Eur Arch Otorhinolaryngol (1997) 254: 169-176 © Springer-Verlag 1997 M. Remacle • G. Lawson • J. Jamart • M. Minet J. B. Watelet • M. Delos C02 laser in the diagnosis and treatment of early cancer of the vocal fold Received: 6 May 1996 / Accepted: 8 July 1996 Abstract A total of 74 patients underwent cordectomy using CO2 laser for either diagnosis or treatment of an early cancer of the vocal fold. Type I cordectomy con- sisted in the resection of the entire epithelium, while leav- ing the vocal ligament intact. Type II cordectomy in- volved removal of the vocal fold from the vocal process to the anterior commissure and passing through the inferior thyroarytenoid muscle. Type IIIA required vocal fold re- section along the internal side of the thyroid ala, while type IIIB included removal of the anterior commissure. Type I cordectomies were carried out with an Acuspot mi- cromanipulator, which provided a 250-gm-diameter beam for a working distance of 400 mm, and in the shot-by-shot cutting mode with 3 W power superpulse. This cordec- tomy was carried out in 39 patients and a dysplasia or an early carcinoma were detected in 45.9% of cases. Type II and type III procedures were performed with the Mi- croslad micromanipulator having a 700-~tm-diameter beam in the continuous cutting mode, 7 W power super- pulse. Fifteen cases were treated by type II cordectomy, of which 3 TlaNOM0 cases underwent postoperative radio- therapy due to insufficient resections and 2 cases with TlbNOM0 tumors later underwent reconstructive laryn- gectomy. A type III cordectomy was used for 14 cases of TlaNOM0 carcinomas and 3 cases of severe dysplasia. The margins of resection were found to be positive histo- logically in 23.5% of these cases, making frozen section examinations mandatory at time of surgery. Results of all Presented in part during the First European Laryngological Society Conference, Marburg, 26-29 September 1996 M. Remacle (N~) • G. Lawson • M. Miner. J. B. Watelet ORL and Head and Neck Department, University Hospital of Mont-Godinne, B-5530 Yvoir, Belgium J. Jamart Biostatistics Centre, University Hospital of Mont-Godinne, B-5530 Yvoir, Belgium M. Delos Department of Anatomic Pathology, University Hospital of Mont-Godinne, B-5530 Yvoir, Belgium procedures showed that voice was best after a type I cordectomy where only the epithelium was resected. In the type II and type III cordectomies, the quality of voice depended on the development of a fibrous fold and the ab- sence of anterior synechia in the healed larynx. Key words Glottic carcinoma - Laser cordectomy • Quality of voice • Acoustic voice analysis Introduction It is now a generally accepted principle of clinical laryn- gology that any chronic hypertrophic laryngitis requires histological examination and appropriate treatment in or- der not to overlook an early glottic cancer. The risk of neoplastic transformation is not, however, directly propor- tional to the amount of keratosis present [5, 7]. This is why it can be difficult to orient biopsied tissues despite the possible aid of vital staining with toluidine blue, which is fixed preferentially by abnormal epithelial cells [12] or by stroboscopy to reveal "silent" vibratory zones suggestive of tumoral infiltration [8]. The surest solution to the occurrence of neoplasia is to- tal resection of the epithelium of the vocal fold. If histo- logical examination reveals only hyperplasia or dysplasia, then treatment has been administered at the same time. If, on the other hand, a specimen is found to be positive, fur- ther treatment must be decided upon after taking into ac- count the pathologist's report. We describe our experi- ences with the CO2 laser in the diagnosis and treatment of early cancer of the vocal fold, as well as the voice quality produced after this type of treatment. Materials and methods From April 1989 until the end of December 1993, we used an Acuspot micromanipulator (Sharplan Laser Industries, Tel Aviv, Israel) to carry out endoscopic surgery with a CO2 laser on 74 pa- tients either for the diagnosis or treatment of early cancer of the vocal fold.