Treatment Outcomes of Angiolytic Laser-Assisted Glottoplasty in Patients With Sulcus Vocalis

Objective: We have been performing glottoplasty using angiolytic laser, including pulsed dye laser (PDL) or potassium titanyl phosphate (KTP) laser, for the treatment of sulcus vocalis. In this study, we retrospectively reviewed the treatment results of sulcus vocalis patients who had undergone glottoplasty using angiolytic laser and evaluated the efficacy and safety of this surgical technique. Methods: From January 2008 to April 2016, 79 patients with sulcus vocalis who underwent angiolytic LASER-assisted glottoplasty were enrolled in the study. Results: Of the 79 patients who participated in this study, 55 were male, and 24 were female. PDL was used for glottoplasty in 68 patients, and KTP was used in the remaining 11 patients. Seventy-seven patients underwent surgery for bilateral vocal cord lesions, and only 2 patients underwent surgery for unilateral vocal cord lesion. After glottoplasty using angiolytic laser, most patients showed continuous improvement of the GRBAS (grade, roughness, breathiness, asthenia, strain) score and Voice Handicap Index score until 6 months after the operation. In addition, we observed improvement of objective voice indices such as noise to harmonic ratio, jitter, shimmer, and maximal phonation time postoperatively. Conclusions: Based on these results, we confirmed the efficacy and safety of glottoplasty using angiolytic laser in sulcus vocalis patients. Further studies are needed to confirm appropriate laser settings such as frequency of treatments and total energy delivered to the lesion. Also, multi-institutional studies are needed to confirm the efficacy and safety of the operation.

Value and utility of 532 nanometre pulsed potassium-titanyl-phosphate laser in endoscopic laryngeal surgery

Objectives:Recently, the 532 nm pulsed potassium-titanyl-phosphate laser has emerged as an effective angiolytic laser for treating mucosal lesions of the larynx in the operating theatre and clinic. We sought to assess the current impact of potassium-titanyl-phosphate laser on our laryngeal surgery practice.Study design:Retrospective review of 710 patients undergoing endoscopic laryngeal surgery over a one-year period.Methods:Medical records of the endoscopic laryngeal procedures were reviewed; 386/710 had been performed in the clinic and 324/710 in the operating theatre under general anaesthesia. Indications for the procedures were classified by pathology.Results:Pulsed potassium-titanyl-phosphate laser was used in 209/386 clinic procedures. The indications for these procedures were: dysplasia (114/209 procedures), papillomatosis (89/209), varices or ectasia (three of 209), and ‘other’ (three of 209). Pulsed potassium-titanyl-phosphate laser was used in 178/324 operating theatre endoscopic laryngeal procedures. The indications for these procedures were: cancer (54/178 procedures), dysplasia (52/178), papillomatosis (38/178), varices or ectasia (13/178), polyps (six of 178), nodules (six of 178), stenosis (five of 178), granulation (three of 178), and amyloid (one of 178).Conclusions:Due to its versatility, the 532 nm pulsed potassium-titanyl-phosphate laser is our most commonly utilised instrument for performing endoscopic laryngeal surgery.

Laryngeal Laser Surgery for Recurrent Respiratory Papillomatosis, Cancer and Dysplasia: Operating Room and Office

Since their introduction in laryngology over 30 years ago, lasers have facilitated critically-important innovations that have now evolved into office-based surgery. Recent advances include the application of angiolytic lasers that treat vocal fold lesions by ablating vasculature and the use of the thulium laser as a more efficient and versatile tissue dissector. In our experience, the 532nm pulsed KTP laser has emerged thus far as the optimal angiolytic laser to treat vocal-fold lesions both in the operating room and in the clinic setting. Despite the fact that the skill-sets to adopt office-based laser treatment are an easy transition for most laryngological surgeons, the primary impediment to widespread adoption is the cost of the technology. Furthermore, critical development of these new lasers will occur with broader use of these lasers in other surgical disciplines, which should diminish costs for all surgeons and thereby promote better outcomes for individuals with voice disorders.