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Bhat AM, Marrero-Gonzalez AR, Nguyen SA, Scharner M, Meenan K, Sataloff RT. Photoangiolytic Lasers for Treatment of Benign Laryngeal Lesions: A Systematic Review and Meta-Analysis. Laryngoscope 2024. [PMID: 39119758 DOI: 10.1002/lary.31658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/24/2024] [Accepted: 07/09/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVES To compare the efficacy of the 445-nm blue laser to the 585-nm pulsed dye laser (PDL) and 532-nm potassium-titanyl-phosphate (KTP) laser in the treatment of benign laryngeal lesions. DATA SOURCES Cochrane Library, PubMed, Scopus, and CINAHL. REVIEW METHODS Following PRISMA guidelines, databases were searched from inception through January 29, 2024, for studies reporting the use of photoangiolytic lasers for treatment of benign laryngeal lesions, including the 585-nm PDL, 532-nm KTP laser, and 445-nm blue laser. Outcome measures included lesion resolution (%), mean differences (Δ) in Voice Handicap Index (VHI-10), and summed dysphonia grade, roughness, and breathiness (GRB) scale. RESULTS A total of 45 studies were included for meta-analysis, consisting of 348 patients treated with PDL, 550 patients with KTP laser, and 338 patients with blue laser. Treatment with blue laser resulted in the greatest lesion resolution (94.0%; 95% confidence interval [CI]: 90.2%-96.7%), followed by KTP laser (90.4%; 95% CI: 84.1%-95.2%), and PDL (86.9%; 95% CI: 62.9%-99.2%). VHI-10 improved significantly in patients following treatment with blue laser (Δ13.3; 95% CI: 10.7-16.0; p < 0.0001), KTP laser (Δ10.3; 95% CI: 7.4-13.3; p < 0.0001), and PDL (Δ7.4; 95% CI: 4.8-10.1; p < 0.0001). GRB improved significantly in patients following treatment with blue laser (Δ4.1; 95% CI: 2.9-5.2; p < 0.0001), KTP laser (Δ3.0; 95% CI: 2.0-4.0; p < 0.0001), and PDL (Δ2.5; 95% CI: 0.8-4.2; p = 0.005). CONCLUSIONS Photoangiolytic lasers are effective in treating benign laryngeal lesions. Blue lasers are promising for laryngeal laser surgery. Laryngoscope, 2024.
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Affiliation(s)
- Akash M Bhat
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Alejandro R Marrero-Gonzalez
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Megan Scharner
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Kirsten Meenan
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
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Shu M, He P, Wei C. KTP laser alone or combined with bleomycin for pharyngolaryngeal hemangioma: a lesion grade-based determination of prognosis. Acta Otolaryngol 2023:1-6. [PMID: 37335214 DOI: 10.1080/00016489.2023.2220744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 06/21/2023]
Abstract
BACKGROUND No standard potassium titanyl phosphate (KTP) laser treatment strategy is available yet for pharyngolaryngeal hemangioma. OBJECTIVES To explore the therapeutic effect of KTP laser, alone or combined with bleomycin injection, for pharyngolaryngeal hemangioma. MATERIAL AND METHODS This observational study included patients with pharyngolaryngeal hemangioma treated between May 2016 and November 2021: KTP laser under local anesthesia, KTP laser under general anesthesia, or KTP laser combined with bleomycin injection under general anesthesia. RESULTS A total of 60 patients were recruited, including 17, 19, and 24 patients with grade 1, 2, and 3 hemangiomas, respectively. A total of 21 patients underwent KTP laser under local anesthesia, 31 underwent KTP laser under general anesthesia, and 8 underwent KTP laser under general anesthesia combined with bleomycin. The cure rates were 100%, 89.5%, and 20.8% for grade 1, 2, and 3 lesions, respectively. The prognosis was significantly different among the grades of hemangioma (p < .001). CONCLUSION KTP laser treatment might be an effective treatment for adult patients with pharyngolaryngeal hemangioma. The size of the hemangioma might be the major factor influencing the prognosis. The method of anesthesia and whether it was combined with bleomycin injection might not affect the prognosis.
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Affiliation(s)
- Min Shu
- Otolaryngology Department of the Eye, ENT Hospital of Fudan University, Shanghai, PR China
| | - Peijie He
- Otolaryngology Department of the Eye, ENT Hospital of Fudan University, Shanghai, PR China
| | - Chunsheng Wei
- Otolaryngology Department of the Eye, ENT Hospital of Fudan University, Shanghai, PR China
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Puneeth PJ, Balushi F, Gandhi S. Vallecular Cyst: 10 Years Experience and Review of the Literature. Indian J Otolaryngol Head Neck Surg 2023; 75:492-495. [PMID: 37274970 PMCID: PMC10235318 DOI: 10.1007/s12070-022-03319-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- P. J. Puneeth
- Laryngology Department, Deenanath Mangeshkar Hospital and Research Centre, Pune, India
| | - Firyal Balushi
- Laryngology Department, Deenanath Mangeshkar Hospital and Research Centre, Pune, India
| | - Sachin Gandhi
- Laryngology Department, Deenanath Mangeshkar Hospital and Research Centre, Pune, India
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Zheng M, Arora N, Bhatt N, O'Dell K, Johns M. Factors Associated With Tolerance for In-Office Laryngeal Laser Procedures. Laryngoscope 2021; 131:E2292-E2297. [PMID: 33405311 DOI: 10.1002/lary.29370] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/13/2020] [Accepted: 12/28/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS A variety of laryngeal pathologies are increasingly being managed with in-office KTP laser (IOKTP) endoscopic procedures. The primary goal of this study was to identify patient characteristics and disease-related features that correlated with tolerance for IOKTP. STUDY DESIGN Retrospective chart review. METHODS The study was a retrospective review of adult patients undergoing office-based laryngeal laser procedures between November 2016 and December 2019 at a tertiary care center. Two blinded otolaryngologist reviewers scored videotaped recordings of IOKTP procedures and assessed severity and distribution of disease using a modified Derkay score, and evaluated procedure tolerance using a visual analog scale. RESULTS A total of 56 patients who received IOKTP procedures for laryngeal pathology were reviewed, 42 male and 14 female, with a mean age of 61 years. Gender, age, and BMI were not correlated with tolerance. There was a moderate, negative correlation between tolerance and total number of pathological anatomic laryngeal subsites (rs(56) = -0.35, P = .01). There was a weak, negative correlation between tolerance and total modified Derkay score (rs(56) = -0.29, P = .03). The median tolerance score was lower for patients with posterior lesions (Mdn = 6.4) compared with patients with non-posterior lesions (Mdn = 7.4), P = .04, and lower for current or former smokers (Mdn = 6.5) compared with never smokers (Mdn = 7.3), P = .04. CONCLUSION Patients with large disease burden or posterior lesions and patients with smoking history may exhibit poorer tolerance of IOKTP procedures, factors which can help guide pre-procedural counseling and management decisions. LEVEL OF EVIDENCE IV Laryngoscope, 131:E2292-E2297, 2021.
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Affiliation(s)
- Melissa Zheng
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Nikhil Arora
- Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Neel Bhatt
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Karla O'Dell
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Michael Johns
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
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Wang GX, Zhang FZ, Zhao J, Wang H, Li HB, Wang XM, Zhang J, Ni X. Minimally invasive procedure for diagnosis and treatment of vallecular cysts in children: review of 156 cases. Eur Arch Otorhinolaryngol 2020; 277:3407-3414. [PMID: 32621247 DOI: 10.1007/s00405-020-06163-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/20/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Vallecular cyst is an uncommon but potentially life-threatening disease. The aim of this study was to review the presentation, evaluation, and treatment of vallecular cysts in children. METHODS Medical records of 156 patients treated for vallecular cysts between 2013 and 2016 were retrospectively reviewed. The patients were divided into four age groups for comparison of clinical data: A, < 1 month; B, 1-6 months; C, 7-12 months; and D, > 1 year. RESULTS The median age of all patients (98 males and 58 females) was 12.1 months (range 1 day-11 years), including 21, 86, 21, and 28 patients in group A, B, C, and D, respectively. A diagnosis of vallecular cysts was made for 135 patients using a combination of flexible laryngoscopy and ultrasound, and ten patients (all in group A) required pre-surgery ventilation support. The most common symptoms were wheezing (59.6%) and stridor (36.5%). Ten patients experienced difficulty with intubation. Endoscopic-assisted transoral coblation marsupialization was performed for all patients, combined with supraglottoplasty for 41 out of 68 patients with concurrent laryngomalacia. Patients in group D had a longer operation time and higher incidence of intraoperative bleeding, two of whom experienced post-operation recurrence, and symptoms resolved after a second operation in both cases. CONCLUSIONS Flexible laryngoscopy and ultrasound are recommended for a diagnosis in suspected cases of vallecular cysts. Coblation marsupialization has advantages of minor damage, low recurrence rate, and suitability for all age groups.
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Affiliation(s)
- Gui-Xiang Wang
- Department of Otolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China
| | - Feng-Zhen Zhang
- Department of Otolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China
| | - Jing Zhao
- Department of Otolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China
| | - Hua Wang
- Department of Otolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China
| | - Hong-Bin Li
- Department of Otolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China
| | - Xiao-Man Wang
- Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China
| | - Jie Zhang
- Department of Otolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China.
| | - Xin Ni
- Department of Otolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China.
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Li Y, Irace AL, Dombrowski ND, Perez-Atayde AR, Robson CD, Rahbar R. Vallecular cyst in the pediatric population: Evaluation and management. Int J Pediatr Otorhinolaryngol 2018; 113:198-203. [PMID: 30173985 DOI: 10.1016/j.ijporl.2018.07.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/20/2018] [Accepted: 07/21/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To review the presentation of pediatric vallecular cysts and outline an approach for evaluation and management. METHODS Medical records of patients diagnosed with vallecular cyst between 2005 and 2017 were reviewed. Data on demographics, clinical characteristics, diagnostic methods, surgical procedures, and outcomes were collected and analyzed. A comprehensive literature search for pediatric cases of vallecular cyst was conducted for comparative analysis. RESULTS Twenty patients underwent surgery for congenital vallecular cysts during the study period. Age at diagnosis ranged from birth to 8 years (median age = 1.1 years). The most common preoperative symptom was inspiratory stridor (45%) followed by feeding difficulties (40%). Eight patients (40%) initially presented with laryngomalacia and 7 (35%) with feeding difficulties. Imaging was obtained in 16 patients and consisted of plain films, ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI). Marsupialization of the cyst was performed in all 20 patients. Three patients (15%) presented with recurrence. CONCLUSION Vallecular cysts can cause feeding difficulties due to upper airway obstruction and pressure at the laryngeal inlet. Diagnostic work-up for vallecular cysts should include a detailed medical history, complete head and neck examination including endoscopic examination, and appropriate imaging, as each of these components complements the histopathologic findings. Our findings indicate that performing marsupialization is associated with low rate of recurrence or complication.
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Affiliation(s)
- Youjin Li
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA 02115, USA
| | - Alexandria L Irace
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA 02115, USA
| | - Natasha D Dombrowski
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA 02115, USA
| | - Antonio R Perez-Atayde
- Department of Pathology, Boston Children's Hospital, Boston, MA 02115, USA; Department of Pathology, Harvard Medical School, Boston, MA 02115, USA
| | - Caroline D Robson
- Department of Radiology, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Radiology, Harvard Medical School, Boston, MA 02115, USA
| | - Reza Rahbar
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA 02115, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA 02115, USA.
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Three new d10 transition metal selenites containing PO4 tetrahedron: Cd7(HPO4)2(PO4)2(SeO3)2, Cd6(PO4)1.34(SeO3)4.66 and Zn3(HPO4)(SeO3)2(H2O). J SOLID STATE CHEM 2018. [DOI: 10.1016/j.jssc.2018.03.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kim SH, Vitek JC, Kryniak MP, Pagel PS. An Unanticipated Airway Problem in a Man Undergoing Femoral-Popliteal Bypass. J Cardiothorac Vasc Anesth 2017; 31:2312-2314. [PMID: 28389185 DOI: 10.1053/j.jvca.2016.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Soo H Kim
- Anesthesia, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Jason C Vitek
- Anesthesia, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Minerva P Kryniak
- Pathology Services, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Anesthesia, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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