Abstract
Laryngeal lesions such as papilloma, precancerous dysplasia, and vascular malformations can significantly impact voice production and patients’ quality of life. These nonmalignant conditions of the larynx can disrupt glottic closure patterns and inhibit propagation of the mucosal wave during phonation. Surgical techniques for the management of these lesions have advanced exponentially with further understanding of the importance of preserving the superficial lamina propria (SLP) layer and advances in surgical technology. Laser applications for nonmalignant conditions of the larynx have allowed for lesions such as papilloma and precancerous dysplasia to be optimally treated with maximum preservation of the underlying layered vocal fold microstructure. Photoangiolytic lasers such as the 585 nm pulsed-dye laser (PDL) and 532 nm KTP laser specifically target the microvasculature associated with the growth of these nonmalignant lesions and offer a fiber-based delivery system that allows for office-based surgery using topical anesthesia. In general, the primary advantages of laser surgery for nonmalignant conditions of the larynx are extreme precision, hemostasis, and selectivity for certain tissue “targets” such as blood vessels, without harming surrounding tissue. Also, a 2013 nm diode-pumped thulium laser has been introduced into endoscopic laryngeal surgery for the treatment of certain benign conditions. This laser’s chromophore is water, allowing for properties of hemostatic cutting on a fiber-based delivery system. This chapter will highlight salient principles of angiolytic laser use in the surgical management of vocal fold papilloma, precancerous dysplasia, and microvascular malformations both in the operating room under general anesthesia and in office-based settings with topical anesthesia. Additionally, office-based and microlaryngeal applications of the thulium laser in performing endolaryngeal surgery for benign conditions are reviewed.
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References
Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science. 1983;220(4596):524–7.
Anderson RR, Parrish JA. Microvasculature can be selectively damaged using dye lasers: a basic theory and experimental evidence in human skin. Lasers Surg Med. 1981;1(3):263–76.
Anderson RR, Jaenicke KF, Parrish JA. Mechanisms of selective vascular changes caused by dye lasers. Lasers Surg Med. 1983;3(3):211–5.
Zeitels SM, Franco Jr RA, Dailey SH, Burns JA, Hillman RE, Anderson RR. Office-based treatment of glottal dysplasia and papillomatosis with the 585-nm pulsed dye laser and local anesthesia. Ann Otol Rhinol Laryngol. 2004;113(4):265–76.
Zeitels SM, Akst LM, Burns JA, Hillman RE, Broadhurst MS, Anderson RR. Office-based 532-nm pulsed KTP laser treatment of glottal papillomatosis and dysplasia. Ann Otol Rhinol Laryngol. 2006;115(9):679–85.
McMillan K, Shapshay SM, McGilligan JA, Wang Z, Rebeiz EE. A 585-nm pulsed dye laser treatment of laryngeal papillomas: preliminary report. Laryngoscope. 1998;108(7):968–72.
Valdez TA, McMillan K, Shapshay SM. A new laser treatment for vocal cord papilloma—585-nm pulsed dye. Otolaryngol Head Neck Surg. 2001;124(4):421–5.
Franco Jr RA, Zeitels SM, Farinelli WA, Anderson RR. 585-nm pulsed dye laser treatment of glottal papillomatosis. Ann Otol Rhinol Laryngol. 2002;111(6):486–92.
Burns JA, Zeitels SM, Akst LM, Broadhurst MS, Hillman RE, Anderson RR. 532 nm pulsed potassium-titanyl-phosphate laser treatment of laryngeal papillomatosis under general anesthesia. Laryngoscope. 2007;117(8):1500–4.
Zeitels SM. Vocal fold atypia/dysplasia and carcinoma. Atlas of phonomicrosurgery and other endolaryngeal procedures for benign and malignant disease. San Diego, CA: Singular; 2001. p. 177–218.
Franco Jr RA, Zeitels SM, Farinelli WA, Faquin W, Anderson RR. 585-nm pulsed dye laser treatment of glottal dysplasia. Ann Otol Rhinol Laryngol. 2003;112(9 Pt 1):751–8.
Zeitels SM, Hillman RE, Desloge R, Mauri M, Doyle PB. Phonomicrosurgery in singers and performing artists: treatment outcomes, management theories, and future directions. Ann Otol Rhinol Laryngol Suppl. 2002;190:21–40.
Hsiung MW, Kang BH, Su WF, Pai L, Wang HW. Clearing microvascular lesions of the true vocal fold with the KTP/532 laser. Ann Otol Rhinol Laryngol. 2003;112(6):534–9.
Zeitels SM, Akst LM, Bums JA, Hillman RE, Broadhurst MS, Anderson RR. Pulsed angiolytic laser treatment of ectasias and varices in singers. Ann Otol Rhinol Laryngol. 2006;115(8):571–80.
Brandsma JL, Lewis AJ, Abramson A, Manos MM. Detection and typing of papillomavirus DNA in formaldehyde-fixed paraffin-embedded tissue. Arch Otolaryngol Head Neck Surg. 1990;116:844–8.
Jackson C. Cancer of the larynx: is it preceded by a recognizable precancerous condition? Trans Am Laryngol Assoc. 1922;44:182–201.
Pierce NH. Leukoplakia Laryngis. Ann Otol Rhinol Laryngol. 1920;29:33–56.
Burns JA, Kobler JB, Heaton JT, et al. Predicting clinical efficacy of photoangiolytic and cutting/ablating lasers using the chick chorioallantoic membrane model: implications for endoscopic voice surgery. Laryngoscope. 2008;118(6):1109–24.
Zeitels SM, Burns JA, Akst LM, et al. Office-based and microlaryngeal applications of a fiber-based thulium laser. Ann Otol Rhinol Laryngol. 2006;115:891–6.
Broadhurst MS, Akst LM, Burns JA, et al. Effects of 532nm pulsed-ktp laser parameters on vessel ablation in the avian chorioallantoic membrane: implications for vocal fold mucosa. Laryngoscope. 2007;117:220–5.
Rees CJ, Halum SL, Wijewickrama RC, Koufman JA, Postma GN. Patient tolerance of in-office pulsed dye laser treatments to the upper aerodigestive tract. Otolaryngol Head Neck Surg. 2006;134(6):1023–7.
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Burns, J.A. (2016). Laser Applications for Nonmalignant Conditions of the Larynx. In: Wong, BF., Ilgner, J. (eds) Biomedical Optics in Otorhinolaryngology. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1758-7_5
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DOI: https://doi.org/10.1007/978-1-4939-1758-7_5
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