(0827) Partial Laryngectomy for Anterior Commissure Laryngeal Tumors: New Closure Technique

Introduction: Transoral laser microsurgery for the treatment of glottic carcinoma with anterior commissure (A-com) involvement is associated with a high rate of recurrence. Upfront radiation also has failures in this area due to cartilage invasion. In efforts to better clear anterior commissure tumors, the combined open/endoscopic technique has been described. We have adopted this technique, and have added an absorbable orbital plate to close the thyroid cartilage defect.

Methods: Twelve patients with glottic carcinomas involving the anterior commissure underwent combined transoral and external resection. None of our patients had concurrent neck dissections. Our final 2 patients in the series had closure of the cartilaginous window with the absorbable orbital plate.

Results: After transoral laser micro-resection combined with open resection, all patients achieved microscopic clear resection margins. We did not have any recurrences. No significant postoperative hoarseness or airway obstruction was noted. The patients who underwent closure with an absorbable plate did not experience a postoperative web or granuloma, and no hoarseness.

Conclusions: Laser microsurgery is an effective treatment modality in early glottic cancer with anterior commissure involvement but is still associated with a high rate of recurrence. We have used the combined endoscopic and open approaches in resecting these tumors to help decrease the rate of recurrence. We have also found that closure of the cartilaginous window with absorbable plates is useful in these patients and may prevent some of the postoperative airway and voice concerns.