Carcinoma of the Vocal Fold

Early vocal fold carcinoma can occur unilaterally (T1aN0M0) or bilaterally (T1bN0M0). The specific anatomic sites of the vocal fold that are important to take into consideration when assessing early vocal fold carcinoma include the anterior commissure, laryngeal ventricle, infraglottis, and the arytenoid. The assessment of early vocal fold carcinoma prior to surgical excision should clearly define the extent of spread of the tumor for assessment of stage as well as resectability. Normal vocal fold motion must be assured to confirm early glottic disease. Disease that originates at the anterior commissure is distinct in its behavior from disease that starts unilaterally and crosses over to the contralateral true vocal fold. The European Laryngological Society introduced a classification system for endoscopic partial cordectomy that assigns a value of I–VI depending on the extent of resection. Larger resections are higher numbers and correlate with increased risk of poorer voice outcome. The most common method for excision of early vocal fold carcinoma is using the CO2 laser via a microlaryngoscopy approach. Detailed and angled visualization with telescopes, specifically, 0°, 30°, and 70° telescopes, is essential to determine the extent of the tumor from an anterior-posterior, lateral, and infraglottic perspective. A cold-steel excision is best suited for relatively superficial lesions that have neither deep muscle involvement nor cartilage involvement (arytenoid). The CO2 laser has the advantage of precision, small spot size, and its hemostatic properties for excision of the vocal fold cancer. The type of resection approach includes en bloc and bisection of the tumor. The latter is best suited for larger tumors where depth of invasion is difficult to assess.  Orientation of the excision specimen with fixation is essential for pathologic analysis and to minimize the amount of tissue that is damaged or removed during the treatment of early vocal fold carcinoma. The KTP laser ablative removal of tumor is becoming more popular but does not follow established cancer resection principles, using an ablation approach rather than excision.