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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2018, Vol. 12 Issue (3) : 301-306    https://doi.org/10.1007/s11684-017-0549-0
RESEARCH ARTICLE |
Prevention of laryngeal webs through endoscopic keel placement for bilateral vocal cord lesions
Jian Chen1, Yilai Shu1, Matthew R. Naunheim2,3, Min Chen1, Lei Cheng1(), Haitao Wu1()
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
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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%, 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     
Corresponding Authors: Lei Cheng,Haitao Wu   
Just Accepted Date: 18 July 2017   Online First Date: 26 September 2017    Issue Date: 04 May 2018
 Cite this article:   
Jian Chen,Yilai Shu,Matthew R. Naunheim, et al. Prevention of laryngeal webs through endoscopic keel placement for bilateral vocal cord lesions[J]. Front. Med., 2018, 12(3): 301-306.
 URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-017-0549-0
http://academic.hep.com.cn/fmd/EN/Y2018/V12/I3/301
Characteristics Number of cases
Age (year)
18–3910
40–5925
60+19
Gender
Male49
Female5
Diagnosis
Glottic carcinoma2
Laryngeal papilloma10
Hypertrophic laryngitis8
Glottic leukoplakia34
Treatment
Laser cordectomy2
Laser stripping52
Tab.1  Distribution of cases according to selected characteristics
Fig.1  Intraoperative views of keel placement. (A) A 0.3-mm-thick keel was placed through the laryngoscope; (B) the keel was kept in place to separate raw laryngeal surfaces.
 Patients with web formationPatients without web formationTotal
Keel placement83543
Control6511
Total144054
Tab.2  Effectiveness of endoscopic keel placement for bilateral vocal cord lesions in preventing laryngeal webs
Fig.2  Comparison of pre- and post-surgical Voice Handicap Index-10 (VHI-10) scores of patients with and without web formation, in keel placement group (A) and control group (B). PWB, patients with web formation before surgery; PWA, patients with web formation after surgery; PWOB, patients without web formation before surgery; PWOA, patients without web formation after surgery; ns: not significant; ****P<0.0001; *** P<0.001.
Fig.3  Laryngoscopic examinations of bilateral glottic carcinoma (arrows) involving the anterior commissure before surgery (left), at the time of keel removal (middle two), and more than 3 months after surgery (right). Pseudomembrane (arrowheads) was observed at the time of keel removal, and an obvious laryngeal web (Asterisk) was formed after surgery. Arrows, carcinoma lesions; arrowheads, pseudomembrane; asterisk, laryngeal web.
Fig.4  Laryngoscopic examinations of bilateral glottic leukoplakia (arrows) involving the anterior commissure before surgery (left), at the time of keel removal (middle two), and more than 3 months after surgery (right). No significant pseudomembrane and no obvious web were observed. Arrows, leukoplakia lesions; arrowheads, silastic sheet.
 Patients with web formationPatients without web formationTotal
PSE discovered707
PSE undiscovered13536
Total83543
Tab.3  Association between pseudomembrane and web formation in the keel placement group
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