Objective: To observe the end results related to the early glottic cancer by means of phonomicrosurgery.
Methods: During 1989-1997, 44 cases of the early glottic cancer underwent phonomicrosurgery. The early glottic cancer were classified into three types according to depth of penetration of the vocal cord lesions, such as carcinoma in situ (5 cases), microinvasive carcinoma (33 cases) and invasive carcinoma (6 cases). Microflap resection techniques were used in both of the carcinoma in situ( CIS) and the microinvasive carcinoma (CA), while the laser cordectomy was used in patients of invasive glottic cancer with surgical margins dissected by the carbon dioxide laser. Submucosal vocal cord infusion is employed to indentify the two different choices. 1/10,000 epinephrine sterile saline was injected into superficial lamina propria, if the lesion was swollen as well as the epithelium, it suggested the vocal cord lesions were above the superficial lamina propria, microflap excision could be selected. Otherwise "doughnut effect" phenomena was observed that demonstrated distension of the SLP peripheral to the central attachment of the neoplastic lesion to the MLP or DLP, then laser cordectomy was choose. Each patient was recorded pre and post-operation with histopathological analysis. A long term follow-up was established at 2-month to 1 year interval. The longest had been 11-year, while the shortest 5-year.
Results: Six (15.8%) of 38 lesions treated for CIS and CA with microflap excision were recurred locally within 2 to 3-year. All of them were performed with microflap resection. One of 6 cases underwent 3 times of microflap operation within 10-year, one patient developed invasive cancer, therefore transcervical laryngectomy was used. The 5-year survival rate was 89.5%. Two of 6(33.3%) invasive carcinoma with cordectomy were recurred parcel two months postoperatively, they were submitted to traditional laryngectomy. One lost to follow-up was found recrudesc three years after operation, he received open transcervical laryngectomy. One patient with fusiform cell cancer employed local radiation therapy . The 5-year survival rate was 66. 7% .
Conclusions: On the management of early glottic cancer, Phonomicrosurgery not only eliminates the diseases, but also preserves "normal" voice. Microflap excision is an effective microtrauma therapeutic technique, and the resected specimen is also a "golden criterion" for the diagnosis and differential diagnosis related to early glottic carcinoma.