Use of Co2 Laser versus conventional microlaryngeal surgery in treatment of vocal fold benign lesions

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hesham El-Halaby ◽  
Marwa M El-Begermy ◽  
Mina Zakaria Hakim
Keyword(s):  
Lamina Propria ◽  
Co2 Laser ◽  
Vocal Fold ◽  
Meta Analysis ◽  
Vocal Folds ◽  
Superficial Layer ◽  
Sufficient Evidence ◽  
Benign Lesions ◽  
Benign Vocal Fold Lesions ◽  
Microlaryngeal Surgery

Abstract Background Benign superficial lesions of vocal fold (nodule, polyp, cyst and Reinke's edema) arise from the epithelium and the lamina propria. Vocal abuse and misuse presumably lead to excessive mechanical stress and trauma in the membranous portion of vocal fold, resulting in wound formation. Wound healing leads to remodeling of the superficial layer of the lamina propria. This tissue remodeling leads to formation of benign vocal fold lesions. These lesions are classically treated by conventional microsurgery and recently by CO2 laser. The use of the CO2 laser for the surgical treatment of Minor Associated Pathological Lesions (MAPL's) is still controversial. Some preferred cold instruments, whereas others appreciate CO2 laser as a novel alternative to conventional microsurgery for benign vocal fold lesions. To summarize the reviewed literature the issue of CO2 laser versus cold instruments is still controversial and the stage is open for more studies. Aim The aim of this study is to investigate the effect of Co2 Laser versus cold instruments in the treatment of benign lesions of the vocal folds regarding voice outcome & vocal fold function. Methodology A meta-analysis study is done to assess the use of Co2 Laser versus conventional microlaryngeal surgery in treatment of vocal fold benign lesions. Results This study does not reveal any detectable differences in clinical outcomes in patients with nodules, polyps and cysts who underwent excision via CO2 laser or cold instruments. Conclusion There is no sufficient evidence to determine if conventional surgery or CO2 assisted surgery is better.

Indirect Microsurgery of the Vocal Folds - Videostroboscopy vs. Microstroboscopy

1993 ◽  
Vol 72 (2) ◽  
pp. 134-141 ◽  
Author(s):  
Zoran Milutinović
Keyword(s):  
Laser Surgery ◽  
Vocal Fold ◽  
Vocal Folds ◽  
Surgical Approaches ◽  
Surgical Trauma ◽  
Benign Lesions ◽  
Functional Control ◽  
Microlaryngeal Surgery ◽  
Surgical Manipulation ◽  
Vocal Fold Surgery

In spite of the great significance of direct microlaryngeal surgery (DML), the inadequacies of this technique are evident. In order to avoid surgical trauma and introduce functional control during surgery, indirect microstroboscopic (IMS) and indirect videostroboscopic surgery (IVS) of the vocal folds are advocated. Both of these meet most criteria for surgical work in this field. The aim of this work was to make a comparative study of these techniques. The study is based on 603 operations conducted for benign lesions of the vocal folds. We are of the opinion that indirect vocal fold surgery for small benign lesions has significant advantages when compared with the conventional microlaryngoscopy, including laser surgery, which was proven elsewhere. When comparing these two indirect surgical approaches, the principal advantages of IVS surgery over the IMS method are easier surgical manipulation and better view. With respect to other areas of comparison, these techniques are quite similar. As complementary methods to conventional microlaryngoscopy, we believe that both IVS and IMS surgery should be used in practice.

Imaging the Mucosa of the Human Vocal Fold with Optical Coherence Tomography

2005 ◽  
Vol 114 (9) ◽  
pp. 671-676 ◽  
Author(s):  
James A. Burns ◽  
Steven M. Zeitels ◽  
R. Rox Anderson ◽  
James B. Kobler ◽  
Mark C. Pierce ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Lamina Propria ◽  
Vocal Fold ◽  
Imaging Techniques ◽  
Vocal Folds ◽  
Superficial Layer ◽  
Optical Coherence ◽  
Cross Sectional ◽  
Superficial Lamina

Objectives: Discerning the layered microstructure of the vocal folds is critical for effective phonomicrosurgery. Optical coherence tomography (OCT), a noncontact, noninvasive technology that provides cross-sectional images by means of backscattered light, offers the potential for delineating these layers in vivo. Methods: The glottal mucosa of 3 human cadaver larynges was imaged with conventional OCT and polarization-sensitive OCT (PS-OCT). Images were obtained through the epithelium and lamina propria. Results: Although the superficial layer of the lamina propria appeared quite homogeneous, the outer surface of the superficial lamina propria was correlated with an increase in backscatter with OCT. The superficial lamina propria and vocal ligament were correlated with a marked increase in tissue birefringence with PS-OCT. Conclusions: This preliminary study demonstrates the capacity of OCT and PS-OCT for visualizing the layered microstructure of the vocal fold mucosa. We believe that these imaging techniques will have applications in the exploration of solutions to vocal fold scarring and in imaging vocal fold disorders in the clinic and operating room.

Reinke's Edema: Phonatory Mechanisms and Management Strategies

1997 ◽  
Vol 106 (7) ◽  
pp. 533-543 ◽  
Author(s):  
Steven M. Zeitels ◽  
Glenn W. Bunting ◽  
Robert E. Hillman ◽  
Traci Vaughn
Keyword(s):  
Lamina Propria ◽  
Fundamental Frequency ◽  
Vocal Fold ◽  
Management Strategies ◽  
Vocal Folds ◽  
Vocal Fold Vibration ◽  
Reinke’S Edema ◽  
Subglottal Pressure ◽  
Almost All ◽  
Superficial Lamina

Reinke's edema (RE) has been associated typically with smoking and sometimes with vocal abuse, but aspects of the pathophysiology of RE remain unclear. To gain new insights into phonatory mechanisms associated with RE pathophysiology, weused an integrated battery of objective vocal function tests to analyze 20 patients (19 women) who underwent phonomicrosurgical resection. Preoperative stroboscopic examinations demonstrated that the superficial lamina propria is distended primarily on the superior vocal fold surface. Acoustically, these individuals have an abnormally low average speaking fundamental frequency (123 Hz), and they generate abnormally high average subglottal pressures (9.7 cm H20). The presence of elevated aerodynamic driving pressures reflects difficulties in producing vocal fold vibration that are most likely the result of mass loading associated with RE, and possibly vocal hyperfunction. Furthermore, it is hypothesized that in the environment of chronic glottal mucositis secondary to smoking and reflux, the cephalad force on the vocal folds by the subglottal driving pressure contributes to the superior distention of the superficial lamina propria. Surgical reduction of the volume of the superficial lamina propria resulted in a significant elevation in fundamental frequency (154 Hz) and improvement in perturbation measures. In almost all instances, both the clinician and the patient perceived the voice as improved. However, these patients continued to generate elevated subglottal pressure (probably a sign of persistent hyperfunction) that was accompanied by visually observed supraglottal strain despite the normalsized vocal folds. This finding suggests that persistent hyperfunctional vocal behaviors may contribute to postsurgical RE recurrence if therapeutic strategies are not instituted to modify such behavior.

Effects of Voice Therapy as Objectively Evaluated by Digitized Laryngeal Stroboscopic Imaging

2002 ◽  
Vol 111 (10) ◽  
pp. 902-908 ◽  
Author(s):  
Renée Speyer ◽  
Pieter A. Kempen ◽  
George Wieneke ◽  
Willem Kersing ◽  
Elham Ghazi Hosseini ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Lesion Size ◽  
Voice Therapy ◽  
Benign Lesions ◽  
Objective Measurements ◽  
Significant Parameter ◽  
Surface Areas ◽  
Vocal Fold Vibration ◽  
Maximal Opening

Objective measurements derived from digitized laryngeal stroboscopic images were used to demonstrate changes in vocal fold vibration and in the size of benign lesions after 3 months of voice therapy. Forty chronically dysphonic patients were studied. By means of a rigid stroboscope, pretreatment and posttreatment recordings were made of the vocal folds at rest and under stroboscopic light during phonation. From each recording, images of the positions at rest and during vibration at maximal opening and at maximal closure were digitized. The surface areas of any lesions and of the glottal gap were independently measured in the digitized images by 2 experienced laryngologists. Referential distances were determined in order to compensate for discrepancies in magnification in the various recordings. After 3 months of voice therapy, significant improvement in lesion size and degree of maximal closure during vibration could be demonstrated in about 50% of the patients. The degree of maximal opening did not prove to be a significant parameter.

Immunocytochemical Study of Proteoglycans in Vocal Folds

1996 ◽  
Vol 105 (1) ◽  
pp. 6-11 ◽  
Author(s):  
Agnieszka S. Pawlak ◽  
Elizabeth Hammond ◽  
Thomas Hammond ◽  
Steven D. Gray
Keyword(s):  
Chondroitin Sulfate ◽  
Lamina Propria ◽  
Vocal Fold ◽  
Keratan Sulfate ◽  
Vocal Folds ◽  
Basement Membrane Zone ◽  
Immunocytochemical Study ◽  
Frozen Sections ◽  
Intense Staining ◽  
Immunocytochemical Techniques

We evaluated the proteoglycan composition of normal vocal folds using immunocytochemical techniques. Frozen sections of 14 normal cadaveric vocal folds were obtained within 12 hours of death and sectioned immediately. Vocal fold sections were stained with antibodies against keratan sulfate, chondroitin sulfate, heparan sulfate proteoglycan (HSPG), decorin, and hyaluronate receptor. We found that the lamina propria has diffuse staining of fibrillar components with keratan sulfate and decorin. Intense staining was observed in the vocal ligament area with keratan sulfate. The HSPG was localized to the basement membrane zone. Chondroitin sulfate, HSPG, and hyaluronate receptor were detected in the cytoplasm of interstitial cells with immunocytochemical characteristics of macrophages. The keratan sulfate distribution suggests that fibromodulin may be significant in normal vocal folds. Production of HSPG and probably versican occurs in macrophages and fibroblasts in the lamina propria.

Benign Lesions of the Vocal Folds: Histopathology and Phonotrauma

1995 ◽  
Vol 104 (9) ◽  
pp. 698-703 ◽  
Author(s):  
Frederik G. Dikkers ◽  
Peter G. J. Nikkels
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Histopathologic Examination ◽  
Benign Lesions ◽  
Ultrastructural Examination ◽  
Abnormal Increase ◽  
Reinke Edema ◽  
Histopathologic Findings ◽  
Single Blind ◽  
Vocal Fold Nodules

Benign lesions of the vocal folds have various appearances. Histopathologic examination might provide the true diagnosis. Therefore, histologic slides of 74 patients (92 vocal folds) with clinically well-defined diagnoses were single-blind examined by a pathologist. Single histologic features did not differentiate between different clinical entities, but combinations make some diagnoses more likely than others. Ultrastructural examination of submucosal vessels in the three most common clinical entities (polyps, Reinke edema, and vocal fold nodules) showed an entity-unique pattern of abnormal increase of layers of basement membrane—like material. A potential pathogenetic model of benign lesions of the vocal folds is presented, employing a combination of histopathologic findings and their possible relations with various forms of trauma inducing and maintaining these lesions.

Hepatocyte Growth Factor and its Receptor C-Met in Rat and Rabbit Vocal Folds

2002 ◽  
Vol 111 (8) ◽  
pp. 661-666 ◽  
Author(s):  
Shigeru Hirano ◽  
Susan Thibeault ◽  
Charles N. Ford ◽  
Diane M. Bless ◽  
Shin-Ichi Kanemaru
Keyword(s):  
Wound Healing ◽  
Growth Factor ◽  
Hepatocyte Growth Factor ◽  
Lamina Propria ◽  
Vocal Fold ◽  
Vocal Folds ◽  
Enzyme Linked Immunosorbent Assay ◽  
Alternative Approach ◽  
Fibrotic Scar ◽  
Hepatocyte Growth

Vocal fold fibrotic scar is characterized by fibrosis of the lamina propria and epithelium, and is difficult to treat. Hepatocyte growth factor (HGF) has antifibrotic activity and has received attention as a possible therapeutic alternative to treat fibrosis. In this study, in order to clarify whether HGF can be involved in vocal fold scarring, we examined the existence of HGF and its receptor, c-Met, in rat vocal folds, and then the activity of HGF in rabbit injured vocal folds, using immunohistochemistry and enzyme-linked immunosorbent assay. We found HGF and c-Met on epithelial cells and gland cells of the rat vocal folds. On the injured vocal folds of rabbits, little HGF was observed immediately after injury, but prominent activity occurred simultaneously with reepithelialization of the vocal fold mucosa on days 10 to 15. The activity of HGF was observed on fibroblasts in the lamina propria, as well as the epithelium. It is suggested that HGF in the vocal folds is produced by the fibroblasts and delivered to the epithelium. The implication of these findings is that HGF is involved in wound healing of the vocal fold, and may provide an alternative approach in preventing and treating vocal fold scarring.

scholarly journals Adipose-Derived Mesenchymal Stem Cells in the Regeneration of Vocal Folds: A Study on a Chronic Vocal Fold Scar

2016 ◽  
Vol 2016 ◽  
pp. 1-12 ◽  
Author(s):  
Angelou Valerie ◽  
Kalodimou Vassiliki ◽  
Messini Irini ◽  
Psychalakis Nikolaos ◽  
Eleftheria Karampela ◽  
...  
Keyword(s):  
Stem Cells ◽  
Hyaluronic Acid ◽  
Lamina Propria ◽  
Vocal Fold ◽  
Rabbit Model ◽  
Vocal Folds ◽  
Scar Tissue ◽  
Elastic Fibers ◽  
Adipose Derived Stem Cells ◽  
Vocal Fold Scar

Background. The aim of the study was to assess the histological effects of autologous infusion of adipose-derived stem cells (ADSC) on a chronic vocal fold scar in a rabbit model as compared to an untreated scar as well as in injection of hyaluronic acid.Study Design. Animal experiment.Method. We used 74 New Zealand rabbits. Sixteen of them were used as control/normal group. We created a bilateral vocal fold wound in the remaining 58 rabbits. After 18 months we separated our population into three groups. The first group served as control/scarred group. The second one was injected with hyaluronic acid in the vocal folds, and the third received an autologous adipose-derived stem cell infusion in the scarred vocal folds (ADSC group). We measured the variation of thickness of the lamina propria of the vocal folds and analyzed histopathologic changes in each group after three months.Results. The thickness of the lamina propria was significantly reduced in the group that received the ADSC injection, as compared to the normal/scarred group. The collagen deposition, the hyaluronic acid, the elastin levels, and the organization of elastic fibers tend to return to normal after the injection of ADSC.Conclusions. Autologous injection of adipose-derived stem cells on a vocal fold chronic scar enhanced the healing of the vocal folds and the reduction of the scar tissue, even when compared to other treatments.

Hyaluronic Acid Concentration in Female Vocal Folds With Reinke’s Edema

2021 ◽  
pp. 019459982110089
Author(s):  
Cristiana Vanderlei de Melo Lins ◽  
João Roberto Maciel Martins ◽  
Elsa Yoko Kobayashi ◽  
Gustavo Polacow Korn ◽  
Sung Woo Park ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Vocal Fold ◽  
Binding Protein ◽  
Vocal Folds ◽  
Superficial Layer ◽  
Control Group ◽  
Nasal Cartilage ◽  
Tertiary Center ◽  
Reinke’S Edema ◽  
The Mean

Objective The aim of the present study was to investigate hyaluronic acid (HA) concentrations in vocal folds among patients with Reinke’s edema. Study Design Prospective and experimental study. Setting Single tertiary center. Methods An HA binding protein isolated from bovine nasal cartilage was used to identify and isolate the HA from samples. Plates coated with biotin-conjugated binding protein and streptavidin-europium conjugate were sequentially incubated with 18 Reinke’s edema samples and 11 female vocal fold cover samples from cadavers (the superficial layer of the lamina propria; control group). After the release of europium from streptavidin in enhancement solution, final fluorescence was measured in a fluorometer. Results The mean HA concentration in Reinke’s edema vocal folds was significantly higher than that in the control vocal folds (9.2 × 103 vs 0.9 × 103µg/g). Conclusion Vocal fold covers affected by Reinke’s edema present a higher concentration of HA than do vocal fold covers with no edema.

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