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Anterior Glottic Web

last modified on: Mon, 08/07/2023 - 11:11

see also: Congenital Laryngeal / Glottic Web

 

Non-congenital anterior glottic webs commonly result from intubation or laryngeal surgery.

  • The following image shows a patient who has had multiple operations for recurrent respiratory papillomatosis affecting the anterior larynx:

Anterior glottic webs occurring in the absence of intubation injury or previous surgery may result from autoimmune disorders, infections with pathogens such as C. diphtheriae or B. cereus (Ramasawamy 2018) and may also occur following treatment with irradiation and reflux (Yilmaz 2019).

  • The combination of the presence of anterior glottic cancer, endoscopic cold steel resection with concurrent treatment with KTP laser and then external beam irradiation were associated with the web presented in the example below:

Webs occurring in the absence of a known cause may be associated with the presence of an early glottic cancer as was reported by Ramasawamy et al. in a series of 6 'idiopathic' anterior glottic webs found to be associated with squamous cell carcinoma in each case (T1b) (Ramasawamy 2018).

  • The following video shows an example of an exceptional early vocal result following resection of an anterior web developing with carcinoma in situ:

Surgical correction of an anterior glottic web can be complicated and may require multiple procedures due to the proclivity for the web to reform.

Inducing an anterior web has been practiced to feminize a voice. In a comparison of feminization procedures for male-to-female transgender patients, two surgical approaches were compared by Mora et al. (Mora 2018) by way of cricothyroid approximation (CTA) [aka 'Isshiki type IV thyroplasty'] and Glottoplasty. Glottoplasty (ascribed to Wendler in 1990 as first reporting it) decreases the length of the vibrating vocal fold by creating an anterior web. Mora et al. identified a stable (2 to 4 year followup) duration of increased fundamental frequency but also decreased pitch range and increased roughness.

 

References

Endoscopic Laser Surgery of the Upper Aerodigestive Trach.  eds Steiner W and Ambrosch P.   2000  Thieme Stutgart  New York pp 60-61 "Prevention of Anterior Commissure Webs"

Pinheiro TG, Ishikawa CC, Imamara R, Frizzarini R, Montagnoli AN, and Tsuji DH: Fundamental Frequency in Excised Human Larynges after Anterior Glottic Web Formation of Various Extents. Otolaryngology-Head and Neck Surgeyr 2019, Vol. 160(4) 672-678

Mora E, Cobeta I, Becerra A, and Lucio MJ: Comparison of Cricothyroid Approximation and Glottoplasty for Surgical Voice Feminization in Male-to-Female Transsexuals. Laryngoscope, 128:2101-2109, 2018

cited by Mora ----  Wendler J. Vocal pitch elevation after transsexualism male to female. In: Proceedings of the Union of the European Phoniatricians, Salsomaggiore, Italy; 1990

Ramasawamy AT, Tian L, Bock JM, Klein AM, Pitman MJ.Carcinoma Presenting as Idiopathic Anterior Glottic Webs: A Case Series. Laryngoscope. 2018 Dec 28. doi: 10.1002/lary.27711. [Epub ahead of print]

Yilmaz T: Surgical Treatment ofGlottic Web Using Butterfly Mucosal Flap Technique: Experience on 12 Patients Laryngosocpe, 129:1423-1427, 2019