CO2-LASER IN THE DIAGNOSIS AND TREATMENT OF EARLY CANCER OF THE VOCALFOLD

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 c ordectomy consisted in the resection of the entire epithelium, while l eaving the vocal ligament intact. Type II cordectomy involved removal of the vocal fold from the vocal process to the anterior commissure an d passing through the inferior thyroarytenoid muscle. Type IIIA requir ed vocal fold resection along the internal side of the thyroid ala, wh ile type IIIB included removal of the anterior commissure. Type I cord ectomies were carried out with an Acuspot micromanipulator, which prov ided a 250-mu m-diameter beam for a working distance of 400 mm, and in the shot-by-shot cutting mode with 3 W power superpulse. This cordect omy was carried out in 39 patients and a dysplasia or an early carcino ma were detected in 45.9% of cases. Type II and type In: procedures we re performed with the Microslad micromanipulator having a 700-mu m-dia meter beam in the continuous cutting mode, 7 W power superpulse. Fifte en cases were treated by type II cordectomy, of which 3 T1aN0M0 cases underwent postoperative radiotherapy due to insufficient resections an d 2 cases with T1bN0M0 tumors later underwent reconstructive laryngect omy. A type III cordectomy was used for 14 cases of T1aN0M0 carcinomas and 3 cases of severe dysplasia. The margins of resection were found to be positive histologically in 23.5% of these cases, making frozen s ection examinations mandatory at time of surgery. Results of all proce dures 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 an d the absence of anterior synechia in the healed larynx.