Curative effect of chemotherapy,KTP lasers,and CO2 lasers combined with chemotherapy in the treatment of adult laryngeal hemangioma

Purpose: To evaluate three methods for treating adult laryngeal hemangiomas: conventional chemotherapy, CO₂ laser combined with chemotherapy, and KTP laser. And to identify risk factors that affected the prognosis of the lesions.

Method: A retrospective analysis was performed on the data from patients with adult laryngeal hemangiomas treated by one of three aforementioned methods, the curative efficacy, and safety of those methods was compared.

Results: All cases were confirmed by suspension micro-laryngoscope examination. Pre- and post-treatment clinical photographs were taken and the outcomes were graded. Thirty-eight patients in 48 different cases were enrolled in the study between June 2010 and June 2016, and some patients were treated more than once. The treatment efficacy of the KTP laser was higher than that of chemotherapy according to the Kruskal–Wallis ANOVA test; however, the ordinal logistic regression showed that the choice of surgical procedure did not affect the treatment results; only the size of the bases of the lesions affected the prognosis of adult laryngeal hemangiomas.

Conclusions: Pingyangmycin injection, KTP laser, and CO₂ laser combined with chemotherapy are safe and effective methods for the treatment of adult laryngeal hemangiomas. The size of base of the lesion affects the prognosis of the hemangiomas.     

Use of the CO2-laser micropoint micromanipulator for the treatment of laryngomalacia

Between September 1989 and June 1994, 21 children (17 boys, 4 girls) with moderate to severe symptoms due to laryngomalacia underwent endoscopic surgery using the CO₂-laser micropoint manipulator (shot-by-shot, 0.1 s, super-pulse, 2–3 W power; 280 m beam; 400 mm working distance). Mean age of the children was 5 months (range, 1–11 months). The procedure was performed under high-frequency jet ventilation and consisted in the resection and/or vaporization of the aryepiglottic folds. This tissue removal could be extended to the laryngeal mucosa of the arytenoids and the lateral edge of the epiglottis. Results of surgery were excellent with normalization (8 patients) or, at worst, a very definite improvement of symptoms (4 patients). Furthermore, no complications occurred due to the technique used. These results have convinced us that the CO₂-laser micropoint manipulator technique, with the super-pulse shooting mode and high-frequency jet ventilation, is by far superior to microsurgery with cold instruments when endoscopic treatment of laryngomalacia is indicated.     

Treatment with laser CO2 cordectomy and clinical implications in management of mild and moderate laryngeal precancerosis

All the classification of precancerous lesions are based on the progression of specific histopathological characteristics, which in turn considers the grade of epithelial hyperplasia and dysplasia, nevertheless the transformation of laryngeal keratosis into carcinoma occurs through progressive modifications of normal epithelium in keratosis without dysplasia, to the point of degenerating into carcinoma in situ. The treatment of laringeal precancerosis has not yet defined a gold standard: according to some authors, a simple excision biopsy may be sufficient, others, instead, perform the stripping of the involved vocal cord, while others yet perform vaporization by means of CO₂ laser. The aim of this paper is to evaluate and possibly validate the treatment of mild and moderate laryngeal dysplasia (LIN1-2) by CO₂ laser, with particular attention to oncological and functional results. Fifty-eight patients (44 males and 14 females, mean age 54.3 years) affected by mild and moderate dysplasia (32 LIN I and 26 LIN II) diagnosed by a bioptic exam, were treated by performing a CO₂ laser cordectomy (following the European Society of Laryngology’s criteria). Before surgery to the patients was given a questionnaire to identify primary risk factors such as smoking, alcohol use and gastroesophageal reflux, were also handed a Vocal Performance Questionnaire. In all patients was performed a pH measurement over a 24-h period, a voice evaluation using a Kay digital Strobe 920. 84% of patients were smokers; the presence of reflux was reported in 11 patients (19%). The 32 LIN1 cases treated with type I cordectomy determined four recurrences (12.4%), of which two LIN1, one LIN2 and one carcinoma in situ. Of the 26 LIN2 cases examined, the 12 treated with type 1 cordectomy generated 1 recurrence alone with the presence of an invasive carcinoma (T1a) (8.3%), while no recurrences were reported in the group of 14 LIN2 cases treated with type II cordectomy. 93.1% (54/58) of cases showed a complete closing of the glottal plane over time. Considering the results in terms of disease control, and functional outcomes, our experience suggests subepithelial cordectomy (ELS I) for LIN 1 and subligament cordectomy (ELS II) for LIN 1 recurrences; therefore we suggest subligament cordectomy (ELS II) in LIN 2 cases.     

Treatment of lingual tonsillitis by transoral CO2 laser endoscopy

The authors report on their clinical experiences concerning 100 cases of chronic lingual tonsillitis. The surgical treatment employed was endoscopic vaporization of affected tissues with the CO₂ laser. Prior to surgical intervention, predisposing conditions such as allergy, rhinosinusitis, and gastroesophageal reflux were identified and treated. The surgical technique consisted of progressive vaporization of the lymphoid tissue at the base of the tongue until the lingual fascia was reached. A slightly defocused (700 mm) continuous 10–15W laser beam was used at a working distance of 400 mm. Following surgery, no dyspnea was observed secondary to epiglottis edema and only one patient required postoperative hemostasis. Symptoms related to tonsil or tongue inflammation were eliminated or alleviated in 87 patients, remained unchanged in 12 patients and were worse in 1 patient.     

CO2 laser supraglottoplasty for severe laryngomalacia: a study of symptomatic improvement

OBJECTIVE: To investigate post-operative symptom improvement in patients with severe laryngomalacia. STUDY DESIGN: Severe laryngomalacia was diagnosed in 138 patients (average age of 6.97 months) by bronchoscopy. Laryngomalacia was defined by the direction of supraglottic collapse: type A (posterolateral), type B (complete), and type C (anterior). As multiple laryngomalacia types within an individual were common, patients were further categorized into group I (type A only), group II (type B or B+A), and group III (type C, C+A, or C+B+A). CO(2) laser supraglottoplasty was performed. Improvements in inspiratory stridor, suprasternal retraction, substernal retraction, feeding difficulty, choking, post-feeding vomit, failure to thrive, and cyanosis were investigated. The presence of a symptom was scored as 1, and the absence as 0. The total score of symptoms was calculated for each patient. General medical history, age at time of surgery, type of laryngomalacia, post-operative intubation period, duration in ICU and dates of postoperative admission were recorded. RESULTS: Overall symptom improvement was observed in 82.6% of patients, with statistically significant resolution evident in group III (B-value=0.79, 95% CI: -0.01, 1.59). Symptoms were not well improved in patients with cerebral palsy (n=32, B-value=-1.02, 95% CI: -1.80, -0.25; p<0.01). The two most improved symptoms were substernal retraction and suprasternal retraction, while the two least improved symptoms were choking and feeding difficulties. CONCLUSION: CO(2) laser supraglottoplasty is an effective treatment option for severe laryngomalacia, especially for group III laryngomalacia cases in the absence of cerebral palsy. It has the superiority of facilitating significant symptomatic resolution and reducing the post-operative complications.     

CO2 laser resurfacing of intraoral lymphatic malformations: A 10-year experience

Objective

To evaluate the safety and efficacy of CO₂ laser resurfacing in the symptomatic treatment of intraoral lymphatic malformations (LM).

Design

Retrospective review.

Methods

Charts were reviewed on 26 patients (16 male, 10 female) from January 1997 to July 2007 who underwent CO₂ laser resurfacing for symptomatic treatment of intraoral LM. A questionnaire was given in order to elucidate effectiveness in controlling symptoms and speed of postoperative recovery.

Results

Mean age at time of first treatment was 9.2 years (median 6.8). Mean number of treatments was 3.0 (median 2.5). Average time between treatments was 9.7 months (median 5.6). Questionnaires were returned for 17 patients (65%). Common preoperative symptoms included swelling, bleeding, vesicle formation, and pain. All 17 patients reported symptomatic improvement after laser treatment. Five patients (29%) tolerated oral intake immediately, 10 (59%) the following day, and 1 (6%) was gastric tube dependent. Four patients (24%) returned to normal activity immediately after treatments, six (35%) by the following day, six (35%) within a few days, and one (6%) within a week. No postoperative complications were seen.

Conclusion

CO₂ laser resurfacing appears to be both safe and efficacious in treatment of symptoms related to intraoral LM. Intermittent treatments for recurrent symptoms is expected.     

The use of forced ventilation during microlaryngoscopy with laser CO<Subscript>2</Subscript>

CO(2) laser is currently used in the treatment of laryngeal lesions. The technique leads to vaporisation of the tissues on which it is focused, resulting in the production of smoke that remains in the laryngoscope and in the area of the exposed larynx. The fumes can only be partially removed with an aspiration tube. As a result, the vision of the operative field becomes obscured, thus making it difficult to perform surgery. We present a method to resolve this problem consisting in forced ventilation of the air present in the laryngoscope and the exposed larynx. Simultaneous use of the forced ventilation air and the aspiration tube permits a more efficient withdrawal of fumes from the operative field and a better view of the larynx for the surgeon. Since 1986, we have performed 200 CO(2) laser cordectomies in patients with early stage glottic cancer without any kind of complication.     

The clinical characteristics of congenital laryngeal saccular cysts

Conclusion: The first step when treating newborns and infants with hoarseness and dyspnea is to consider the possibility of CLSCs. The appropriate operation can then be chosen based on the cyst sub-type. Complete resection of the cyst wall is the key to preventing recurrence. Background: A laryngeal saccular cyst is an unusual congenital lesion that appears clinically during the neonatal period or early infancy. Because few reports on congenital laryngeal saccular cysts (CLSCs) exist, this study investigated the clinical features of patients with a history of CLSCs to determine the clinical characteristics of this disease. Methods: The data from 28 CLSC patients admitted to Beijing Tongren Hospital from July 2004 to September 2014 were reviewed. Gender, age at onset of symptoms, number of surgical procedures performed, effect of the operation, and CLSC classification were analyzed. Results: CLSCs accounted for 0.79% of laryngeal operations during the study period. Of the cases examined, 35.7% (10/28) had first been treated as laryngomalacia. With respect to cyst type, 17.9% (5/28) were anterior laryngeal saccular cysts, and 82.1% (23/28) were lateral saccular cysts. The patients underwent a total of 53 surgeries, including 21 procedures performed at other hospitals. The time to recurrence of the cysts following needle aspiration ranged from 5–10 days. The time to recurrence after the roof of the cyst was excised ranged from 1–10 months. There were no recurrences after the complete resection of the cyst wall using a CO₂ laser and microsuturing of the wound surfaces via an endoscopic procedure, which is much better than the 41% of endoscopic de-roofing cases which recurred reported by Mitchell et al.     

Combined therapy with Isoprinosine and CO2 laser microsurgery for the treatment of laryngeal papillomatosis

Summary Recurrent laryngeal papillomas and their potential malignant degenerations in adult patients have been known clinically for about 100 years. An early effective treatment has great importance in preventing possible obstruction of the airway or malignant change. The use of endoscopic microsurgery with the CO₂ laser has resulted in a significant improvement in the eradication of papillomatous nodules. The advantages of laser surgery are: better visualization of the larynx to allow more precise and deeper resection of papillomas, limited bleeding, and a reduced possibility of seeding uninvolved mucosa. Although laser surgery is the current method of choice for treating laryngeal papillomatosis, it has not solved completely the problems of recurrences. To make treatment more effective, we have developed a therapeutic regimen that combines laser microsurgery with the immunostimulant methisoprinol (Isoprinosine). Our observations in 18 patients have shown that this combined management was more successful than using a single modility with either the laser or Isoprinosine alone. The combined approach was also effective in recurrent cases, with the timing of the combination influencing the results of the treatment given.     

Conservative laser microsurgery for T1 glottic carcinoma

OBJECTIVE: The purpose of the study was to assess whether partial cordectomy or complete cordectomy with narrow free margins is a safe oncological procedure for T1 glottic carcinoma. We also studied surgical margins and the involvement of anterior commissure. METHODS: Thirty-one T1 glottic carcinomas underwent endoscopic CO(2) laser excision of the lesion based on the depth of infiltration by the tumor with 1-2mm free margins. If detecting free margins was not macroscopically possible, additional biopsies along all the uncertain margins of the excision's residual area were taken. After excision, the specimen was mounted on a plastic support, flattened and then held in place with fine needles. It was then oriented and mapped. The pathologist measured the lesion's point of maximum infiltration and its distance from the free margins. RESULTS: Local and ultimate control at 36 months was 95% and 100%, respectively. We performed 29 partial and two complete cordectomies. Complete resection of the lesion was obtained in 90.4% of the cases. Re-resection was necessary in 9.6% of the cases due to positive margins. The anterior commissure was affected in 38.7% of the cases, and was the site of maximum infiltration in 9.6% of the cases. The mean maximum infiltration was 0.93mm in the anterior commissure, 2.18mm in the anterior 1/3rd of the vocal cord, 1.71mm in the middle 1/3rd of the vocal cord and 1.5mm in the posterior 1/3rd of the vocal cord. In 83.9% of the cases (p<0.01), the anterior 1/3rd of the vocal cord was the section most frequently involved. In 19 patients (61.3%) (p<0.01), the anterior 1/3rd of the vocal cord was also the area with the highest incidence of maximum infiltration by the tumor. CONCLUSION: We concluded that.     

History and physical examination, screening and diagnostic testing

The oral medicine specialist and oral pathologist are the disciplined subspecialists in dentistry who deal with oral disease and related systemic conditions. Dental colleagues are an invaluable resource for the diagnosis and treatment of diseases unfamiliar to the otolaryngologist. This article reviews the process of history taking, the physical examination, head and neck examination, oral soft tissue anatomy, the oral examination, and screening and diagnostic testing.     

Pediatric laryngeal neurofibroma: Case report and review of the literature

Presentation of a case of pediatric laryngeal neurofibroma (LNF) and review of the world literature. Comprehensive review of the world literature using Pubmed and Google scholar. Pediatric LNF was identified in 62 cases reported in the world literature. The most common presenting symptom is stridor and the most common location of the tumor in the larynx is the aryepiglottic fold. Recent reports demonstrate increased utilization of endoscopic resection with reduced need for tracheostomy. Pediatric LNF is a rare disorder. Review of the world literature since 1940 suggests a recent trend away from aggressive open resection and toward more conservative endoscopic resection with excellent functional results.     

Polysomnography outcomes following transoral CO2 laser microsurgery in pediatric patients with laryngomalacia

Objective

Laryngomalacia is the most common cause of stridor in newborns and infants. The aim of the contribution was to present objectified data of the outcome of transoral CO₂ laser microsurgery in patients with laryngomalacia utilizing polysomnography (PSG).

Patients and methods

This retrospective study comprised 21 patients who were diagnosed to suffer from laryngomalacia. Diagnosis was confirmed by pharyngo-laryngoscopy under spontaneous breathing. If there was evidence for laryngomalacia a transoral CO₂ lasersurgical intervention and/or epiglottopexy was performed in the same session. 8 patients, on whom the following should be focused, received pre- and postoperative PSG which was performed for efficiency control of the applied treatment.

Results

All 21 patients underwent invasive treatment for laryngomalacia (lasersurgical division of the aryepiglottic folds: n = 13; epiglottopexy: n = 5; combined procedure: n = 3). All patients were successfully extubated after surgery. In 20/21 cases breathing improved clearly after one single intervention. Stridor disappeared completely in the further course of the disease. In the 8 patients who received pre- and postinterventional PSG, lasersurgical interventions were performed. Statistical analysis of pre- and postoperative PSG revealed that MOAI/h (mixed obstructive apnea index/hour) improved significantly (p = 0.016, Wilcoxon-Signed-Rank Test). Also desaturation/hour improved in the postoperative course (p = 0.11).

Conclusion

The presented concept describes an effective and reliable approach for diagnostics and treatment for laryngomalacia. To objectify the success of supraglottoplaty in patients suffering from severe laryngomalacia a pre- and postoperative PSG seems to be useful and advisable. The present results of PSG demonstrate that children with laryngomalacia to benefit from lasersurgical division of the aryepiglottic folds and/or epiglottopexy. This fact is supported by the postoperative improved clinical aspect.     

Variation in prognosis of early laryngeal carcinoma after different types of cordectomy with transoral laser microsurgery

Background: The lack of standardized treatment is problematic in laser surgery for laryngeal cancer, and may result in an increased recurrence rate. This study analyzed the prognosis of early laryngeal carcinoma after different types of cordectomy with laser surgery.

Methods: A cohort of 818 patients with stage Tis or T1 primary early glottic squamous cell carcinoma treated with CO₂ laser surgery was retrospectively analyzed.

Results: Of the 818 patients, According to the Kaplan–Meier method, the rate of 5-year overall survival was 92.8%, and the rates for 5-year disease-specific survival and 5-year locoregional control were 96.9% and 91.3%, respectively. Among the T1 patients, type II cordectomy with laser surgery had a significant impact on the 5-year locoregional control rate, but no obvious impact on the 5-year overall survival rate.

Conclusions: There must be sufficient depth and extent of excision in T1 patientsand in early carcinoma especially those with possible microinvasive carcinoma     

Endoscopic resections of glottic and supraglottic carcinomas with the C02 laser

Clinical experiences with transoral CO₂ laser resections of glottic and supraglottic carcinomas are presented. 47 patients with variously sized supraglottic tumors and 114 patients with early glottic cancers were treated at the University of Kiel from 1979 to 1993. Although 10 patients with glottic tumors developed recurrences, curative treatment was possible with either repeat laser surgery (3 cases), irradiation (3 cases) or salvage laryngectomy (3 cases). One patient refused further treatment. Among the 30 patients with supraglottic lesions treated for cure 18 are currently alive and free of disease. 6 patients died with no evidence of disease, 2 patients died from secondary malignancies and 3 patients succumbed to their tumors. Present findings justify routine use of laser resections of laryngeal neoplasms, although patients must still be carefully selected for treatment.Presented at the combined meeting of the Society of Head and Neck Surgeons and the European Organization for Research and Treatment of Cancer, Paris, France, 25–28 May 1994     

CO<Subscript>2</Subscript> laser treatment of laryngeal stenoses after reconstructive laryngectomies with cricohyoidopexy,cricohyoidoepiglottopexy or tracheohyoidoepiglottopexy

Supracricoid laryngectomy with cricohyoidopexy (CHP) or cricohyoidoepiglottopexy (CHEP) is a conservative laryngeal surgery tailored to T1b-T2-T3 glottic-supraglottic carcinomas. Tracheohyoidopexy (THP) and tracheohyoidoepiglottopexy (THEP) allow a chance of conservative surgery also for selected transglottic carcinomas. These techniques are comprehensively named reconstructive laryngectomies (RLs). Post RL laryngeal stenosis not due to carcinoma persistence or recurrence is an unusual occurrence. The aim of the present study has been to analyse retrospectively and describe the treatment of the cases of laryngeal stenosis after RL, which occurred in Vittorio Veneto Otolaryngological Department in a 6 year period. In the period between 1999 and 2004, 225 patients underwent RL in our Department. In 18 of them (8%) a laryngeal stenosis after RL was diagnosed. The same evidence was shown in 2 patients who underwent RL in other Institutions. All patients underwent CO₂ laser surgical treatment of the laryngeal stenosis. The 14 patients who underwent RL-CHEP, the 5 patients who underwent THEP and the patient who underwent CHP were treated on average with CO₂ laser 1.2 (range 1–2), 4.2 (range 2–7), and 2 times, respectively. Decannulation was possible in all patients but one after CO₂ laser treatment of the stenosis in a mean period of 3.4 months. Laryngeal stenoses after RLs can be successfully treated with CO₂ laser excision with a very limited morbility. The only reasonable contra-indication to CO₂ laser excision could be a cranio-caudal length of the laryngeal stenotic tract longer than 1 cm: in this occurrence diagnosed after THP or THEP, an external surgical approach could be preferred.     

Effect of the stapedotomy technique on early post-operative hearing results--Preliminary results

Objective

To compare three stapedotomy modalities used to fenestrate the stapes footplate in patients with primary otosclerosis.

Materials

The non-randomized and unblinded one-center study included 48 patients with primary otosclerosis who underwent stapes surgery between May 2008 and April 2009. The patients were divided into three groups (single shot and two-shot CO₂ laser stapedotomy, perforator) depending on the modality used for stapedotomy. Bone conduction (BC) and air conduction (AC) thresholds, air–bone gap (ABG), and the difference between mean pre-operative and 2- to 3-week post-operative BC thresholds were analyzed.

Results

The temporary BC deterioration was most pronounced at 6 and 8 kHz after 2-shot laser stapedotomy. A significant drop in AC or BC was not found in any of our 48 patients. Age, high-dose cortisone therapy, and ‘preoperative hearing’ did not influence the post-operative hearing results.

Conclusion

Even though the number of patients presented here was small and statistical analysis was limited, the study showed a trend toward worse BC thresholds at 6 and 8 kHz after a second shot CO₂ application. Whenever possible, treatment should avoid a second laser shot on the already opened inner ear with the laser parameters used for the initial shot.     

Chordektomia wewnętrzna i zewnętrzna poprzez rozszczepienie krtani i zastosowaniem lasera CO2

Introduction

The aim of this work was to evaluate the therapy results of patients with glottic carcinoma in the T1NoMo advanced clinical stage on internal or external chordectomy via the thyroid cartilage with the use of CO₂ laser.

Material and methods

The study was conducted in 110 patients, including 7 women aged 52–68 and 103 men aged 52–73, who were treated in the Department of Otolaryngology and Laryngological Oncology, Military Medical Academy Teaching Hospital in Lodz, during the years 2010–2012, due to laryngeal carcinoma (T1N0M0).

Results

The studied material was subjected to external chordectomy via laryngofissure in 51 men (46.4%), and internal chordectomy with the use of CO₂ laser in 52 men (47.2%) and 7 women (6.4%). In the patients operated via laryngofissure, the following types of external chordectomy were performed: IV – in 25 cases (49.0%), Vc – in 12 cases (23.6%), and Vb and Vd – in 7 cases each (13.7% each). Internal chordectomy was conducted with the use of the following types: III – in 31 cases (52.5%), IV – in 15 cases (25.4%) and Vd – in 13 cases (22.1%). During the post-operative follow-up of 1–3 years, no recurrence of carcinoma was observed.

Conclusions

The place and size of carcinoma are often dependent on the type of internal and external chordectomy, which is preceded by tracheotomy and is usually dependent on a patient's consent. Too short post-operative follow-up does not allow for the comparison of effective therapies of the two surgical methods.