Improving Voice Outcomes After Transoral Laser Surgery for Early Glottic Cancer: A Systematic Review

To determine which intraoperative and postoperative interventions improve voice outcomes following transoral laser microsurgery (TLM) for early-stage glottic squamous cell carcinoma (T1-T2).

English literature was searched on PubMed, OVID Medline, CINAHL, Embase, and Scopus.

PRISMA guidelines were followed. Studies were excluded if patients received radiotherapy or non-TLM surgical approaches, had advanced-stage disease (>T2) or nonsquamous cell histology, had less than 5 participants, or were published in a non-English language. Commentaries, letters to the editor, literature reviews, and conference abstracts were also excluded.

Two thousand and seventy-five articles were screened and 13 were included categorized into 4 domains: voice therapy (n = 2), injection augmentation (n = 2), intraoperative surgical modifications (n = 5), and postoperative reconstruction (n = 4). Voice therapy demonstrated significant benefit over controls in an RCT (VHI-30: -31.5 vs +3.35 points, P < .01). Modified Type III cordectomy preserving the inferior vocalis muscle achieved voice outcomes comparable to Type I/II resections with 85% complete glottic closure versus 33% with classical resection (P = .026). Injection augmentation showed no benefit for contralateral hyaluronic acid (RCT) and mixed results for ipsilateral autologous fat. Reconstruction procedures demonstrated postoperative improvements in select individuals but lacked standardized implant materials and comparative controls.

Voice rehabilitation following TLM remains understudied. Current evidence supports structured voice therapy as an effective intervention. Modified Type III cordectomy demonstrates benefit in select patients with favorable tumor location. Injection augmentation is not yet supported but highlights an area of future research. Future multi-center randomized trials with standardized outcomes are needed to distinguish intervention effectiveness.