Bi-layered microflap surgery for the treatment of anterior glottic web.

Introduction: Anterior glottic webs are epithelium-covered fibrous tissue formations at the anterior commissure, leading to synechiae between the bilateral vocal folds. They manifest with symptoms ranging from hoarseness to airway obstruction. However, treating anterior glottic webs are challenging due to their high recurrence rates. In this study, we report our treatment outcomes using the bi-layered microflap surgery.

Methods: This retrospective case series analyzed nine patients with anterior glottic webs from a tertiary medical center. All patients underwent the bi-layered microflap technique for the treatment of anterior glottic webs under the setting as microlaryngeal surgery. The primary treatment outcome was the web length ratio (relative to vocal fold length), while secondary outcomes included the Voice Handicap Index-10 (VHI-10), smoothed Cepstral Peak Prominence (CPPs), and GRB scores.

Results: The nine patients comprised five men and four women aged 32 to 71 years, with a mean of 48.6 years. The average web length ratio decreased from 56.9 ± 20.0% to 35.2 ± 13.7%. VHI-10 scores improved from 31.9 ± 7.5 to 16.8 ± 10.1. CPPs increased from 6.4 ± 3.1 to 8.4 ± 3.1, and GRB scores (summation) decreased from 5.4 ± 1.0 to 3.7 ± 1.8 (p < 0.05, Wilcoxon signed-ranks test).

Conclusion: The bi-layered microflap technique is an effective method for managing anterior glottic webs. This single-stage, stent-free endoscopic procedure results in a statistically significant decrease in web length ratio, VHI-10, CPPs, and GRB scores.