Impact of ipsilateral false vocal fold resection on swallowing following transoral laser cordectomies — A fibreoptic endoscopic evaluation of swallowing study

Purpose

To investigate early and late impact of false vocal fold removal (vestibulectomy) on swallowing using FEES following type III, IV and V transoral laser cordectomies (TLC).

Material and method

Fifteen transorally resectable glottic cancers (10 T1a, 2 T1b, 2 T2, 1 selected T3) necessitating TLC with vestibulectomy were included. All participants underwent TLC in the investigation period. FEES was performed preoperatively and in the early and late postoperative period establishing modified penetration-aspiration scale (mPAS) and pharyngeal residue severity scale (PRSS) to statistically assess possible differences among the investigated timepoints. Laryngeal preservation and local recurrence were also noted.

Results

2 type III, 9 type IV, 2 type Va and 2 type Vd cordectomies were performed. Early postoperative mPASs changed significantly compared to preoperative status (p = 0.046). Difference between early and late postoperative mPASs was also significant (p = 0.046). There was no difference between preoperative and late postoperative mPASs (p = 1.0). Regarding pharyngeal residue, significant changes were noted in the early postoperative period compared to preoperative values (p = 0.002). Regarding late postoperative PRSSs, statistically significant decline was found compared to early postoperative scores (p = 0.004). No remarkable difference was found between preoperative and late postoperative PRSSs (p = 0.317). Laryngeal preservation failed in only one case due to recurrence.

Conclusion

In our serie, ipsilateral vestibulectomy during TLC did not deteriorate swallowing in the long term neither by increased pharyngeal residue nor by increased aspiration risk. Investigation of cases without co-morbidities may further confirm our observations. Nevertheless, TLC provided excellent laryngeal preservation.