Efficacy of type I thyroplasty after endoscopic cordectomy for early-stage glottic cancer: Literature review

Abstract

Objective: As phonomicrosurgical techniques have evolved, endoscopic cordectomy (EC) has been used more commonly for early-stage glottic cancer. Patients undergoing more extensive surgery often experience significant postoperative dysphonia for which there is no standard treatment. Surgical options include injection laryngoplasty and thyroplasty. We reviewed the literature to evaluate the efficacy of thyroplasty after EC.

Methods: A comprehensive literature search was conducted to identify studies of adults undergoing thyroplasty for dysphonia after EC for glottic cancer. Primary outcomes included voice, as measured subjectively by the voice handicap index (VHI) and objectively by aerodynamics-specifically maximum phonation time (MPT). Secondary outcomes included additional acoustic and aerodynamic measurements, variations in the technical aspects of thyroplasty, and a description of adverse events.

Results: Seven articles met inclusion criteria. Each study allowed 6 to 12 months after EC before performing thyroplasty. General anesthesia frequently was used rather than monitored anesthesia care . Implants varied between centers and were chosen based on surgeon preference. Of the three studies including statistical analysis, one reported improvement in VHI and grade. The second reported improvement in VHI; grade, roughness, breathiness, asthenia, strain; jitter; shimmer; noise-to-harmonic ratio (NHR); and MPT. The third reported improvements in jitter, shimmer, NHR, fundamental frequency, MPT, and sound pressure level. The most frequent adverse events were hematoma, infection, and implant extrusion.

Conclusion: Optimizing voice after EC remains a clinical challenge. Our review suggests that thyroplasty is one potentially beneficial option in appropriately selected patients. More controlled studies are needed to assess efficacy of thyroplasty in this context. Laryngoscope, 128:690-696, 2018.

Keywords: Early glottic cancer; dysphonia; endoscopic cordectomy; larynx cancer; thyroplasty.