ELS Classification for Endoscopic Cordectomy

• The European Laryngological Society (ELS) classification for endoscopic cordectomy classifies cordectomies based on the layer and extent of the vocal cord that is resected.¹
  • Recall that from superficial to deep, the vocal cord is comprised of the (1) epithelium, (2) superficial lamina propria, (3) intermediate lamina propria, (4) deep lamina propria, and (5) vocalis muscle (also known as the thyroarytenoid).
  • The superficial lamina propria is also known as Reinke’s space.
  • The intermediate and deep lamina propria comprise the vocal ligament.

• As such, the ELS classified cordectomies into 5 types:
• Type I (Subepithelial cordectomy)
  • Resection of the epithelium and superficial lamina propria
  • Spares the vocal ligament, and the vocalis muscle.
  • Commonly used for vocal fold lesions suspicious for pre-malignant or early malignant transformation.
• Type II (Subligamental cordectomy)
  • Resection of the epithelium, Reinke’s space, and the vocal ligament.
  • Spares the vocalis muscle.
• Type III (Transmuscular cordectomy)
  • Resection extends through to the vocalis.
  • Spares at least part of the vocal cord.
• Type IV (Complete cordectomy)
  • Resection extends from the vocal process to the anterior commissure (removal of the entire vocal cord).
  • Does not extend beyond the vocal cord itself.
• Type V (Extended cordectomy)
  • Resection extends beyond the vocal cord itself. This is further divided into Va, Vb, Vc, and Vd.
  • Va: involving the contralateral vocal cord with resection including the anterior commissure.
  • Vb: involving the arytenoids.
  • Vc: involving the ventricular fold.
  • Vd: involving the subglottis (resection including 1 cm inferior to glottis to expose the cricoid cartilage).

European Laryngological Society (ELS) Classification for Endoscopic Cordectomies