Optimizing voice after endoscopic partial laryngectomy.

Phonosurgical management of early and midsized glottic cancer has evolved considerably during the past decade. There has been a partial migration from transcervical to transoral partial laryngectomy to diminish perioperative morbidity (ie, tracheotomy) and to facilitate subsequent voice restoration. After an endoscopic partial laryngectomy heals, a medialization of the glottal neocord should be done. An endolaryngeal injection or transcervical medialization is used to reconstruct the glottal valve and the associated aerodynamic competency, which ultimately enhance voice quality. These reconstructive techniques will improve the voice outcome subsequent to almost any endoscopic vertical partial laryngectomy; however,a near-normal conversational level voice can be achieved inpatients in whom there is one remaining normal vocal fold. These favorable results are based on the fact that after effective glottal closure is achieved through the reconstruction, the primary oscillator is the layered microstructure of noncancerous glottal tissue.