Combined therapy in the treatment of auricular keloids

Management of earlobe keloids is still controversial. Many different treatment modalities have been employed; however, no single approach has been completely successful. We used combination therapy that included compression therapy, laser excision, and serial steroid injection, which has improved our therapeutic outcomes for earlobe keloids.     

Laser therapy for T1 glottic carcinoma of the larynx

We treated 21 previously untreated T1 or tumor in situ squamous cell carcinomas of the true vocal cords by carbon dioxide laser excision. The mean follow-up was 42 months, with a range of 26 to 64 months. Recurrent vocal cord carcinomas, with an average interval to recurrence of 21 months developed in four patients. Three of the four recurrences involved the anterior portion of the true vocal cord, including the anterior commissure. One of the patients with recurrence was treated again with the laser, and the other three underwent radiotherapy. All four patients are alive and have retained their larynges. Laser excision of selected T1 and in situ carcinomas of the true vocal cords is a cost-effective and viable alternative to radiotherapy or more radical surgical therapy.     

Auricular keloids: treatment and results

The aim of this study was to present long-term results in patients with auricular keloids after surgical excision and/or medical therapy by corticoid injection. A retrospective study at an academic tertiary referral centre is presented. Seventeen patients after excision, injection of corticoid, full skin grafting (single therapy or combination of interventions) for auricular keloids were followed up. The validated questionnaires SF-36 and patient outcomes of surgery-head/neck were applied to evaluate the quality of life and the patients’ satisfaction after therapy. Photographs of the former keloid site were rated by an experienced facial plastic surgeon being unaware of treatment method and the patient’s own estimation. The best results for retroauricular keloids were reached by excision, skin grafting and triamcinolone injection, and for earlobe keloids by excision, primary wound closure and triamcinolone injection. Both in rating by the patients and in grading by an investigator, the highest scores for aesthetics and satisfaction were found after triamcinolone injection together with or without excision or skin grafting. A size-related resection of keloids with defect reconstruction by full thickness skin grafting for retroauricular keloids and primary wound closure of ear lobe keloids with an additional steroid injection lead to good cosmetic results and high level of satisfaction among patients.     

Radiofrequency tissue volume reduction for treatment of auricle keloids

Objectives/Hypothesis:

Keloids are often refractive to treatment, and recurrences occur quite frequently. Radiofrequency tissue volume reduction (RFTVR) is a surgical technology that induces extensive fibrosis at the target tissues.

Methods:

We applied RFTVR in 14 patients (19 auricles, 5 patients treated bilaterally; 9 female, 5 male; range, 10–66 years) with keloids of the auricle. Keloids were located at the earlobe in 4 patients (5 auricles), helix in 9 patients (12 auricles), and at both earlobe and helix in 1 patient (2 auricles). In 6 patients (8 auricles) RFTVR was the sole treatment modality applied, and in 7 patients (10 auricles) intralesional steroid injection was also performed. Patients underwent one to seven sessions of RFTVR. Patients were followed up between 2 and 92 months postoperatively (median, 24.5 months).

Results:

Good cosmetic results were achieved in 10 of 14 patients (13 auricles). Three patients (5 auricles) were refractive to treatment, and 1 patient (1 auricle) showed progressive disease despite treatment.

Conclusions:

Radiofrequency tissue volume reduction may be considered as a new, minimally invasive treatment option for keloids of the auricle.     

Using the carbon dioxide laser for tonsillotomy in children

Carbon dioxide laser tonsillotomies were performed on 33 children aged 1-12 years for the relief of obstructive symptoms due to tonsillar hyperplasia. As opposed to conventional tonsillectomy, only the protruding part of each tonsil was removed. A carbon dioxide laser delivering 20 W was used for the excision. Twenty-one children were seen in active short-term follow-up and the records of all the children were checked for possible surgery related events up to 20-33 months after surgery. Laser tonsillotomy was uniformly effective in relieving the obstruction, with good hemostasis. The tonsillar remnants healed completely within 2 weeks. No major adverse events occurred. Post-operative pain appeared slight and easily controlled. There was no gain in operating time compared with conventional tonsillectomy. The laser tonsillotomies were in most cases done in day surgery. No recurrence of obstructive problems was reported up to 20-33 months after surgery. It was concluded that tonsillotomy, using a carbon dixoide laser, is a valid treatment for obstructive symptoms caused by enlarged tonsils, which can be performed with little bleeding and post-operative pain. The improved hemostasis may enable a shift from in-patient to day surgery.     

An approach to management of keloids.

Keloids present a major therapeutic dilemma for the surgeon because of frequent recurrences. We use a new protocol for management of large primary or recalcitrant keloids. The technique employs carbon dioxide laser resection of the keloid and then allows the open wound bed to heal by secondary intention. The open wound is treated as though it were a third-degree skin burn. The wounds invariably orient their long axis parallel to the relaxed skin tension lines. No keloid has ever been noted to recur before epithelial migration is complete. Careful follow-up detects early recurrences that are then treated with injection consisting of 40 mg/mL of triamcinolone acetonide (Kenalog), 150 mg of hyaluronidase (Wydase), and 2% lidocaine via a dermajet. Thirty-seven patients were treated with this protocol and have been followed up for at least 2 years. A control rate of 84% has been achieved with compliant patients.     

3d printed custom made pressure clips for ear keloid treatment after surgical excision

Summary backgroundThe aim of this study is to introduce the efficacy of our 3D printer custom made pressure adjustable clips for preventing keloid recurrence after ear keloid surgical excision. Mechanical pressure is increasingly applied as a means to prevent or treat keloid scars.Methods10 patients were included in the study, and were treated for six months with the 3D custom printed pressure clips after ear keloid excision surgery. The mean follow-up was one year. The primary outcome assessed was the degree of recurrence of keloids, with patient satisfaction as the secondary outcome assessed by subjective history.ResultsKeloid scars were reduced in the treated patient group. Patient scarring was decreased. There were no negative side effects observed after the therapy. Conclusion: Our 3d printed custom pressure-adjustable earclip model is an effective tool in the prevention of ear keloid recurrence and is associated with high patient satisfaction. The benefits should prompt further study on its value as an adjuvant therapy to surgery in keloid treatment.Level of evidenceLevel III on the Evidence Rating Scale for Therapeutic Studies.     

复发性耳部瘢痕疙瘩的形态特征及疗效观察

目的 探讨复发性耳部瘢痕疙瘩的形态特点及手术方式的选择,并观察其治疗效果.方法 回顾性分析2014年1月至2019年1月暨南大学第二临床医学院(深圳市人民医院)耳鼻咽喉头颈外科所有采用手术治疗的复发性耳部瘢痕疙瘩患者的临床资料,根据瘢痕疙瘩的位置、大小、有无窦道以及表面皮肤是否正常等特征选择不同的手术方式,术后半年每3...     

Laryngeal adenocarcinoma, not otherwise specified, treated with carbon dioxide laser excision and postoperative radiotherapy.

Glandular carcinomas of the larynx are aggressive neoplasms that comprise less than 1% of all laryngeal malignancies. Adenocarcinoma, not otherwise specified, is the most common histologic type. The rarity of these lesions has prohibited clarification of definitive therapy. Traditionally, radical surgery is performed because of the usually high stage at presentation and the relative insensitivity to radiotherapy. A case of glottic T1 adenocarcinoma, not otherwise specified, is reported. The tumor presented clinically as a vocal fold granuloma. The treatment modalities included endoscopic excision with the carbon dioxide laser and postoperative radiotherapy. The patient has been followed up for 39 months without evidence of recurrence or metastases. The current literature is reviewed in regard to treatment of laryngeal glandular carcinomas.     

Endoscopic laser excisional biopsy for selected glottic carcinomas

From January 1988 to December 1990, 44 previously untreated patients with squamous cell carcinomas (SCCs) of the true vocal cord (33 T1a, 11 Tis) underwent carbon dioxide laser excision. The mean follow-up was 28 months (range, 12 to 44 months). Endoscopic excisional biopsy was the primary treatment in 38 of the 44 patients, whereas postoperative radiotherapy was added in 6 cases in which the pathology report showed positive margins. Recurrent vocal cord SCC developed in 8 (18%) of the cases, with an average interval of 17.8 months. Re-treatment consisted of a second laser excision in 4 cases, radiotherapy in 1, hemilaryngectomy in 1, and total laryngectomy in 2. The definitive cure rate with endoscopic excisional biopsy for the patients originally treated with laser excision alone was 94.7% (36/38). Endoscopic laser treatment for selected glottic SCC proves to be an excellent alternative to radiotherapy or open neck surgery.     

Use of transoral carbon dioxide laser for supraglottic web from caustic ingestion in a 13 year old

A 13 year old male was referred to the Department of Otorhinolaryngology due to unsuccessful decannulation. At 2 years of age, patient accidentally ingested a caustic liquid alkali and underwent emergency tracheostomy, exploratory laparotomy, and tube gastrectomy. 11 years after, patient was seen at the outpatient department for decannulation. On nasopharyngolaryngoscopy, a supraglottic stenosis with a central 1-mm opening was visualized. Patient underwent transoral carbon dioxide laser excision of supraglottic stenosis. Fused aryepiglottic folds were released from the epiglottis. Patient was discharged well with no immediate complications and was successfully decannulated 1 month post operation with good voice outcome. No recurrence of stenosis at one year post operation. Accidental caustic ingestion commonly occurs in the pediatric age group. A frequent complication of accidental caustic ingestion is strictures. The use of transoral carbon dioxide laser in the surgical treatment of supraglottic stenosis is a suitable option for pediatric patients as this offer several advantages such as less post operative edema, good intraoperative control of hemorrhage, few post-operative complications and is less invasive compared to open laryngeal procedures. This case exhibits the importance of close monitoring for pediatric patients after caustic ingestion in order to diagnose complications earlier.     

Curative effect of cold micro forceps and CO2 laser in the treatment of laryngeal amyloidosis

Abstract

Background: Amyloidosis is a benign, slowly progressive disease. However, the treatment of laryngeal amyloidosis (LA) has not been studied systematically.

Objectives: To investigate the treatment results of cold micro forceps or carbon dioxide laser under microlaryngoscope in the treatment of LA.

Methods: A retrospective review was conducted for the cases collected from January 1990 to March 2016 at our department.

Results: One hundred and eighteen patients (44 males and 74 females, with an average age of 51.7 years) with LA were identified. The amyloidosis was not found in organs other than the larynges and tracheas. The patients most commonly presented with hoarseness and dyspnea. All patients underwent surgical removal of the amyloid deposits (via micro forceps or CO₂ laser). Twenty-nine patients developed recurrences requiring further treatments. The mean interval from treatments to recurrences in these patients was 16.5 months. Five patients were treated more than once. No significant difference was found between cold micro forceps and CO₂ laser methods in recurrences.

Conclusions: LA generally behaves as a benign disease. Resection of LA either via cold micro forceps or CO₂ laser under microlaryngoscope is both safe and effective methods. Regular follow-up with laryngoscopy is indicated for early diagnosis of recurrence.     

Laser excision of glomus tympanicum tumours: long-term results

The purpose of this study was to evaluate the long-term results of laser excision of glomus tympanicum tumours in a series of patients who had been referred to the senior author (DAM) in a retrospective case review. Nine patients underwent complete excision of their glomus tympanicum tumours using a Diode or KTP laser. There were no cases of tumour recurrence. There were no complications during the peri- or postoperative period. Follow-up time was 31.8 months. In our experience, laser excision can be performed with minimal bleeding and morbidity, and it provides excellent tumour control in glomus tympanicum surgery.     

Open excision of subglottic hemangioma with microscopic dissection

OBJECTIVE: To evaluate the efficacy of open excision of subglottic hemangioma utilizing microscopic dissection techniques. DESIGN: Retrospective review of case series. SETTING: Tertiary care teaching children's hospital. PATIENTS: The study included 8 patients ages 7 weeks to 8 months. All patients underwent open microscopic excision of subglottic hemangioma between 2000 and 2006. INTERVENTION: All patients underwent full pre-operative evaluation including micro-direct laryngoscopy and bronchoscopy. All resections were carried out with an anterior cricoid split and partial laryngofissure. Intra-laryngeal dissections were carried out under a cross-table binocular dissecting microscope. Mucosal preservation was practiced whenever possible. Thyroid ala cartilage graft was used to augment subglottic laryngeal framework. Patients were intubated for 3-7 days prior to reassessment and extubation. RESULTS: Eight patients were treated with microscopic open excision of subglottic hemangioma. All patients were successfully extubated. During the follow-up period, 2/8 patients developed early subglottic stenosis that required endoscopic laser treatment. Median follow-up time was 37 months (range 3-84 months). No recurrences have been observed. CONCLUSION: Microscopic dissection adds precision to open excision of subglottic hemangioma. Such precision enables complete excision while accomplishing maximal mucosal preservation, thus limiting the risk of recurrence and subglottic stenosis.     

Local recurrences following transoral laser surgery for early glottic carcinoma: frequency, management, and outcome

Although transoral laser surgery (TLS) for the treatment of early stage glottic carcinoma is now widely used, the patterns of local recurrences, related re-treatment methods, and results have not been documented comprehensively. Two hundred fifty-two patients with glottic carcinoma stage I or II were treated for cure with TLS alone and followed up for 24 to 139 months (mean, 62 months). Their charts were retrospectively reviewed to identify local recurrence patterns. Thirty-five patients (13.9%) presented with local recurrences or second laryngeal primaries 4 to 84 months (mean, 23 months) after initial treatment. Of the 161 patients classified T1N0M0, 21 (13.0%) suffered local recurrences, and in the 91 classified T2N0M0, 14 (15.4%) tumors recurred. If tumors recurring more than 60 months after initial treatment are considered second primary tumors rather than recurrences, then only 18 (11.2%) of 161 patients classified T1N0M0 would have had a recurrence. However, the difference in local control between patients with stage I versus stage II disease would still not be significant (p = .41). Of the 35 patients with local recurrences, 16 (45%) were managed with total laryngectomy, 10 (28.6%) with further TLS, 4 (11.4%) with partial laryngectomy, and 2 (5.7%) with radiotherapy, and 3 (8.6%) had no curative treatment. Accordingly, 16 patients (45.7%) with local treatment failure could be treated with further organ-sparing treatment methods. The actuarial overall survival, disease-specific survival, and organ preservation rates 5 years after the diagnosis of recurrent disease were 43.6%, 74.6%, and 33.7%. Transoral laser surgery leads to local control rates that are comparable to those found after radiotherapy for lesions classified T1 and leads to slightly better control rates for lesions classified T2, but the results are inferior to those achieved with conventional partial laryngectomy. However, if local recurrence occurs, then more re-treatment options are available after TLS as compared to initial radiotherapy or open surgery.     

Powered instrumentation in the treatment of recurrent respiratory papillomatosis: an alternative to the carbon dioxide laser

OBJECTIVE: To assess the advantages of powered instrumentation vs the carbon dioxide laser in treating patients with juvenile-onset recurrent respiratory papillomatosis. DESIGN: A retrospective study. SETTING: Tertiary care children's hospital. PATIENTS: Patients operated on for juvenile-onset recurrent respiratory papillomatosis between January 1, 1999, and December 31, 2000. Papillomas were excised using the microdebrider in one group and the carbon dioxide laser in the second group. INTERVENTIONS: Direct laryngoscopy and bronchoscopy, suspension microlaryngoscopy, and excision of papillomas by the carbon dioxide laser or the microdebrider. MAIN OUTCOME MEASURES: Operative time and postoperative complications. RESULTS: Seventy-three operations were performed (23 with the laser and 50 with the microdebrider). Sixteen patients were included, 10 with active disease and 5 with disease in remission; 1 was lost to follow-up. They had a mean age of 3.75 years, and the male-female ratio was 7:9. The patients presented mostly with hoarseness (13 [81%]). Four (25%) had soft tissue complications with the laser. The microdebrider was less time-consuming than the laser, although those treated with the microdebrider had more active disease. No factor could be used to measure treatment outcome due to disease variability. Those who were older, female, and African American tended to have less severe manifestations of disease. CONCLUSIONS: The microdebrider proved to be less time-consuming than the carbon dioxide laser when used in patients with juvenile-onset recurrent respiratory papillomatosis. Soft tissue complications were nonexistent. In addition to safety, the microdebrider is more appealing to the surgeon, anesthesiologist, and parents, especially because these children often need subsequent surgical procedures.     

Clinical applications of the holmium:YAG laser in disorders of the paediatric airway

OBJECTIVE: The aim of this study was to review the role of the holmium:YAG laser in the management of paediatric airway disorders. METHOD: Twenty-six paediatric patients underwent 42 airway procedures between June 1993 and August 1996 in a tertiary care centre. A case series design was used. OUTCOME MEASURES: Safety, precision, hemostasis, bone-cutting properties, and accessibility of the lesion to the equipment were compared to standard therapies. Postoperative outcomes were then compared to standard therapies. RESULTS: Eight patients underwent correction of choanal atresia or revision, 10 patients underwent functional endoscopic sinus surgery, 3 underwent excision of tracheal granuloma, 2 underwent excision of tracheal web or revisions, 1 underwent excision of subglottic stenosis and bronchial stenosis, 1 underwent excision hemangioma of the tongue, and 1 underwent excision papilloma of the oral cavity. One patient in 42 procedures suffered a surgical complication. Our early success rates are comparable to other series using the carbon dioxide laser or cold instruments. CONCLUSION: The holmium:YAG laser is a safe, effective tool in the treatment of paediatric airway disorders and offers the advantage of a flexible fibre-optic system, good hemostasis, and better bone-cutting characteristics compared to the carbon dioxide laser, which is in widespread clinical use.     

Endonasal endoscopic surgical treatment of paranasal sinus inverted papilloma--first experiences.

PURPOSE: Surgical excision is generally regarded as the treatment of choice for inverted papilloma. However, the approach and extent of surgery has been subject of much debate. The purpose of this study is to evaluate the results of endoscopic sinus surgery in the treatment of paranasal sinus inverted papilloma. PATIENTS AND METHODS: Thirteen cases of inverted papilloma of the paranasal sinuses treated via endoscopic sinus surgery were evaluated. The follow-up averaged from 9 months to 48 months with a mean of 27 months. RESULTS: A close follow-up of all patients was maintained. Seventy-seven per cent (10/13) of the patients had no recurrence after the initial endoscopic procedure. Three patients had recurrences of their tumor within 11 months after surgery, which means a rate of 23% (3/13). In 2 patients, the recurrences were treated endoscopically. In one patient, recurrence and malignant transformation (squamous cell carcinoma) developed after 36 months, which means that the associated carcinoma rate was 7% (1/13). This patient underwent radical maxillectomy and postoperative radiotherapy. None of the patients died of inverted papilloma. CONCLUSION: Endoscopic sinus surgery is a viable treatment alternative for paranasal sinus inverted papilloma in selected cases. This approach should be performed by experienced surgeons and a close follow-up is mandatory. When the disease is more extensive, it should be approached by radical surgery, e.g. en-bloc excision by medial maxillectomy via lateral rhinotomy or mid-facial degloving.     

Results of treatment with alpha-interferon in adult-onset laryngeal papillomatosis

Juvenile laryngeal papilloma occurs mainly in childhood, but is also occasionally seen in adults. The treatment of this disease has been very unsatisfactory. During the last decade, vaporization of the papillomas with the carbon dioxide laser has been the most frequently applied method of treatment, but recurrences are often observed. Alpha-interferon seems to affect the clinical course of juvenile laryngeal papillomatosis in children. We therefore started treating 3 patients with persistent adult-onset laryngeal papillomatosis with alpha-interferon in combination with regular endoscopic removal using the CO2 laser. In 1 case a complete remission occurred within 3 months. Administration of alpha-interferon was continued for another 6 months. Laryngoscopy in the 2 other patients showed only minor lesions after treatment with alpha-interferon for 1 1/2 years. Alpha-interferon treatment is still being continued. The dramatic improvement in the laryngeal picture of these patients during the treatment with alpha-interferon leads to the conclusion that alpha-interferon can affect the course of this disease. Whether a definite cure can be achieved is, however, still questionable.