Single stage transcutaneous suture fixation of anterior commissure defect using buccal mucosa graft following laser excision (STABLE).

[BACKGROUND] CO2 Transoral laser microsurgery (TLM) is a preferred technique for early-stage glottic lesions [1] (Yin et al Auris Nasus Larynx 50(3):415-422, 1), but reconstruction of the anterior commissure remains an unresolved issue. The anterior commissure is a surgically challenging area due to limited accessibility, high incidence of postoperative stenosis and risk of recurrence [2] (Chone et al Arch Otolaryngol Head Neck Surg 133(9):882-887, 2).

[OBJECTIVE] To share our experience with a single-stage reconstruction technique for anterior commissure defects following TLM, using a buccal mucosal graft secured with sutures and tissue glue, and to present post-surgical outcomes.

[METHODS] A series of five cases performed at VPS Lakeshore Hospital, Kochi, over a 1.5-year period (January 2024-April 2025) in patients with squamous cell carcinoma or carcinoma in situ of anterior commissure of glottis following TLM were evaluated. Written informed consent was obtained from all patients. TLM was performed using carbon dioxide laser, followed by reconstruction using a buccal mucosal graft fixed with polypropylene sutures and tissue glue. Outcomes were assessed using Voice Handicap Index (VHI) scores (Johnson et al Am J Speech-Language Pathol 6: 66-70, 3), video laryngoscopic evaluation of graft integrity, and rates of postoperative stenosis or adhesion.

[RESULTS] All patients remained free of disease at the end of the follow up period. VHI scores indicated acceptable postoperative voice quality. Post operative healing in patients who underwent transcutaneous suture fixation of grafts with tissue glue support demonstrated better and predictable outcomes in terms of stable graft positioning, good vocal cord approximation and minimal fibrosis.

[CONCLUSION] This novel, single-stage reconstruction technique allows good healing of anterior commissure defects by preventing stenosis. Functional outcomes measured by VHI are good. It offers a cost-effective alternative to staged procedures while ensuring optimal vocal outcomes.