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<p>Lesions involving the anterior commissure (AC) of the larynx are surgically challenging because of the region’s unique anatomy and propensity for cicatricial healing. Anterior glottic web formation remains a common and often disabling complication despite multiple described preventive strategies.&#xa0;To evaluate a staged, biology-driven, endoscopic strategy, emphasizing early slough clearance and avoidance of postoperative voice rest in the management of anterior commissure lesions.&#xa0;A total of six patients were included, with etiologies comprising type III anterior glottic web (n=1), post-cordectomy with radiotherapy web (n=1), inflammatory granuloma (n=1), ventricular inflammatory lesion (n=1), high-grade spindle cell neoplasm (n=1) and juvenile-onset recurrent respiratory papillomatosis (RRP) (n=1). Five of six patients had undergone prior surgical intervention elsewhere. In five patients managed with complete clearance of anterior commissure lesion, inflammatory slough developed within the first postoperative week and required staged endoscopic clean-up (mean 2 procedures; range 1–3). The paediatric RRP case underwent intentional staged excision to prevent bilateral raw surfaces. A mean of two staged clean-up procedures (range: 1–3) were required. At last follow-up (3–6 months), no patient developed a clinically significant anterior glottic web. Functional voice parameters - Voice Handicap Index (VHI) and GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain)&#xa0;demonstrated improvement or stabilization in all cases.&#xa0;Anterior commissure lesions demand a nuanced surgical approach that integrates anatomical precision with an understanding of early postoperative healing dynamics. Early, protocol-driven endoscopic surveillance with slough clearance—combined with avoidance of voice rest—can effectively prevent anterior glottic web formation, even in revision and high-risk cases.</p>

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“Anterior Commissure: Handle With Care!”

  • 期刊论文

  • 发表日期：

    2026年6月15日

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  • Nupur Kapoor Nerurkar,
  • Aman Bansal

摘要

Lesions involving the anterior commissure (AC) of the larynx are surgically challenging because of the region’s unique anatomy and propensity for cicatricial healing. Anterior glottic web formation remains a common and often disabling complication despite multiple described preventive strategies. To evaluate a staged, biology-driven, endoscopic strategy, emphasizing early slough clearance and avoidance of postoperative voice rest in the management of anterior commissure lesions. A total of six patients were included, with etiologies comprising type III anterior glottic web (n=1), post-cordectomy with radiotherapy web (n=1), inflammatory granuloma (n=1), ventricular inflammatory lesion (n=1), high-grade spindle cell neoplasm (n=1) and juvenile-onset recurrent respiratory papillomatosis (RRP) (n=1). Five of six patients had undergone prior surgical intervention elsewhere. In five patients managed with complete clearance of anterior commissure lesion, inflammatory slough developed within the first postoperative week and required staged endoscopic clean-up (mean 2 procedures; range 1–3). The paediatric RRP case underwent intentional staged excision to prevent bilateral raw surfaces. A mean of two staged clean-up procedures (range: 1–3) were required. At last follow-up (3–6 months), no patient developed a clinically significant anterior glottic web. Functional voice parameters - Voice Handicap Index (VHI) and GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) demonstrated improvement or stabilization in all cases. Anterior commissure lesions demand a nuanced surgical approach that integrates anatomical precision with an understanding of early postoperative healing dynamics. Early, protocol-driven endoscopic surveillance with slough clearance—combined with avoidance of voice rest—can effectively prevent anterior glottic web formation, even in revision and high-risk cases.