Anterior Glottic Web After Anterior Commissure Lesions Treatment: Does TruBlue Laser Lower the Risk?

Abstract

Objective: Laser treatment of the anterior commissure (AC) poses a potential risk of anterior glottic web (AGW) formation. Effectively addressing and mitigating this potential complication is vital for procedure safety and efficacy. This study evaluates the incidence of AGW following TruBlue laser treatment in patients undergoing AC laryngeal surgery.

Study design: Retrospective case series.

Methods: A retrospective analysis was conducted on a cohort of nine patients who underwent TruBlue laser ablation under general anesthesia between August 2020 and February 2024. All lesions were superficial and involved the AC. Laser parameters were set at 10 W, with 30 ms on-time and 300 ms off-time. The AC was thoroughly cleared of abnormal tissue in a single, non-staged operation. Laryngoscopic evaluations were performed at regular intervals.

Results: Underlying pathologies included moderate dysplasia (11%), high-grade dysplasia/carcinoma in situ (55.5%), and squamous cell carcinoma (33%). Among the study participants, only one (11%) developed AGW post TruBlue laser treatment, which was subjectively insignificant. No other adverse events were observed. The stroboscopic findings and patient-reported assessments demonstrated considerable variability.

Conclusions: This study suggests TruBlue laser ablation is a promising treatment for AC premalignant and malignant lesions, with a low incidence (11%) of AGW. Our protocol involved a single non-staged procedure that ablated both sides of the vocal folds and the AC, resulting in favorable outcomes compared to CO₂ laser surgery and potentially improved results compared to other photoangiolytic lasers. The study marks an important stride toward alternative therapies for AC lesions, suggesting that the TruBlue laser could be a viable alternative to radiotherapy.