty—Reply

Cordectomy With Imbrication Laryngoplasty—Reply In reply Thank you for the opportunity to respond to Luna-Ortiz’s letter. The goal of our article was to reintroduce ARCHIVES readers to partial laryngectomy with imbrication laryngoplasty (PLIL), which has not been discussed recently in the literature. In his letter, Luna-Ortiz refers to an article by Muscatello and coauthors from 1997. However, this excellent article describes a different procedure that includes laryngofissure—resection of a tumor limited to the middle third of the vocal fold without resection of cartilage and without imbrication laryngoplasty. This is not PLIL and should not be compared with PLIL. In fact, patients with T1a tumors like those described in the article by Muscatello et al have many surgical (eg, endoscopic, open) and nonsurgical treatment options. Partial laryngectomy with imbrication laryngoplasty, however, although used also for treating patients with T1a tumors, has significant advantages in the treatment of T2b tumors. Twenty-three of our 24 patients had T1 and T2 tumors. One patient underwent radiation therapy in the past for a T1 tumor with a complete response. However, he developed vocal cord paralysis secondary to the treatment. He eventually presented with a recurrent tumor on the paralyzed cord. This was defined as a T3 tumor, although it was actually a T1 tumor on a paralyzed cord. We included the patient in the study to prevent exclusion bias. We do not recommend PLIL for a T3 tumor. As for tracheotomy and initiation of oral food intake, again, Luna-Ortiz compares our results with an article describing a different procedure in a different cohort of patients with smaller tumors. Imbrication laryngoplasty medializes the thyroid cartilage and brings it closer to the contralateral normal vocal fold. Then, coverage with a superiorly based false vocal fold flap is provided. Therefore, the immediate postoperative glottic airway is significantly smaller than the airway after cordectomy without imbrication. That is why tracheotomy is performed. This is the price we pay to achieve a more medialized neocord that forms a good phonating “partner” for the contralateral cord. The procedure results in less breathiness, and because the false fold mucosa is loose and mobile, mucosal waves are seen on stroboscopy. As Luna-Ortiz noted, we did state that a weakness of a retrospective study is that we report subjective voice assessment. However, we did report on the patients’ and their families’ satisfaction, which is of course a subjective matter. As for objective measurements, Luna-Ortiz will be pleased to learn that we have been performing stroboscopy on patients undergoing PLIL and we hope to present the visual and auditory results during the upcoming Combined Otolaryngological Spring Meeting in Boca Raton, Fla (May 15, 2005). As Luna-Ortiz also noted, our study is not limited to 1 surgeon’s experience. Any head and neck surgeon can perform this procedure. We continue to offer our patients PLIL for unilateral vocal cord cancer, especially for treating T2b tumors. Unlike endoscopic laser procedure, PLIL provides immediate reconstruction without the need for a secondary procedure. We educate our patients and present them with all of the options. Back to top Article Information Correspondence: Dr Har-El, Department of Otolaryngology, Long Island College Hospital, 134 Atlantic Ave, Brooklyn, NY 11201 (gadyh@aol.com). http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

Cordectomy With Imbrication Laryngoplasty—Reply

Download PDF
2 pages

Loading next page...
 
/lp/american-medical-association/cordectomy-with-imbrication-laryngoplasty-reply-W0YbL4nLnY

References (0)

References for this paper are not available at this time. We will be adding them shortly, thank you for your patience.

Publisher
American Medical Association
Copyright
Copyright © 2005 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.131.3.280-b
Publisher site
See Article on Publisher Site

Abstract

In reply Thank you for the opportunity to respond to Luna-Ortiz’s letter. The goal of our article was to reintroduce ARCHIVES readers to partial laryngectomy with imbrication laryngoplasty (PLIL), which has not been discussed recently in the literature. In his letter, Luna-Ortiz refers to an article by Muscatello and coauthors from 1997. However, this excellent article describes a different procedure that includes laryngofissure—resection of a tumor limited to the middle third of the vocal fold without resection of cartilage and without imbrication laryngoplasty. This is not PLIL and should not be compared with PLIL. In fact, patients with T1a tumors like those described in the article by Muscatello et al have many surgical (eg, endoscopic, open) and nonsurgical treatment options. Partial laryngectomy with imbrication laryngoplasty, however, although used also for treating patients with T1a tumors, has significant advantages in the treatment of T2b tumors. Twenty-three of our 24 patients had T1 and T2 tumors. One patient underwent radiation therapy in the past for a T1 tumor with a complete response. However, he developed vocal cord paralysis secondary to the treatment. He eventually presented with a recurrent tumor on the paralyzed cord. This was defined as a T3 tumor, although it was actually a T1 tumor on a paralyzed cord. We included the patient in the study to prevent exclusion bias. We do not recommend PLIL for a T3 tumor. As for tracheotomy and initiation of oral food intake, again, Luna-Ortiz compares our results with an article describing a different procedure in a different cohort of patients with smaller tumors. Imbrication laryngoplasty medializes the thyroid cartilage and brings it closer to the contralateral normal vocal fold. Then, coverage with a superiorly based false vocal fold flap is provided. Therefore, the immediate postoperative glottic airway is significantly smaller than the airway after cordectomy without imbrication. That is why tracheotomy is performed. This is the price we pay to achieve a more medialized neocord that forms a good phonating “partner” for the contralateral cord. The procedure results in less breathiness, and because the false fold mucosa is loose and mobile, mucosal waves are seen on stroboscopy. As Luna-Ortiz noted, we did state that a weakness of a retrospective study is that we report subjective voice assessment. However, we did report on the patients’ and their families’ satisfaction, which is of course a subjective matter. As for objective measurements, Luna-Ortiz will be pleased to learn that we have been performing stroboscopy on patients undergoing PLIL and we hope to present the visual and auditory results during the upcoming Combined Otolaryngological Spring Meeting in Boca Raton, Fla (May 15, 2005). As Luna-Ortiz also noted, our study is not limited to 1 surgeon’s experience. Any head and neck surgeon can perform this procedure. We continue to offer our patients PLIL for unilateral vocal cord cancer, especially for treating T2b tumors. Unlike endoscopic laser procedure, PLIL provides immediate reconstruction without the need for a secondary procedure. We educate our patients and present them with all of the options. Back to top Article Information Correspondence: Dr Har-El, Department of Otolaryngology, Long Island College Hospital, 134 Atlantic Ave, Brooklyn, NY 11201 (gadyh@aol.com).

Journal

Archives of Otolaryngology - Head & Neck Surgery – American Medical Association

Published: Mar 1, 2005

There are no references for this article.