Effects of Stripping and Laser Excision on Vocal Fold Mucosa in Cats

Abstract

We compared the effects of stripping and laser excision on vocal fold mucosa in cats. Of particular interest were the comparative effects of each procedure on the mucosa's sensory structures. Mucosa was stripped from one vocal fold in three cats, lased in three additional cats, and histologically examined at 1-, 2-, and 3-week intervals postoperatively. Results indicate that both procedures produce unique and degenerative effects that are still apparent 3 weeks after operation; however, nervous elements in lased tissue samples appeared less disrupted than in stripped tissue. Unique effects on the composition of epithelial tissue also were noted for the two procedures. Implications for voice quality in human patients undergoing similar procedures are discussed.

Practice variations in voice treatment selection following vocal fold mucosal resection

“…To our knowledge, this analysis represents the first application of a nationally representative claims dataset to characterize outcomes in this clinical population. Notably, despite targeting patients with presumed sufficiently sized resection margins to result in clinically significant mucosal loss, fibrosis, and impaired vocal function, we observed a cumulative incidence of any initial voice treatment event at 3 years postindex of just 14%. This finding suggests that a large number of Medicare patients with postresection dysphonia do not receive voice‐focused care, presumably due to 1) limited clinical indication (or contraindication), 2) limited patient interest, or 3) limited treatment access.…”

“…We focused on the following procedures: 1) partial laryngectomy with a resection margin that included the vocal fold mucosa (Healthcare Common Procedure Coding System [HCPCS] 31375, 31380, 31382; ICD‐9‐CM 30.2, 30.29, 30.1, 30.22); and 2) direct laryngoscopy with vocal fold stripping (HCPCS 31540, 31541; ICD‐9‐CM 30.09), when coded alongside a vocal fold leukoplakia or cancer diagnosis (ICD‐9‐CM 161.0, 161.2, 161.8, 161.9, 231.0, 478.5). These specific procedure–diagnosis combinations (in this study collectively referred to as the index procedure ) were implemented to capture surgical procedures with sufficiently sized resection margins to result in a high likelihood of dysphonia . Dysphonia itself (ICD‐9‐CM 784.40, 784.41, 784.42, 784.49) was not used as an inclusion criterion because surgeons typically code for the primary laryngeal pathology at the time of resection rather than the functional voice deficit.…”

“…Because no International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic code for vocal fold fibrosis or scarring currently exists, we designed proxy inclusion criteria whereby patients were required to have had a surgical procedure known to result in clinically significant vocal fold mucosal volumetric loss, fibrosis, and glottal incompetence. [33][34][35] We focused on the following procedures: 1) partial laryngectomy with a resection margin that included the vocal fold mucosa (Healthcare Common Procedure Coding System [HCPCS] 31375, 31380, 31382; ICD-9-CM 30.2, 30.29, 30.1, 30.22); and 2) direct laryngoscopy with vocal fold stripping (HCPCS 31540, 31541; ICD-9-CM 30.09), when coded alongside a vocal fold leukoplakia or cancer diagnosis (ICD-9-CM 161.0, 161.2, 161.8, 161.9, 231.0, 478.5). These specific procedure-diagnosis combinations (in this study collectively referred to as the index procedure) were implemented to capture surgical procedures with sufficiently sized resection margins to result in a high likelihood of dysphonia.…”

“…These specific procedure-diagnosis combinations (in this study collectively referred to as the index procedure) were implemented to capture surgical procedures with sufficiently sized resection margins to result in a high likelihood of dysphonia. 33,34,36,37 Dysphonia itself (ICD-9-CM 784. 40, 784.41, 784.42, 784.49) was not used as an inclusion criterion because surgeons typically code for the primary laryngeal pathology at the time of resection rather than the functional voice deficit.…”

“Window” Laryngoplasty: A New Combined Laser Endoscopic and Open Technique for Conservation Surgery

“…They may provide information critical to phonatory control, such as rapid and fine adjustments ofthe larynx. 17 Using fascia for the reconstructed vocal cord has certain advantages. Itcan be mobilized and tailored to cover or fill defects and has a strong ability to resist infections because of its low metabolic rate.…”