The point at which the vocal cords are joined together, which is at the most anterior end of each cord. Compare this with the posterior commissure.
See also: Anterior Commissure Microweb
Breaking Cancer “Rules” Intelligently with Use of Laser
Post radiotherapy stage (1 of 8)
This woman had completed radiotherapy elsewhere many months ago for early vocal cord cancer. Recent biopsy of these lesions shows persistent cancer. At the same time, she is under treatment for unrelated stage IV lung cancer. Standard treatment here would be total laryngectomy.
Laser surgery typically not acceptable (2 of 8)
Under narrow band light and at closer range. Not only due to failure of radiation to cure, but also because this tumor crosses the anterior commissure (where the two vocal cords meet at the bottom of the photo), the widely accepted "rule" is that she should undergo total laryngectomy. The blue lines are located in the same place in the following photo.
Laser removal of tumor with careful followup (3 of 8)
In light of the patient’s uncertain future due to advanced lung cancer, her near-refusal of total laryngectomy, and with detailed inclusion of patient in “breaking the rules” thinking, the tumor was removed with the laser. Tissue margins were negative. Still, tumor behavior is not as predictable as it would be in a previously-untreated patient. Careful followup is therefore critical. Hashmarks show area of removal, to include everything even faintly abnormal-looking and the blue lines are located in the same place in the previous photo.
Second view post laser surgery (4 of 8)
Better view of the anterior commissure, where soft tissue was removed all the way to the inner perichondrium of the thyroid cartilage at the arrow.
Six months post laser surgery (5 of 8)
Nearly 6 months after laser surgery. Healing is complete. No obvious tumor is seen. The patient has developed very serviceable false cord voice (see photos 7 and 8).
Blood vessels stable two months post surgery (6 of 8)
Narrow band light allows more intense monitoring for aberrant blood vessels that might indicate tumor regrowth before there is any visible bulk. Vessels in the area of arrows have been stable for 2 months but require careful comparison with future examination photos.
Open phase of false vocal cord phonation (7 of 8)
False cord phonation, open phase. The true cords cannot oscillate at all due to dense scarring.
Closed phase of false vocal cord phonation (8 of 8)
True vocal cords are obscured by the false cord vibratory closure.
