The Relationship Between the Glottic Configuration After Frontolateral Laryngectomy and the Acoustic Voice Analysis *Elio G. Pfuetzenreiter, Jr., *,†Roge ´ rio A. Dedivitis, *,‡De ´ bora S. Queija, §Nataniele P. Bohn, and *,‡Ana Paula B. Barros, *yzxSa˜o Paulo, Brazil Summary: The relative measurement of the anterior commissure synechia (S) is a crucial factor worsening voice quality and the perceptual analysis score has a strong correlation to the synechia’s impact. The aim of this study is to correlate the laryngeal configuration regarding the anterior commissure synechia and its relationship with the acoustic vocal parameters. Fifteen male patients underwent frontolateral partial vertical laryngectomy and reconstruction with bipedicle sternohyoid muscle flap for the treatment of T1b/T2 glottic cancer. The patients were free of disease, and the evaluation was performed after a minimum postoperative period of 12 months. Measurements of the anterior commis- sure synechia and the free border of both the preserved and the reconstructed vocal folds were simultaneously performed with the acoustic analysis of the voice. We calculated the mathematical proportion between the midsagital dimension of the synechia of the anterior commissure and the measurement of the free border of the intermembranous region of each vocal fold—the preserved one and that reconstructed with the bipedicle sternohyoid muscle flap. The acoustic evaluation showed an important increase in the fundamental frequency, and the values of all parameters were changed regardless of the anterior commissure synechia findings. These results suggest that the acoustic voice parameters are always changed because of the aperiodic pattern regardless of the anterior commissure synechia findings. Key Words: Partial laryngectomy–Acoustic analysis of the voice–Glottic configuration–Voice. INTRODUCTION In 1956, Leroux-Robert described the frontolateral laryngec- tomy technique. 1 Besides the adequate resection of the tumor, the main requirements are an adequate lumen for breathing, a smooth surface for epithelialization, voice restoration, and good deglutition. 2 A bipedicle muscle and perichondral flap are prepared to provide an optimal surfacing tissue and a certain amount of bulky tissue to provide a buttress for the opposite vestibular and vocal folds 3 in a single-staged operation, with satisfactory preservation of the laryngeal function. The partial laryngectomy for early glottic carcinoma results in complex changes of the glottis. In a previous report, 4 it was suggested that the anterior commissure synechia (S) has a sig- nificant impact on the voice quality in such patients regarding the overall grade of dysphonia (G), the roughness (R), and the strained quality (S). Thus, the relative measurement of the anterior commissure synechia was considered a crucial factor worsening the voice quality, and the perceptual analysis score had a strong correlation to the synechia’s impact. The commissure synechia had a significant impact upon the voice quality in the perceptive analysis, 4 using the GRBAS scale. 5 The aim of this study was to characterize the laryngeal configuration regarding the anterior commissure synechia in relationship with the acoustic voice parameters. METHODS This is a retrospective analysis of 15 consecutive male patients undergoing frontolateral laryngectomy as the primary treatment modality for early laryngeal cancer. They were enrolled from January 1996 to December 2004. The median age was 61 years. All, but one, patients were heavy chronic smokers. The gross extension of the lesion and the vocal fold mobility were studied through videostroboscopy. Our cases were preoperatively classified as T 1b N 0 M 0 (13) and T 2 N 0 M 0 (2). Neck dissection was not performed in our patients. All diagnoses were confirmed histopathologically before starting the treatment. All patients were decannulated and did not present any significant aspiration without significant difficulty in swallow- ing. Everyone could tolerate oral intake after the first postoper- ative day. All patients could communicate without difficulty. They had undergone rehabilitation with a speech-language pathologist for at least 2 months in the postoperative period. The patients were free of disease, and the evaluation was performed after a minimum postoperative period of 12 months. The measurements of the anterior commissure synechia and the free border of both the preserved and the reconstructed vocal folds and the acoustic analysis of the voice were performed. The assessment was performed with the speakers standing up at a mouth-to-microphone distance of 15 cm in an acoustically treated room. Two trained (more than 3 years’ experience in voice assessment) speech therapists judged all samples reach- ing consensus. The tape recorded the voice samples of sustained vowel /a/ at comfortable pitch and loudness, and was used for acoustic measurements. Voice-objective acoustic assessment was performed using digital acoustic measures of the Kay Ele- metrics Multidimensional Voice Program (Lincoln Park, NJ) using the same voice samples that were used in the From the *Hospital Helio ´polis, Sa ˜o Paulo, Brazil; yHead & Neck Surgery, Federal Univer- sity of Sa ˜o Paulo, Sa ˜o Paulo, Brazil; zDepartment of Voice, Speech and Swallowing Re- habilitation, Hospital Helio ´polis, Sa ˜o Paulo, Brazil; and the xHospital Irma ˜ Dulce, Sao Paulo, Brazil. Address correspondence and reprint requests to Roge ´rio A. Dedivitis, Rua Olinto Ro- drigues Dantas, 343 conjunto 92—11050-220 Santos, Sa ˜o Paulo, Brazil. E-mail: dedivitis.hns@uol.com.br Journal of Voice, Vol. 24, No. 4, pp. 499-502 0892-1997/$36.00 Ó 2010 The Voice Foundation doi:10.1016/j.jvoice.2008.10.009