treatment of carcinoma in situ and early invasive squamous cell carcinoma of the larynx has changed significantly with the advent of transoral endoscopic co2 laser microsurgery . historically early glottic tumours have been treated with radiotherapy . it has proven efficacy and a perception of functionally better outcome , as no tissue is removed . transoral laser microsurgery of the larynx has been considered experimental and is not standard practice throughout uk . it has been used to debulk the larynx but with little confidence in the ability to completely resect tumours . the advantages to the patient include a short stay procedure , with little pain , avoidance of radiotherapy side effects , and voice preservation . a short - stay procedure may have financial benefit for the hospital and patient compared with an average six - week course of radiotherapy which requires daily commute for outpatient treatment or an inpatient stay . we present our experience of transoral laser microsurgery for glottic squamous cell carcinoma with regards to local and distant tumour control , quality of voice , and swallowing . all patients had full disclosure of available treatment options and counselling as to the advantages and disadvantages of each . the only potential problems we considered were the patient 's general fitness to undergo anaesthesia and tlm or a radical course of radiotherapy . all our patients were considered suitable for either treatment . as both treatments were already established within the service , ethics approval was not required . written informed consent was obtained from all patients .   a retrospective study of all patients undergoing transoral laser microsurgery under the care of the senior author ( s. mortimore ) with a diagnosis of tis , t1 , or t2 glottic tumour ( tnm 6th edition ) from january , 2002 to december , 2004 . information was collected from our ent laser database , oncology and pathology databases , and patient notes . quality of voice was analysed by our speech and language therapist using the oates russell voice profile ( the appendix ) , an overall grade system with scores of 1 to 5 . swallowing was also assessed using a standard bedside dysphagia assessment and cervical auscultation of swallow sounds . f. e. e. s ( fiberoptic endoscopic evaluation of swallowing ) was carried out to assess and manage dysphagia symptoms in most cases . patients with t1 and t2 disease had radiological imaging of larynx , neck , and chest . 22 patients had tlm for early laryngeal cancer with an average age of 67 ( range 5483 ) . all patients had an initial endoscopy and either laser or conventional biopsy to confirm the diagnosis . the t staging for the early glottis tumours staged 4 patients with tis , 9 patients with t1 disease ( t1a = 6 , t1b = 3 ) , and 9 patients with t2 tumours . five patients had treatment for recurrent disease , 3 with tlm , 1 with radiotherapy , and 1 with both tlm and chemoradiotherapy . 1 patient had recurrent disease which was not resectable endoscopically . unfortunately , they were unable to complete the radiotherapy course , as they were medically unfit and later died with residual disease . one patient had a metachronous tongue tumour and one a synchronous lung tumour which later metastasised . two patients with t2 disease developed nodal disease and underwent bilateral selective neck dissections . 6 had dysplasia at resection margins and underwent second look procedures and 4 with further resection . voice outcomes were assessed with the oates russell voice profile , 8 patients had normal voices , and 7 had mild changes . 1 patient died of other causes prior to having voice analysis by a speech and language therapist ( slt ) , and 1 had a laryngectomy . was predominantly postoperative ; however , a few patients with preoperative dysphagia were seen before surgery . first assessment was in nearly all cases 1 - 2 days postoperatively . in cases where the patient was unwell the first assessment was up to one week after surgery . patients whose resection only involved a small part of the vocal folds recovered normal eating and drinking 13 weeks after surgery . patients with large resections required a longer period of swallowing rehabilitation to learn and review compensation strategies . a few patients required up to 810 contacts over approx 6 months to reach their potential . at their last followup , one patient had previous treatment for a metachronous base of tongue tumour resulting in swallowing difficulty and was fed via gastrostomy tube . 5 patients died within the 5-year follow - up period , and only one death was due to disease recurrence . the 5-year local control rate for t1 tumours is 89% and 56% for t2 tumours . the mortality rate from local or distant disease is 4.5% with an overall disease - free survival rate of 77% at 5 years . transoral laser microsurgery can be used in any patient who is fit for general anaesthesia . posttreatment surveillance may be easier following tlm , as the oedema and mucosities associated with ebrt are absent . tlm and ebrt offer comparable cure rates for early glottic tumours . comparing the treatment modalities tlm allows for accurate staging of the tumour ( during resection ) , whilst radiotherapy relies on the initial microlaryngoscopy for clinical staging . with transoral laser microsurgery , the tumour is resected until the tissue feels and appears healthy under the microscope . a second - look procedure is common if there is any concern over histological margins , residual or recurrent disease , or failure to improve postoperatively . the ability to perform repeat laser resections should be viewed as a benefit of surgery rather than a failure of the procedure .   in traditional resection methods , the excision line represents the extent of resection , and any histological evidence of tumour at the margins means that the tumour has not been adequately resected . with laser resection , there is a zone of thermal injury to either side of the excision line , and it may , therefore , be difficult for a histopathologist to say with certainty that the tumour is fully excised . it is also difficult in the larynx to give the usually accepted millimetres of clearance . frozen section has in the past been advocated ; however , we feel it does not add to the intraoperative management . it may be helpful to send separate specimens from the edge of the resected area which is macroscopically clear of tumour . transoral laser microsurgery , therefore , relies heavily on the surgeon making a competent assessment of the resection . there is no universally agreed time frame for which disease is counted as residual disease as opposed to recurrence . residual disease suggests that the tumour was incompletely excised ; perhaps the size was underestimated or the tumour understaged . we have used a 1-year cutoff point with tumour recurring in the first twelve months classified as residual disease and tumour after this time being recurrence . our speech and language therapists have previously used generic voice scoring systems such as grbas but have found them inflexible and , therefore , have adopted the oates russell voice profile . subjective voice rating is performed by experienced voice therapists . the grading score of 0 to 5 correlates clinically with a normal voice to severe dysphonia . patients were given postoperative voice care involving routine hydration and humidification ( humidified air ) whilst on the ward . at home , patients were given clear instructions regarding steam inhalation 3 - 4 times per day , conservative voice use in the first week , and routine voice care advice . communication needs were monitored and strategies offered as required such as amplifiers or amplified telephones for patients with permanently compromised vocal loudness . patients were seen within the mdt review or directly by the slt and clinical nurse specialist who conduct the laser follow - up clinic in our service so long - term needs were addressed as they arose . the quality of voice after laser resection reflects the degree of resection required with more superficial tumours having a better outcome [ 9 , 10 ] . interestingly , there was no significant variation if the anterior commissure was involved although this may reflect the small number of cases in this group . the literature suggests that voice outcomes in tlm may be either comparable or better compared with ebrt [ 5 , 6 ] .   swallowing outcomes following tlm are good and recovery time relatively short for early glottic tumours compared to the prolonged discomfort of mucosities and dryness or altered taste following ebrt , which may persist indefinitely . the literature suggests a five - year survival after ebrt to be 85% for t1-t2 glottic tumours , and the rate with tlm is comparable . total laryngectomy rates are quoted as 46% after open surgery and 912% after radiotherapy [ 13 , 14 ] . we have only looked at early glottic tumours so a lower laryngectomy rate would be expected as is the case . tlm can be used to treat residual , recurrent , or new tumours even in a previously treated radiotherapy fields . occ heard / harsh , mild / mod , intermittent , harsh / diplophonic , moderate - persistent , harsh , mod / severe - persistent , severe whispery ,
objectives . to assess the outcome of transoral laser - assisted microsurgery ( tlm ) with regards to local and distant tumour control , quality of voice and swallowing . design . 
 retrospective review of patients with five - year follow - up period . setting . 
 royal derby hospital head and neck department . 
 participants . 
 all patients undergoing tlm with a diagnosis of tis , t1 , or t2 glottic tumour following endoscopic biopsy . 
 main outcome measures . 
 speech , swallowing , cancer - free survival , laryngectomy - free survival , and mortality rate . results . 
 22 patients were treated for early glottic carcinoma with tlm . 
 the 5-year local control rate for t1 tumours is 89% and 56% for t2 tumours . 
 the laryngectomy rate was 4.5% . 
 the mortality rate from local and distant disease was 4.5% with an overall mortality rate of 22% from all causes . 
 40% of patients had normal voices and a further 45% had only mild or moderate voice change . at their last followup 
 , no patients assessed had any difficulty swallowing relating to their treatment for glottic cancer . 
 conclusion . 
 transoral endoscopic co2 laser microsurgery is a valid technique for treating early glottic tumours .