Impact of resection depth on voice outcomes following transoral laser microsurgery for early glottic lesions
Miha Zabret, Marc Remacle, Maja Sereg Bahar, Ales GroseljAbstract
Background
To compare voice quality in patients undergoing the most conservative transoral laser microsurgery (TLM) types classified as type I (subepithelial mucosal resection), versus complete removal of the vocal ligament and/ or part of the vocal muscle (type II/III cordectomy).
Patients and methods
Between 2021 and 2024, 65 patients with limited, clinically suspicious vocal fold lesions were included in a single-centre, prospective longitudinal study. Among them, 29 were diagnosed with high-grade intraepithelial neoplasia or early-stage glottic carcinoma (Tis/T1a) and were treated with TLM. Patients were divided into two groups: Group 1 (n = 13) included patients after type I cordectomy, and Group 2 (n = 16) included patients after type II/III cordectomy. Subjective and objective voice outcomes were assessed pre-treatment and at 1, 3, and 12 months post-treatment.
Results
At 12 months, both groups demonstrated comparably favourable subjective voice outcomes, although recovery was slower in Group 2. Perceptual analysis revealed poorer voice quality up to 6 months, followed by improvement in both groups at 12 months. Videostroboscopy showed progressive improvement in vibratory function only in Group 1. Acoustic measures in Group 1 demonstrated normalisation of F0 and the s/z ratio, while jitter and shimmer remained relatively stable and mean intensity remained unchanged. In Group 2, jitter, shimmer, VTI, and the s/z ratio remained elevated at 12 months, with more frequent scarring and presence of muscle tension dysphonia.
Conclusions
Objective voice measures demonstrated faster postoperative recovery in Group 1, whereas subjective voice outcomes improved substantially in both groups by 12 months.