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Feasibility and Associated Limitations of Office-Based Laryngeal Surgery Using Carbon Dioxide Lasers.
JAMA Otolaryngol Head Neck Surg. 2017 05 01; 143(5):485-491.JO

Abstract

Importance

There are few reports evaluating awake, office-based carbon dioxide (CO2) laser surgery for laryngeal lesions. To date, this study was the largest reported case series of office-based laryngeal surgery by fiber delivery CO2 laser. Office-based laryngeal surgical procedures have become increasingly popular. Technical problems and treatment outcomes associated with the use of a CO2 laser for office-based laryngeal surgery have yet to be fully addressed.

Objectives

To discuss a single institution's clinical experience with office-based CO2 laser laryngeal surgery and the feasibility and limitations associated with this procedure.

Design, Setting, and Participants

This retrospective study evaluated 49 laryngeal surgical procedures performed using a CO2 laser in 40 consecutive adult patients at a single institution in Taiwan from July 1, 2014, through September 30, 2015. Laryngeal lesions treated included vocal fold leukoplakia (n = 13), benign vocal fold lesions (n = 10), Reinke edema (n = 4), recurrent respiratory papillomatosis (n = 6), and lesions outside the vocal folds (n = 7).

Interventions

Office-based laryngeal surgery performed using a CO2 laser under topical anesthesia.

Main Outcomes and Measures

Videolaryngoscopy was performed on all patients at each follow-up point. Among patients with benign vocal lesions and Reinke edema, videolaryngostroboscopy, voice laboratory measurements, perceptual measurements of vocal quality, and subjective evaluations were conducted before and after surgery.

Results

Among the 40 patients included in this study (28 men [70%] and 12 women [30%]; median [range] age, 56 [29-83] years), median follow-up time was 6.5 months (range, 1-21 months). Among the 49 procedures, 2 (4%) could not be tolerated by patients owing to severe gag reflex and laryngeal hypersensitivity, 6 (12%) could not completely evaporate lesions owing to an inadequate surgical field or laryngeal instability, and 1 (2%) led to a complication (ie, mild vocal fold wound stiffness). In addition, 2 patients with premalignant vocal fold leukoplakia showed lesion recurrence in the subglottic area. Among patients with benign vocal lesions and Reinke edema, postoperative phonatory function showed large improvements in jitter (effect size, 0.61; median difference, -0.98%; 95% CI, -1.57% to -0.11%), noise to harmonic ratio (effect size, 0.63; median difference, -0.02; 95% CI, -0.07 to -0.01), maximal phonation time (effect size, 0.61; median difference, 3.6 seconds; 95% CI, 1.9 to 8.8 seconds), and Voice Handicap Index-10 score (effect size, 0.60; median difference, -7; 95% CI, -12 to -2).

Conclusions and Relevance

Office-based laryngeal surgery performed using a CO2 laser was shown to be a feasible treatment option for various types of vocal lesions. However, patients should not undergo this procedure if they have multiple bulky lesions or lesions involving the subglottic area, the laryngeal ventricle, or (in cases of inadequate laryngeal stability) the free edge of a vocal fold.

Authors+Show Affiliations

Voice Clinic, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan2Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.Voice Clinic, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan.Voice Clinic, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan.Voice Clinic, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan3Department of Otolaryngology, National Yang-Ming University, Taipei, Taiwan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28208177

Citation

Hu, Hao-Chun, et al. "Feasibility and Associated Limitations of Office-Based Laryngeal Surgery Using Carbon Dioxide Lasers." JAMA Otolaryngology-- Head & Neck Surgery, vol. 143, no. 5, 2017, pp. 485-491.
Hu HC, Lin SY, Hung YT, et al. Feasibility and Associated Limitations of Office-Based Laryngeal Surgery Using Carbon Dioxide Lasers. JAMA Otolaryngol Head Neck Surg. 2017;143(5):485-491.
Hu, H. C., Lin, S. Y., Hung, Y. T., & Chang, S. Y. (2017). Feasibility and Associated Limitations of Office-Based Laryngeal Surgery Using Carbon Dioxide Lasers. JAMA Otolaryngology-- Head & Neck Surgery, 143(5), 485-491. https://doi.org/10.1001/jamaoto.2016.4129
Hu HC, et al. Feasibility and Associated Limitations of Office-Based Laryngeal Surgery Using Carbon Dioxide Lasers. JAMA Otolaryngol Head Neck Surg. 2017 05 1;143(5):485-491. PubMed PMID: 28208177.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Feasibility and Associated Limitations of Office-Based Laryngeal Surgery Using Carbon Dioxide Lasers. AU - Hu,Hao-Chun, AU - Lin,Shu-Yi, AU - Hung,Yi-Ting, AU - Chang,Shyue-Yih, PY - 2017/2/17/pubmed PY - 2017/8/5/medline PY - 2017/2/17/entrez SP - 485 EP - 491 JF - JAMA otolaryngology-- head & neck surgery JO - JAMA Otolaryngol Head Neck Surg VL - 143 IS - 5 N2 - Importance: There are few reports evaluating awake, office-based carbon dioxide (CO2) laser surgery for laryngeal lesions. To date, this study was the largest reported case series of office-based laryngeal surgery by fiber delivery CO2 laser. Office-based laryngeal surgical procedures have become increasingly popular. Technical problems and treatment outcomes associated with the use of a CO2 laser for office-based laryngeal surgery have yet to be fully addressed. Objectives: To discuss a single institution's clinical experience with office-based CO2 laser laryngeal surgery and the feasibility and limitations associated with this procedure. Design, Setting, and Participants: This retrospective study evaluated 49 laryngeal surgical procedures performed using a CO2 laser in 40 consecutive adult patients at a single institution in Taiwan from July 1, 2014, through September 30, 2015. Laryngeal lesions treated included vocal fold leukoplakia (n = 13), benign vocal fold lesions (n = 10), Reinke edema (n = 4), recurrent respiratory papillomatosis (n = 6), and lesions outside the vocal folds (n = 7). Interventions: Office-based laryngeal surgery performed using a CO2 laser under topical anesthesia. Main Outcomes and Measures: Videolaryngoscopy was performed on all patients at each follow-up point. Among patients with benign vocal lesions and Reinke edema, videolaryngostroboscopy, voice laboratory measurements, perceptual measurements of vocal quality, and subjective evaluations were conducted before and after surgery. Results: Among the 40 patients included in this study (28 men [70%] and 12 women [30%]; median [range] age, 56 [29-83] years), median follow-up time was 6.5 months (range, 1-21 months). Among the 49 procedures, 2 (4%) could not be tolerated by patients owing to severe gag reflex and laryngeal hypersensitivity, 6 (12%) could not completely evaporate lesions owing to an inadequate surgical field or laryngeal instability, and 1 (2%) led to a complication (ie, mild vocal fold wound stiffness). In addition, 2 patients with premalignant vocal fold leukoplakia showed lesion recurrence in the subglottic area. Among patients with benign vocal lesions and Reinke edema, postoperative phonatory function showed large improvements in jitter (effect size, 0.61; median difference, -0.98%; 95% CI, -1.57% to -0.11%), noise to harmonic ratio (effect size, 0.63; median difference, -0.02; 95% CI, -0.07 to -0.01), maximal phonation time (effect size, 0.61; median difference, 3.6 seconds; 95% CI, 1.9 to 8.8 seconds), and Voice Handicap Index-10 score (effect size, 0.60; median difference, -7; 95% CI, -12 to -2). Conclusions and Relevance: Office-based laryngeal surgery performed using a CO2 laser was shown to be a feasible treatment option for various types of vocal lesions. However, patients should not undergo this procedure if they have multiple bulky lesions or lesions involving the subglottic area, the laryngeal ventricle, or (in cases of inadequate laryngeal stability) the free edge of a vocal fold. SN - 2168-619X UR - https://www.unboundmedicine.com/medline/citation/28208177/Feasibility_and_Associated_Limitations_of_Office_Based_Laryngeal_Surgery_Using_Carbon_Dioxide_Lasers_ L2 - https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/10.1001/jamaoto.2016.4129 DB - PRIME DP - Unbound Medicine ER -