Endoscopic treatment of glottic stenosis: a report on the safety and efficacy of CO2 laser

AbstractBackground:Treatment of glottic stenosis is a considerable challenge to the otolaryngologist. Glottic airway patency can be compromised by bilateral vocal fold palsy, anterior webbing or a posterior segment scar, which may be significant enough to impair arytenoid movement.Method:A retrospective analysis of a prospective database of patients (n = 34) treated by a specialist airway surgeon. All patients underwent endoscopic treatment with a CO2 laser in an attempt to improve airway calibre and, in 12 patients, to decannulate tracheostomy tubes.Results:Twenty-one patients had bilateral vocal fold palsy and 13 had predominantly posterior glottic stenosis. A variety of pathology-directed treatment approaches were used to achieve good functional results. Four patients required a second endoscopic procedure. The overall revision rate was 5 per cent for bilateral fold palsy and 23 per cent for posterior glottic stenosis (p < 0.05). All patients had an adequate functional airway calibre, and all 12 tracheotomised patients were decannulated.Discussion:Pathology-directed endoscopic laser surgery is safe and effective treatment for glottic stenosis. Rather prescriptive use of unilateral or bilateral cordotomy or combined cordo-arytenoidectomy, clinicians must perform the procedure that will treat the lesion most adequately. Our success rate compared favourably with the best reported results.

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Functional results of endoscopic arytenoid abduction lateropexy for bilateral vocal fold palsy

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-07199-1 ◽

2021 ◽

Author(s):

László Rovó ◽

Vera Matievics ◽

Balázs Sztanó ◽

László Szakács ◽

Dóra Pálinkó ◽

...

Keyword(s):

Vocal Fold ◽

Voice Quality ◽

Functional Results ◽

Severity Index ◽

Invasive Treatment ◽

Maximum Phonation Time ◽

Motion Recovery ◽

Bilateral Vocal Fold Paralysis ◽

Vocal Fold Palsy ◽

False Vocal

Abstract Purpose Endoscopic arytenoid abduction lateropexy (EAAL) is a reliable surgical solution for the minimally invasive treatment of bilateral vocal fold palsy (BVFP), providing a stable airway by the lateralization of the arytenoid cartilages with a simple suture. The nondestructive manner of the intervention theoretically leads to higher regeneration potential, thus better voice quality. The study aimed to investigate the respiratory and phonatory outcomes of this treatment concept. Methods 61 BVFP patients with significant dyspnea associated with thyroid/parathyroid surgery were treated by unilateral EAAL. Jitter, Shimmer, Harmonics to Noise Ratio, Maximum Phonation Time, Fundamental frequency, Voice Handicap Index, Dysphonia Severity Index, Friedrich’s Dysphonia Index, Global-Roughness-Breathiness scale, Quality of Life, and Peak Inspiratory Flow were evaluated 18 months after EAAL. Results All patients had a stable and adequate airway during the follow-up. Ten patients (16.4%) experienced complete bilateral motion recovery with objective acoustic parameters in the physiological ranges. Most functional results of the 13 patients (21.3%) with unilateral recovery also reached the normal values. Fifteen patients (24.6%) had unilateral adduction recovery only, with slightly impaired voice quality. Eleven patients (18.0%) had false vocal fold phonation with socially acceptable voice. In 12 patients (19.7%) no significant motion recovery was detected on the glottic level. Conclusion EAAL does not interfere with the potential regeneration process and meets the most important phoniatric requirements while guaranteeing the reversibility of the procedure—therefore serving patients with transient palsy. Further, a socially acceptable voice quality and an adequate airway are ensured even in cases of permanent bilateral vocal fold paralysis.

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Application of ligating loops to control bleeding during endoscopic surgery for a highly vascular hypopharyngeal tumour

The Journal of Laryngology & Otology ◽

10.1017/s002221510600301x ◽

2006 ◽

Vol 120 (11) ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

M Nakahira ◽

H Nakatani

Keyword(s):

Endoscopic Surgery ◽

Endoscopic Treatment ◽

Laser Surgery ◽

Solitary Fibrous Tumour ◽

Endoscopic Approach ◽

External Approach ◽

Feeding Artery ◽

Less Invasive ◽

Endoscopic Laser ◽

Endoscopic Laser Surgery

Endoscopic treatment of hypervascular lesions of the hypopharynx is challenging because of difficulty in controlling bleeding during surgery. We report a highly vascular hypopharyngeal solitary fibrous tumour treated by endoscopic laser surgery combined with ligating loops. Application of dual ligating loops provided easy and secure haemostasis of the feeding artery before resection. Since the endoscopic approach is less invasive than the external approach, we confirm that it is worthwhile to attempt an endoscopic approach using ligating loops before resorting to the external approach in the treatment of hypervascular hypopharyngeal lesions.

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Therapeutic strategy for tracheal chondrosarcoma: report of two cases

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2020.1223 ◽

2020 ◽

Vol 90 (1) ◽

Cited By ~ 1

Author(s):

Angelo Carretta ◽

Paola Ciriaco ◽

Alessandro Bandiera ◽

Piergiorgio Muriana ◽

Gianluigi Arrigoni ◽

...

Keyword(s):

Surgical Treatment ◽

Endoscopic Treatment ◽

Therapeutic Strategy ◽

Slow Growth ◽

Rigid Bronchoscopy ◽

Tracheal Resection ◽

Airway Patency ◽

Endoscopic Laser ◽

Longterm Survival

Primary chondrosarcoma of the trachea is an extremely rare tumor. We report two cases of tracheal chondrosarcoma describing the role of surgical and conservative treatment. Endoscopic treatment with rigid bronchoscopy was performed in both patients to restore airway patency and obtain histological specimens for diagnosis. One of the patients subsequently underwent successful tracheal resection and reconstruction. The other patient, who had a contraindication to surgical treatment due to associated diseases underwent iterative endoscopic LASER treatment and is alive three years after the first diagnosis. Surgical treatment remains the treatment of choice of tracheal chondrosarcoma. When surgery is contraindicated endoscopic treatment may allow relatively longterm survival due to the slow growth of these tumors.

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Endoscopic laser treatment in pre-malignant and malignant vocal fold epithelial lesions

The Journal of Laryngology & Otology ◽

10.1258/002221502761698766 ◽

2002 ◽

Vol 116 (12) ◽

pp. 1019-1024 ◽

Cited By ~ 7

Author(s):

E. E. G. Remijn ◽

H. A. M. Marres ◽

F. J. A. van den Hoogen

Keyword(s):

Radiation Therapy ◽

Laser Treatment ◽

Laser Therapy ◽

Vocal Fold ◽

Verrucous Carcinoma ◽

Endoscopic Laser ◽

Epithelial Lesions ◽

Endoscopic Laser Surgery

Endoscopic laser treatment was performed in 43 patients with pre-malignant or malignant vocal fold epithelial lesions, 10 were treated with endoscopic laser surgery for dysplasia, 12 for carcinoma in situ (CIS), five for verrucous carcinoma and 16 patients for squamous cell carcinoma (SCC). Thirty-two patients received laser therapy as their first therapy, whereas 11 patients had had previous radiation therapy for laryngeal carcinoma (n = 9) or CIS (n = 2).Recurrence after initial laser therapy necessitating re-treatment (a second laser treatment or radiotherapy) occurred in nine out of 32 patients (28 per cent), thus 23 (72 per cent) were maintained free of disease during the follow-up period.Besides the 32 patients without previous therapy, patients who had already undergone radiat on therapy were also included in this study. In this group there were nine patients with SCC, one patient with CIS and one with dysplasia. They all underwent laser therapy. Four were free ofdisease during follow-up (36 per cent) and seven developed recurrences. Six (58 per cent of allpatients with previous radiation therapy) underwent total laryngectomy.

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Idiopathic Subglottic Stenosis Revisited

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940211100806 ◽

2002 ◽

Vol 111 (8) ◽

pp. 690-695 ◽

Cited By ~ 91

Author(s):

Tulio A. Valdez ◽

Stanley M. Shapshay

Keyword(s):

Mitomycin C ◽

Endoscopic Treatment ◽

Laser Surgery ◽

Clinical History ◽

Subglottic Stenosis ◽

Endoscopic Management ◽

Respiratory Compromise ◽

Endoscopic Laser ◽

Endoscopic Laser Surgery ◽

Laryngotracheal Resection

Idiopathic subglottic stenosis (ISS) is a rare inflammatory process of unknown cause, usually limited to the subglottic region and the first 2 tracheal rings. We performed a retrospective analysis of our experience with a series of patients with this condition. The study involved retrospective review of the records of patients with ISS. A series of criteria that included patient clinical history, laboratory tests, flexible nasolaryngoscopic examination, and biopsies were used to establish a diagnosis. Symptoms, treatment, and outcome were examined. A total of 16 patients were identified; 14 were female (87.5%), and 2 were male. The mean follow-up time was 75.5 months. Fourteen patients required surgical treatment for respiratory compromise. Nine of these cases have been controlled effectively with endoscopic laser techniques. Endoscopic management failed in 5 patients, and 2 patients underwent laryngotracheal resection and reconstruction. Mitomycin-C was used in 6 patients as an adjuvant to endoscopic laser surgery. Patients in whom endoscopic treatment failed were noted to have thicker (>1 cm) and more complex stenoses. The diagnosis of ISS is a diagnosis of exclusion. A complete workup of the patient must be performed to rule out other causes of stenosis. Endoscopic laser surgery is a valid initial approach for thinner, noncomplicated lesions. Patients with thicker, complex lesions in whom endoscopic treatment fails are best managed with laryngotracheal resection and reconstruction. However, adjuvant use of mitomycin-C may prove beneficial in the treatment of these patients. Estrogen may play a role in the pathogenesis of ISS by altering the wound healing response.

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Functional results of endoscopic laser surgery in advanced head and neck tumors

10.1117/12.300829 ◽

1998 ◽

Author(s):

Haneen Sadick ◽

Antonio Baker-Schreyer ◽

Wolfgang Bergler ◽

Joachim Maurer ◽

Karl Hoermann

Keyword(s):

Head And Neck ◽

Laser Surgery ◽

Functional Results ◽

Head And Neck Tumors ◽

Advanced Head ◽

Neck Tumors ◽

Endoscopic Laser ◽

Endoscopic Laser Surgery

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Vocal function following laser and conventional surgery of small malignant vocal fold tumours

The Journal of Laryngology & Otology ◽

10.1017/s0022215100135959 ◽

1996 ◽

Vol 110 (12) ◽

pp. 1138-1141 ◽

Cited By ~ 25

Author(s):

Annerose Keilmann ◽

Wolfgang Bergler ◽

Martina Artzt ◽

Karl Hörmann

Keyword(s):

Vocal Fold ◽

Voice Quality ◽

Mean Value ◽

Conventional Surgery ◽

Vocal Function ◽

Wide Range ◽

Endoscopic Laser ◽

Endoscopic Laser Surgery ◽

Laser Cordectomy

AbstractIn the disecribed study, 26 patients after conventional, and 27 patients after laser cordectomy were examined six months or more after the operation. Videolarybogstroboscopy revealed that patients after laser cordectomy more often phonate on a purely glottic level (81 per cent) in comparison to patienbts after conventional cordectomy (19 per cent). Webs were more frequent and more extended after conventional cordectomy compared to endoscopic laser surgery. The maximal phonation time showed a very wide range with a mean value of 9 to 10 sec; there was no statistical difference between the groups of patients. Using yanagihara's classification of sonograms, a better voice quality was measured after laser cordectomy than conventional cordectomy. The patients' estimation of their voice quality did not correlate with objective parameters.

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