Endoscopic Sealing With a PGA Sheet to Reduce Scarring After Vocal Fold Mucosal Resection

Vocal outcomes after cordectomy for benign or malignant lesions are often compromised by tissue defects and subsequent scarring, leading to impaired vibratory function. Enhancing voice preservation could broaden the clinical acceptance of cordectomy. We hypothesized that covering mucosal defects with a polyglycolic acid (PGA) sheet could reduce scar formation and improve the vibratory characteristics of the vocal fold.

Patients with lateral vocal fold lesions, including dysplasia and Tis/T1a glottic carcinoma, who underwent type I or II cordectomy were enrolled. Following surgery, the mucosal defect was either left untreated (control group) or covered with a PGA sheet secured with fibrin glue (PGA group). Sequential auditory-perceptual evaluation using the GRBAS scale, aerodynamic and acoustic measures, as well as videostroboscopic assessment, were conducted before and after surgery. Patient-reported voice-related quality-of-life outcomes (VHI-10 and V-RQOL) were also assessed at 6 and 12 months.

About 22 patients were assigned to the PGA group and 38 to the control group. The PGA group demonstrated significantly lower postoperative Grade scores and longer maximum phonation time. Roughness was more prominent than Breathiness in the postoperative perceptual profile, reflecting differences in vibratory recovery. Videostroboscopy revealed significant advantages in symmetry, glottal closure, and mucosal wave at 3 months in the PGA group, with sustained benefits in glottal closure and mucosal wave at later postoperative time points.

PGA sheet sealing with fibrin glue may serve as a possible adjunct to improve vocal outcomes and reduce scar-related vibratory impairment after relatively superficial cordectomy, predominantly type I. Further experience is needed, particularly for type II cordectomy defects.

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