European Cordectomy Classification

Type ISubepithelial cordectomy– Resection of epithelium through lamina propria but sparing vocal ligament
– Diagnostic when vocal fold lesions suspected of premalignant or malignant transformations
– Therapeutic if histological results confirm hyperplasia, dysplasia, or carcinoma in situ without signs of microinvasion
Type IISubligamental cordectomy
– Resection of epithelium, Reinke’s space, and vocal ligament
– Diagnostic for severe leukoplakia when lesion shows clinical signs of neoplastic transformation and stroboscopic examination indicates deeper infiltration, or “vibratory silence”
– Therapeutic for microinvasive carcinoma or severe carcinoma-in-situ with possible microinvasion
Type IIITransmuscular cordectomy– Resection of epithelium, lamina propria, and part of the vocalis muscle
– Indicated for cases of small superficial cancer of the mobile vocal fold
Type IV Total or complete cordectomy – Extends from vocal process to anterior commissure and depth reaches internal perichondrium of thyroid ala
– Indicated for cases of T1a cancer, where cancer infiltrates vocal fold
Type VaExtended cordectomy encompassing contralateral vocal fold– Resection includes anterior commissure and either a segment or entire contralateral vocal fold (removes Broyle’s ligament)
– Indicated for cancers superficially reaching anterior commissure without infiltrating it and without spreading towards base of epiglottis or towards subglottis
Type VbExtended cordectomy encompassing arytenoid– Indicated for vocal fold carcinoma involving the vocal process posteriorly but sparing the arytenoid
Type VcExtended cordectomy encompassing the ventricular fold– Indicated for ventricular cancers or for transglottic cancers that spread from the vocal fold to the ventricle
Type Vd Extended cordectomy encompassing the subglottis– Cord resection can be continued as deep as 1 cm under the glottis in order to expose the cricoid cartilage
Type VI (from revision)Encompassing anterior commissure and the anterior part of both vocal folds– Indicated for cancer originating in anterior commissure with or without extension to one or both vocal folds, without infiltration of the thyroid cartilage

Remacle M, Eckel HE, Antonelli A, Brasnu D, Chevalier D, Friedrich G, Olofsson J, Rudert HH, Thumfart W, de Vincentiis M, Wustrow TP (2000) Endoscopic cordectomy. A proposal for a classification by the Working Committee, European Laryngological Society. Eur Arch Otorhinolaryngol 257(4):227–231.

Remacle, Marc, et al. “Proposal for revision of the European Laryngological Society classification of endoscopic cordectomies.” European archives of oto-rhino-laryngology 264.5 (2007): 499-504.

Contributed by Emily Zhang