Laser surgery for nodules and other benign laryngeal lesions

Correlation Between the Effects of CO2 Laser and Histopathological Analysis in Vocal Cord Lesions: An Observational Study

Lasers are based on the principle of light amplification by empowering atoms to store and emit light in a coherent form. Through their effect on tissues, lasers reduce hemorrhage allowing the surgeon to work in a clear field with precise removal of the tissues. Irradiation of the soft tissues by lasers produces thermal effects on the surrounding healthy tissues which can make histopathological examination difficult. Hence this study was done to find a correlation between adjustable parameters of CO2 laser and the extent of collateral thermal damage in the excised vocal cord lesions on histopathological examination and diagnosis. In this study, we enrolled 80 patients who were divided into 4 groups with different combinations of laser power and mode, used during transoral laser micro laryngeal surgery for the excision of vocal cord lesions and subsequent histopathological analysis to objectively measure the extent of thermal damage zone and subjectively assess histo-morphological effects of thermal damage in terms of grade of carbonization. The extent of the thermal damage zone is directly related to the power of the laser, but the mode of the laser had no relation with the thermal damage zone in our study. On subjective histo-morphological examination of excised lesions showed that both power and mode of laser have significant effects on tissue morphology. Continuous mode causes a significantly higher grade of carbonization as compared to the superpulsed mode of the laser. However, in our study it was seen that charring in no way affected the diagnosis in any of the biopsies examined whatever the power or mode of the laser used. The depth and width of the tissue thermal damage zone are mainly dependent upon the laser parameters (power and mode). Although considering the limitations of this study carried out in terms of sample size, it would be pertinent to mention here that further studies with larger cohorts need to be done to authenticate these results.

Transoral Flexible Laser Surgery of the Larynx with Blue Laser

INTRODUCTION

Laser surgery of the larynx is currently the standard of clinical practice in a multitude of procedures. Lasers with photoangiolytic properties have a wide application in endolaryngeal lesions. One of their most prominent features is the ability to coagulate blood vessels, reducing unwanted tissue damage. Our objective is to expose the uses of the blue laser (445 nm) in the larynx.

MATERIAL AND METHODS

A retrospective study was carried out including 47 patients treated with blue photoangiolytic laser from October 2021 to January 2023 at a university hospital. Demographic data, type of lesion presented, date of intervention and scope of the procedure, as well as the parameters of the laser used, were recorded. The number of sessions received per patient, the result and complications were also collected.

RESULTS

A total of 47 patients with laryngeal lesions were treated, including vascular angiomas, laryngeal sulcus vocali, vocal cord polyps, Reinke's edemas, laryngeal papillomatoses, subglottic stenosis, laryngeal synechiae, subglottic granulomas, glottic scars, vocal fold leukoplakias, laryngeal dysplasias and tracheostomal granulomas. The mean age was 52.5 years, and 64.3% of the patients were women. The range of power used in the resective surgeries was 2-10 Watts with a 20-millisecond window. The average number of sessions received was 2.1 (range 1-4). A satisfactory situation was obtained in 45 of the 47 patients treated (95.75%), and an evident decrease in lesions was seen in the remaining two. There was no evidence of any complications directly derived from the use of the blue laser. Twenty-seven cases (54%) were treated exclusively in-office.

CONCLUSIONS

The blue laser is safe and effective in the treatment of a wide range of laryngeal pathologies. Its advantages include its portability, its photoangiolytic qualities as well as its ability to vaporize tissue in contact mode, which can treat subepithelial vessels or resect lesions.

Surgical and Nonsurgical Lines of Treatment of Reinke's Edema: A Systematic Literature Review

OBJECTIVES

The aim of this study was to carry out a systematic review of different surgical and nonsurgical lines of treatment of Reinke's edema to identify the effectiveness and the guidelines described to use each of them.

METHODS

We searched PubMed and Coherence for randomized controlled trials and case reports studies did on adult humans aged from 18 to 80 years, from January 1997 to December 2018. We included studies that treated patients with Reinke's edema by one and/or combinations of the following interventions: cold steel microlaryngeal phonosurgery, microdebrider, CO₂ laser, photoangiolytic laser, voice therapy, Steroid and Hyaluronidase injection. We selected studies that assessed patients pre- and post-treatment by at least one of the following measures: subjective assessment of the patient's voice by the voice handicap index, perceptual analysis of the voice by GRBAS scale, video laryngeoscopic examination of the VFs and the lesion, aerodynamic measures, and acoustic analysis of the voice by the computerized speech lab. We assessed quality of the included studies with the Cochrane risk of bias assessment Tool.

RESULTS

After removal of duplicates, research yielded 262 studies. Of 217 abstracts and titles, 36 full-text articles were read, and one study was added through hand search, resulting in 10 included studies.

CONCLUSIONS

Most of literature analyzed were deficient to address the effectiveness of any of the six lines included in this study. This is mainly due to the small number of the included articles and the small sample size in most of these studies. We found only 10 articles that reported the effectiveness based on comparing the results of before and after treatment. In addition, the variability of outcome measures used and the lack of the comprehensive assessment of the patient's voice, vocal image in most of the included studies made it hard to us to compare the results of any of the included studies. More researches with larger sample size and accurate randomization are needed for further accurate assessment of the effectiveness of the surgical and nonsurgical lines of treatment of Reinke's edema. The future researches should take in their consideration the use of an agreed comprehensive assessment protocol for assessing and comparing the outcome measures before and after treatment.

Multidimensional vocal assessment after laser treatment for recurrent respiratory papillomatosis

OBJECTIVES/HYPOTHESIS

Recurrent respiratory papillomatosis (RRP) is a benign epithelial tumor that exhibits a high frequency of recurrence. This study assesses the vocal function after laser treatment for RRP, particularly in relation to the frequency of surgery.

STUDY DESIGN

Retrospective study.

METHODS

Thirty RRP patients who underwent laser surgery that controlled the tumor were included. Preoperative and postoperative Grade, Roughness, Breathiness, Asthenia, and Strain Scale, videostroboscopic findings, aerodynamic and acoustic parameters, and self-assessment questionnaires were measured and compared with an age- and sex-matched control group. Subsequently, to evaluate the association between postoperative voice quality and the number of surgeries, the patients were divided into three groups (group 1: single surgery, group 2: 2-5 surgeries, group3: >6 surgeries), and comparative multidimensional vocal assessments were performed.

RESULTS

The mean number of surgeries was 3.4 (range, 1-8). Although all patients exhibited poorer vocal function than the control group preoperatively, they showed improvement in postoperative subjective and objective parameters. However, four patients who underwent one surgery with relatively aggressive ablation exhibited vocal cord scarring and deteriorated objective parameters. All remaining patients showed voice quality that was on par with the control group. Subgroup analysis proved no association between post-therapeutic voice quality and the patient characteristics, including preoperative staging and the number of surgical treatments performed.

CONCLUSIONS

RRP patients can achieve a close to normal voice with high satisfaction even after recurrent surgical treatment when ablation of a subepithelial lesion using sufficient laser energy is adequate.

LEVEL OF EVIDENCE

3b Laryngoscope, 127:679-684, 2017.

Diagnostic and therapeutic pitfalls in benign vocal fold diseases

More than half of patients presenting with hoarseness show benign vocal fold changes. The clinician should be familiar with the anatomy, physiology and functional aspects of voice disorders and also the modern diagnostic and therapeutic possibilities in order to ensure an optimal and patient specific management. This review article focuses on the diagnostic and therapeutic limitations and difficulties of treatment of benign vocal fold tumors, the management and prevention of scarred vocal folds and the issue of unilateral vocal fold paresis.