Longitudinal Voice Outcomes Following Serial Potassium Titanyl Phosphate Laser Procedures for Recurrent Respiratory Papillomatosis

2020 ◽  
pp. 000348942095037
Author(s):  
Wei-Chen Hung ◽  
Wu-Chia Lo ◽  
Kai-Min Fang ◽  
Po-Wen Cheng ◽  
Chi-Te Wang
Keyword(s):  
Voice Quality ◽  
Vocal Folds ◽  
Estimating Equation ◽  
Lesion Size ◽  
Recurrent Respiratory Papillomatosis ◽  
Potassium Titanyl Phosphate ◽  
Ktp Laser ◽  
Level Of Evidence ◽  
Surgical Interventions ◽  
Initial Procedure

Objective: Repeated surgical interventions are usually required to control recurrent respiratory papillomatosis (RRP), but at considerable risk of worsened postoperative voice quality. Potassium titanyl phosphate (KTP) laser has been reported to effectively manage RRP; however, voice quality after repeated procedures has not been investigated. Methods: This study recruited 16 patients with RRP treated using KTP laser between 2013 and 2019. KTP laser procedures were performed under general anesthesia via direct suspension laryngoscope or under local anesthesia via flexible endoscope, depending on the need for pathological proof, patient tolerance, and lesion size and location. Disease control was investigated by videolaryngostroboscopy. Voice outcome was evaluated using a 10-item voice handicap index (VHI-10), acoustic and perceptual analyzes. Results: We reviewed the medical records of 11 male and 5 female patients with RRP (age range: 23-73 years). Five patients received KTP laser once, six patients received it 2 to 5 times, and five patients received 6 to 15 procedures. Median VHI-10 decreased from 28.3 to 12.0 points after the initial procedure and were maintained at 10.1 to 11.0 points following subsequent procedures ( P < .01, generalized estimating equation). Acoustic and perceptual analysis of voice quality also revealed significant improvements ( P < .01), which remained stable even after 6 to 10 KTP laser procedures. Minor adverse events included slight fibrotic change of vocal folds and glottic web, but these did not significantly alter postoperative voice quality. Conclusion: This longitudinal follow-up study revealed that serial KTP laser procedures can effectively control RRP while preserving phonatory function and maintaining adequate voice quality. Level of evidence: level 4

scholarly journals A 532-nm KTP Laser for Vocal Fold Polyps: Efficacy and Relative Factors

2020 ◽  
Vol 100 (1_suppl) ◽  
pp. 87S-93S
Author(s):  
Jingru Ma ◽  
Rui Fang ◽  
Ruiqing Zhen ◽  
Wenjing Mao ◽  
Xiufa Wu ◽  
...  
Keyword(s):  
Laser Treatment ◽  
Voice Quality ◽  
Reduction Rate ◽  
Potassium Titanyl Phosphate ◽  
Ktp Laser ◽  
Acoustic Parameters ◽  
Factors Affecting ◽  
Laser Treatments ◽  
The Voice ◽  
Relative Factors

Objective: We retrospectively analyzed the laryngoscopy results and voice outcomes of patients with vocal polyps who received potassium titanyl phosphate (KTP) laser treatments in a clinician’s office, in order to establish the effectiveness and relative factors affecting the efficacy of this treatment. Material and Methods: We enrolled 25 patients with vocal polyps who had undergone KTP laser treatment in the Department of Otorhinolaryngology at our hospital between July 2017 and November 2019. Pre- and postoperative evaluations were measured using laryngovideostroboscopy (LVS), the Voice Handicap Index questionnaire (VHI-30), the GRBAS scale (G hoarseness, R roughness, B breathiness, A asthenia, S strain), and objective acoustic parameters. The reduction rate of lesions was calculated and relative factors affecting efficacy (size, side, location, the position of lesions, type, gender, and occupation) were tested. Results: Areas of lesions decreased from 101.95 ± 70.16 before surgery to 30.49 ± 35.80 after surgery ( Z = 5.234, P < .001). The LVS data showed that the postoperative proportions of normal to mild conditions were the same or higher than the preoperative data in 3 instances: glottal closure (100% vs 100%), amplitude (90.91% vs 63.64%), and mucosal wave (81.82% vs 54.55%). A significant improvement was observed in VHI-30 scores, GRBAS scores, and acoustic parameters ( P < .05). The size of lesions had an effect on the GRBAS scores ( P < .001) but not on VHI-30 scores and objective acoustic parameters ( P > .05). Other factors we tested did not affect voice outcomes. Conclusion: Potassium titanyl phosphate laser treatment can effectively reduce the lesion area of vocal polyps and improve the voice quality. The presence of small lesions seems to predict good subjective assessments of voice quality, but it remains to be seen whether this correlates with true voice quality.

Surgery of benign and tumor-like laryngeal formations using 445 nm semiconductor laser

2021 ◽  
Vol 20 (6) ◽  
pp. 102-108
Author(s):  
A. A. Krivopalov ◽  
◽  
P. A. Shamkina ◽  
Yu. E. Stepanova ◽  
E. E. Koren’ ◽  
...  
Keyword(s):  
Semiconductor Laser ◽  
Clinical Case ◽  
Anterior Commissure ◽  
Voice Quality ◽  
Laser Coagulation ◽  
Ktp Laser ◽  
Upper Respiratory Tract ◽  
Surgical Interventions ◽  
Relevant Today ◽  
Laser Systems

The issues of phonosurgery remain truly relevant today since there is a high prevalence of benign and tumor-like laryngeal formations among the pathology of the upper respiratory tract (up to 55–70%). Nowadays, laser technologies are coming to the fore among the possibilities of laryngological practice. Photoangiolytic lasers, such as the KTP laser, are actively used to coagulate subepithelial vessels without destroying the superficial epithelium. A novelty among laser systems is a laser with a wavelength of 445 nm certified in 2018, which combines high hemostatic and cutting effects without the extensive zone of thermal damage to surrounding tissues. This paper presents two clinical cases where a 445 nm laser is used. The first clinical case describes a patient with an anterior commissure scar after previous surgical interventions. Treatment using a 445 nm laser made it possible to dissect the scar and restore the normal laryngeal anatomy without stent placement. 5 weeks after the operation, the patient underwent phonopedic therapy and was satisfied with the voice quality. The second clinical case describes a patient with a cystic-like neoplasm of the left vocal fold. Dissection and enucleation of the formation using a direct micro laryngoscopy was done, followed by laser coagulation of the incision edges. Within 2 weeks, the patient showed restoration of the laryngeal endoscopic state and a voice improvement with normalization of acoustic parameters. Thus, the 445 nm semiconductor laser has shown in practice highly pronounced photoangiolytic and cutting properties, which proves its effectiveness in phonosurgery.

scholarly journals The Effectiveness of the Photoangiolytic Potassium Titanyl Phosphate (KTP) Laser in Managing Vocal Folds Reinke’s Edema A Systematic Review

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M N Saad ◽  
A M Elshoubary ◽  
S M Hassan ◽  
M S Khodeir
Keyword(s):  
Systematic Review ◽  
Lower Cost ◽  
Vocal Folds ◽  
Potassium Titanyl Phosphate ◽  
Cochrane Library ◽  
Ktp Laser ◽  
Inclusion Criteria ◽  
Current Systematic Review ◽  
Reinke’S Edema ◽  
Lesion Regression

Abstract Background Recently, photoangiolytic potassium titanyl phosphate (KTP) laser treatment has been proposed as an alternative treatment for managing Reinke’s edema. Unlike traditional methods that involve the physical removal of the lesion, the KTP laser causes lesion regression by disrupting the blood supply through targeting the oxyhemoglobin. Moreover, KTP could be used as an office-based procedure, indicating its advantage over other operating room surgical procedures, with lower cost and avoidance of the potential complications of microlaryngoscopy. Aim The aim of this work is to conduct a systematic review on the effectiveness of the photoangiolytic KTP Laser as a surgical method for treatment of patients with Reinke’s edema. Study Design: This was a systematic review. Methods Two electronic databases of (PubMed and Cochrane Library) were searched for articles. Relevant studies were further evaluated and studies that met inclusion criteria were reviewed and included. Results The literature search yielded 167 studies. 25 articles were further evaluated to be included. Three studies met all the inclusion criteria and were chosen for the review. The studies investigated the effectiveness of using Photoangiolytic KTP Laser in the management of Rienke’s edema. Conclusion The current systematic review suggested that photoangiolytic KTP Laser has not yet proven as an effective approach for treatment of Reinke’s edema and furthermore studies are needed to assess its effectiveness.

Outcomes of Treating Early Glottic Neoplasms With a Potassium Titanyl Phosphate Laser

2018 ◽  
Vol 128 (2) ◽  
pp. 85-95 ◽  
Author(s):  
S. A. Reza Nouraei ◽  
Edwin B. Dorman ◽  
Andrew Macann ◽  
David E. Vokes
Keyword(s):  
Overall Survival ◽  
Learning Curve ◽  
Potassium Titanyl Phosphate ◽  
Treatment Modalities ◽  
Glottic Cancer ◽  
Ktp Laser ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Laser Development ◽  
Early Squamous Cell Carcinoma

Objectives: The aim of this study was to assess the outcome of treating glottic dysplasia and early squamous cell carcinoma (SCC) with potassium titanyl phosphate (KTP) photoangiolytic laser ablation. Methods: Patient demographics, comorbidities, and tumor characteristics were recorded. Perceptual, patient-reported, and objective voice outcomes were assessed. Use of treatment modalities in addition to the KTP laser, development of locoregional or metastatic SCC, and overall survival were recorded. Results: There were 23 patients with glottic dysplasia and 18 patients with glottic SCC. Mean age at treatment was 69 years. Most patients (95%) were male. Posttreatment fundamental frequency fell from 132 ± 35 to 116 ± 24 Hz ( P = .03). Overall, 61% of patients achieved a normal voice. There was a learning-curve, and most treatment failures occurred in the first half of the series. Five-year KTP-only disease-control rates were 87.1% and 53.5% for dysplasia and malignancy, respectively. Five-year overall survival was 56%, with no laryngectomies or deaths due to SCC. Conclusions: Ablating dysplasia and early glottic cancer using a KTP laser is a viable treatment option. It has a learning curve and a failure rate but, in this series, no ultimate loss of oncologic control. Its introduction into clinical practice should be managed carefully in the context of multidisciplinary cancer care. Level of Evidence: 4.

1842: Catheter Free Potassium-Titanyl-Phosphate (KTP) Laser Photoselective Vaporization Prostatectomy (PVP): Patient Characteristic Analysis

2007 ◽  
Vol 177 (4S) ◽  
pp. 612-612
Author(s):  
Motoo Araki ◽  
Po N. Lam ◽  
Daniel J. Culkin ◽  
Pamela E. Fox ◽  
Glenn M. Sulley ◽  
...  
Keyword(s):  
Potassium Titanyl Phosphate ◽  
Ktp Laser ◽  
Characteristic Analysis ◽  
Photoselective Vaporization

V1540: Potassium-Titanyl-Phosphate (KTP) Laser Nerve-Sparing Laparoscopic Radical Prostatectomy: Effects on Cavernous Nerve Function in a Canine Model

2007 ◽  
Vol 177 (4S) ◽  
pp. 508-509
Author(s):  
Troy R. Gianduzzo ◽  
Jose R. Colombo ◽  
Georges-Pascal Haber ◽  
Kester Nahen ◽  
Cristina Magi-Galluzzi ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Canine Model ◽  
Laparoscopic Radical Prostatectomy ◽  
Potassium Titanyl Phosphate ◽  
Nerve Sparing ◽  
Ktp Laser ◽  
Nerve Function ◽  
Cavernous Nerve

scholarly journals Concurrent YAP/TAZ and SMAD signaling mediate vocal fold fibrosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ryosuke Nakamura ◽  
Nao Hiwatashi ◽  
Renjie Bing ◽  
Carina P. Doyle ◽  
Ryan C. Branski
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Nuclear Accumulation ◽  
Smad Pathway ◽  
Surgical Interventions ◽  
Smad Signaling ◽  
Iatrogenic Damage ◽  
Tgf Β1

AbstractVocal fold (VF) fibrosis is a major cause of intractable voice-related disability and reduced quality of life. Excision of fibrotic regions is suboptimal and associated with scar recurrence and/or further iatrogenic damage. Non-surgical interventions are limited, putatively related to limited insight regarding biochemical events underlying fibrosis, and downstream, the lack of therapeutic targets. YAP/TAZ integrates diverse cell signaling events and interacts with signaling pathways related to fibrosis, including the TGF-β/SMAD pathway. We investigated the expression of YAP/TAZ following vocal fold injury in vivo as well as the effects of TGF-β1 on YAP/TAZ activity in human vocal fold fibroblasts, fibroblast-myofibroblast transition, and TGF-β/SMAD signaling. Iatrogenic injury increased nuclear localization of YAP and TAZ in fibrotic rat vocal folds. In vitro, TGF-β1 activated YAP and TAZ in human VF fibroblasts, and inhibition of YAP/TAZ reversed TGF-β1-stimulated fibroplastic gene upregulation. Additionally, TGF-β1 induced localization of YAP and TAZ in close proximity to SMAD2/3, and nuclear accumulation of SMAD2/3 was inhibited by a YAP/TAZ inhibitor. Collectively, YAP and TAZ were synergistically activated with the TGF-β/SMAD pathway, and likely essential for the fibroplastic phenotypic shift in VF fibroblasts. Based on these data, YAP/TAZ may evolve as an attractive therapeutic target for VF fibrosis.

Combining Microfractures, Autologous Bone Graft, and Autologous Matrix-Induced Chondrogenesis for the Treatment of Juvenile Osteochondral Talar Lesions

2017 ◽  
Vol 38 (5) ◽  
pp. 485-495 ◽  
Author(s):  
Riccardo D’Ambrosi ◽  
Camilla Maccario ◽  
Chiara Ursino ◽  
Nicola Serra ◽  
Federico Giuseppe Usuelli
Keyword(s):  
Bone Graft ◽  
Repeated Measures ◽  
Osteochondral Lesion ◽  
Young Patients ◽  
Case Series ◽  
Autologous Bone Graft ◽  
Lesion Size ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Autologous Bone

Background: The purpose of this study was to evaluate the clinical and radiologic outcomes of patients younger than 20 years, treated with the arthroscopic-talus autologous matrix-induced chondrogenesis (AT-AMIC) technique and autologous bone graft for osteochondral lesion of the talus (OLT). Methods: Eleven patients under 20 years (range 13.3-20.0) underwent the AT-AMIC procedure and autologous bone graft for OLTs. Patients were evaluated preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively, using the American Orthopaedic Foot & Ankle Society Ankle and Hindfoot (AOFAS) score, the visual analog scale and the SF-12 respectively in its Mental and Physical Component Scores. Radiologic assessment included computed tomographic (CT) scan, magnetic resonance imaging (MRI) and intraoperative measurement of the lesion. A multivariate statistical analysis was performed. Results: Mean lesion size measured during surgery was 1.1 cm3 ± 0.5 cm3. We found a significant difference in clinical and radiologic parameters with analysis of variance for repeated measures ( P < .001). All clinical scores significantly improved ( P < .05) from T0 to T3. Lesion area significantly reduced from 119.1 ± 29.1 mm2 preoperatively to 77.9 ± 15.8 mm2 ( P < .05) at final follow-up as assessed by CT, and from 132.2 ± 31.3 mm2 to 85.3 ± 14.5 mm2 ( P < .05) as assessed by MRI. Moreover, we noted an important correlation between intraoperative size of the lesion and body mass index (BMI) ( P = .011). Conclusions: The technique can be considered safe and effective with early good results in young patients. Moreover, we demonstrated a significant correlation between BMI and lesion size and a significant impact of OLTs on quality of life. Level of Evidence: Level IV, retrospective case series.

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