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Microdissection or microspot CO2 laser for limited vocal fold benign lesions: a prospective randomized trial.
Laryngoscope. 2000 Feb; 110(2 Pt 2 Suppl 92):1-17.L

Abstract

CO2 lasers have become an important technological advance and an integral tool for the laryngeal surgeon since the 1960s. Surgeons have used lasers for a variety of benign and malignant lesions in the larynx with good success. With better understanding of the microarchitecture of the vocal folds and the recognition of heat distribution into surrounding tissues that occurs with the use of standard CO2 lasers, questions and concerns have been raised regarding the use of the CO2 laser for benign lesions of the vocal folds. With the advent of the microspot CO2 laser with a spot size of less than 250 microm, the potential heat distribution to the deeper layers of the lamina propria has been reduced. The microspot CO2 laser has been suggested to be an appropriate tool for the excision of superficial benign lesions of the vocal fold and may be considered as an appropriate treatment alternative to microdissection. Only a limited number of studies have compared the efficacy of microdissection versus microspot CO2 laser surgery in the larynx, and no prospective, randomized trials have been performed.

OBJECTIVE

This study was designed to compare microspot CO2 laser excision and microdissection for superficial benign lesions confined to the free margin of the vocal fold.

STUDY DESIGN

A randomized, prospective trial comparing microspot CO2 laser excision and microdissection in the removal of nodules, polyps, and mucous retention cysts of the vocal fold.

METHODS

Acoustic and aerodynamic measures and videostroboscopic and perceptual audio recordings evaluated by a panel of blinded viewers and listeners were studied preoperatively and 2 to 3 weeks and 5 to 12 weeks postoperatively. Surgical and recovery times were compared between the two groups.

RESULTS

Thirty-seven patients met selection criteria and were enrolled, 21 in the microdissection group and 16 in the laser excision group. Significant improvements in videostroboscopic parameters were found over time in both groups. Significant improvements were noted for perceptual analysis over time for the laser excision group with nonsignificant improvements over time for the microdissection group. There was no difference in any measure between laser excision and microdissection at the two postoperative visits. There was no difference in surgical or recovery time between laser excision and microdissection. Acoustic and aerodynamic parameters were noncontributory in evaluating outcomes of treatment, since most values were normal before surgery.

CONCLUSION

No differences in clinical outcomes are identified when comparing microdissection with laser excision of nodules, polyps, and mucous retention cysts of the vocal folds.

Authors+Show Affiliations

Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan 48202, USA.

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10678578

Citation

Benninger, M S.. "Microdissection or Microspot CO2 Laser for Limited Vocal Fold Benign Lesions: a Prospective Randomized Trial." The Laryngoscope, vol. 110, no. 2 Pt 2 Suppl 92, 2000, pp. 1-17.
Benninger MS. Microdissection or microspot CO2 laser for limited vocal fold benign lesions: a prospective randomized trial. Laryngoscope. 2000;110(2 Pt 2 Suppl 92):1-17.
Benninger, M. S. (2000). Microdissection or microspot CO2 laser for limited vocal fold benign lesions: a prospective randomized trial. The Laryngoscope, 110(2 Pt 2 Suppl 92), 1-17.
Benninger MS. Microdissection or Microspot CO2 Laser for Limited Vocal Fold Benign Lesions: a Prospective Randomized Trial. Laryngoscope. 2000;110(2 Pt 2 Suppl 92):1-17. PubMed PMID: 10678578.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Microdissection or microspot CO2 laser for limited vocal fold benign lesions: a prospective randomized trial. A1 - Benninger,M S, PY - 2000/3/4/pubmed PY - 2000/5/20/medline PY - 2000/3/4/entrez SP - 1 EP - 17 JF - The Laryngoscope JO - Laryngoscope VL - 110 IS - 2 Pt 2 Suppl 92 N2 - UNLABELLED: CO2 lasers have become an important technological advance and an integral tool for the laryngeal surgeon since the 1960s. Surgeons have used lasers for a variety of benign and malignant lesions in the larynx with good success. With better understanding of the microarchitecture of the vocal folds and the recognition of heat distribution into surrounding tissues that occurs with the use of standard CO2 lasers, questions and concerns have been raised regarding the use of the CO2 laser for benign lesions of the vocal folds. With the advent of the microspot CO2 laser with a spot size of less than 250 microm, the potential heat distribution to the deeper layers of the lamina propria has been reduced. The microspot CO2 laser has been suggested to be an appropriate tool for the excision of superficial benign lesions of the vocal fold and may be considered as an appropriate treatment alternative to microdissection. Only a limited number of studies have compared the efficacy of microdissection versus microspot CO2 laser surgery in the larynx, and no prospective, randomized trials have been performed. OBJECTIVE: This study was designed to compare microspot CO2 laser excision and microdissection for superficial benign lesions confined to the free margin of the vocal fold. STUDY DESIGN: A randomized, prospective trial comparing microspot CO2 laser excision and microdissection in the removal of nodules, polyps, and mucous retention cysts of the vocal fold. METHODS: Acoustic and aerodynamic measures and videostroboscopic and perceptual audio recordings evaluated by a panel of blinded viewers and listeners were studied preoperatively and 2 to 3 weeks and 5 to 12 weeks postoperatively. Surgical and recovery times were compared between the two groups. RESULTS: Thirty-seven patients met selection criteria and were enrolled, 21 in the microdissection group and 16 in the laser excision group. Significant improvements in videostroboscopic parameters were found over time in both groups. Significant improvements were noted for perceptual analysis over time for the laser excision group with nonsignificant improvements over time for the microdissection group. There was no difference in any measure between laser excision and microdissection at the two postoperative visits. There was no difference in surgical or recovery time between laser excision and microdissection. Acoustic and aerodynamic parameters were noncontributory in evaluating outcomes of treatment, since most values were normal before surgery. CONCLUSION: No differences in clinical outcomes are identified when comparing microdissection with laser excision of nodules, polyps, and mucous retention cysts of the vocal folds. SN - 0023-852X UR - https://www.unboundmedicine.com/medline/citation/10678578/Microdissection_or_microspot_CO2_laser_for_limited_vocal_fold_benign_lesions:_a_prospective_randomized_trial_ L2 - https://doi.org/10.1097/00005537-200002001-00001 DB - PRIME DP - Unbound Medicine ER -