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Blue Laser Surgery
in Laryngology
Abdul-Latif Hamdan
Robert Thayer Satalo
Omar Ramadan
Daniel Eichorn
Mary J. Hawkshaw
Blue Laser Surgery in Laryngology
https://t.me/medicina_free
Abdul-LatifHamdan •
https://t.me/medicina_free
RobertThayerSatalo •
OmarRamadan • DanielEichorn •
MaryJ.Hawkshaw
Blue Laser Surgery
in Laryngology
Abdul-LatifHamdan
https://t.me/medicina_free
Department of Otolaryngology
Drexel University College of Medicine
Philadelphia, PA, USA
OmarRamadan
Department of Otolaryngology- Head
and Neck Surgery
Drexel University College of Medicine
Philadelphia, PA, USA
MaryJ.Hawkshaw
Department of Otolaryngology- Head
and Neck Surgery
Drexel University College of Medicine
Philadelphia, PA, USA
RobertThayerSataloff
Department of Otolaryngology– Head
and Neck Surgery
Drexel University College of Medicine
Philadelphia, PA, USA
DanielEichorn
Department of Otolaryngology– Head
and Neck Surgery
Philadelphia College of Osteopathic
Medicine
Philadelphia, PA, USA
This work contains media enhancements, which are displayed with a “play” icon.
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users.
ISBN 978-3-031-35282-9 ISBN 978-3-031-35283-6 (eBook)
https://doi.org/10.1007/978-3-031-35283-6
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
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To our families.
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Preface
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Laser surgery has revolutionized the treatment of patients with voice disorders. The choice of laser is based primarily on the characteristics of the laser
such as wavelength, mode of delivery and spot size, and on the type of pathology to be treated. The rst laser used in laryngology was the carbon dioxide
(CO2) laser with a wavelength of 10,600nm. Its intense cutting properties
made it useful for excision of laryngeal lesions such as tumors. Despite
renements in its mode of delivery, its high afnity for water made it less
desirable for the treatment of submucosal masses such as cysts and polyps
involving the lamina propria. Excessive heat leading to scar and tissue loss
secondary to carbonization spurred the search for new lasers that could minimize vocal fold injury. Photoangiolytic lasers such as the pulsed dye laser
(PDL) with a wavelength of 582nm and the potassium titanyl phosphate
(KTP) with a wavelength of 532nm became the preferred lasers, particularly
for the management of vascular lesions of the vocal fold. Their high afnity
for oxyhemoglobin usually results in minimal damage to surrounding structures when the lasers are used correctly. A new laser with hybrid characteristics (cutting and hemostatic) has been introduced as the new generation of
photoangiolytic lasers. The blue laser with a wavelength of 445 nm has
gained popularity as an alternative to the used traditional KTP laser.
This book reviews the emerging role of blue laser as a treatment modality
and presents colored photographs of cases of various laryngeal pathology
before and after treatment. Video recordings of surgeries performed in ofce
and in the operating room using the blue laser are included. This book is
designed to provide detailed education for otolaryngologists and laryngologists who perform laser surgery and are interested in using the blue laser,
including “pearls” based on extensive surgical experience with this
technology.
Chapter 1 reviews the evolution of photoangiolytic lasers in laryngology,
highlighting the differences in absorption characteristics associated with the
wavelengths of each of the common lasers. A chart summarizing these data is
particularly useful. Chapter 2 discusses special considerations for anesthesia
in patients undergoing photoangiolytic laser surgery. The chapter addresses
important issues for surgery performed in an operating room, and for ofcebased surgery. The importance of close team collaboration between the surgeon and anesthesiologist is stressed. Chapter 3 addresses blue laser treatment
of vocal fold varicosities and ectasias. Such vascular lesions are common,
and sometimes they cause symptoms and require treatment. Surgeons who
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have long experience with lasers need to understand the differences between
pulsed dye laser, KTP laser, and blue laser, each of which requires slightly
different technique. Failure to make appropriate technical adjustments can
result in avoidable injury. Chapter 4 discusses techniques for blue laser treatment of vocal fold polyps, cysts, Reinke’s edema, and other exudative lesions
of the vocal folds. Chapter 5 reviews the use of blue laser for treatment of
laryngeal granuloma. This challenging lesion is known for its high recurrence
rate. Blue laser can be useful in an operating room or an ofce setting, but
laser treatment must be combined with management of cofactors that predispose to recurrence including reux, voice abuse/misuse, and others. In Chap.
6, techniques for blue laser management of recurrent respiratory papilloma
are reviewed, including precautions regarding the need for histopathologic
evaluation of lesions, at least initially, including viral typing. Blue laser treatment of dysplasia and early carcinoma is discussed in detail in Chap. 7. Scar,
another particularly challenging problem in laryngology, is reviewed in Chap.
8; and the potential value of blue laser in selected patients with vocal fold scar
is discussed in detail. Chapter 9 addresses the extremely complex problem of
laryngotracheal stenosis. Blue laser management offers many advantages
over CO2 laser. Although these cases are treated most commonly in an operating room, ofce-based blue laser surgery for stenosis with partial obstruction
can be particularly valuable; and it can be performed safely. Chapter 10
reviews other applications of blue lasers for the treatment of unusual, uncommon disorders of the larynx. All chapters incorporate a wealth of gures and
case examples, as well as brief video clips of surgical technique. Details of
blue laser technique are listed in each chapter and illustrated extensively in a
manner that we hope will be of value to novice and experienced laryngeal
surgeons.
The authors hope that our readers nd this book practical and valuable for
direct application to patient care. Thorough understanding of laser characteristics and optimal surgical techniques should assist in appropriate patient
selection, as well as in achieving the best possible outcomes.
Preface
Philadelphia, PA, USA Abdul-LatifHamdan
Philadelphia, PA, USA RobertThayerSataloff
Philadelphia, PA, USA OmarRamadan
Philadelphia, PA, USA DanielEichorn
Philadelphia, PA, USA MaryJ.Hawkshaw
Contents
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1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Vascular Lasers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1.1 Pulsed-Dye Laser . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1.2 KTP (Potassium, Titanyl, Phosphate) Crystal Laser . . . . 1
1.1.3 Blue Laser . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.1.4 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.2 Patient Selection and Tolerance in Ofce- Based
Laryngeal Laser Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.2.1 Patient-Related Factors . . . . . . . . . . . . . . . . . . . . . . . . 4
1.2.2 Procedure-Related Factors . . . . . . . . . . . . . . . . . . . . . . 5
1.2.3 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2 Anesthesia Considerations in Office-Based
and OR-Based Laryngeal Surgery . . . . . . . . . . . . . . . . . . . . . . . . 9
2.1 Application of Local Anesthesia in Ofce-Based
Laryngeal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.2 Anesthesia for Operating Room-Based Laser Surgery . . . . . . 11
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
3 Blue Laser Therapy of Vocal Fold Varices and Ectasias . . . . . . . 15
3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3.2 Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.2.1 Case 1: Right Vocal Fold Ectasia . . . . . . . . . . . . . . . . . 17
3.2.2 Case 2: Right Vocal Fold Dilated Submucosal
Vessels with Reinke’s Edema . . . . . . . . . . . . . . . . . . . . 18
3.2.3 Case 3: Right Vocal Fold Tortuous Submucosal
Vessels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
3.2.4 Case 4: Left Vocal Fold Ectasia . . . . . . . . . . . . . . . . . . 20
3.2.5 Case 5: Blue Laser Therapy for Left Vocal Fold
Vascular Mass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
3.2.6 Case 6: Blue Laser Therapy for Bilateral
Vocal Folds Ectasias. . . . . . . . . . . . . . . . . . . . . . . . . . . 22
3.2.7 Case 7: Blue Laser Therapy for Right Vocal
Fold Hemorrhagic Mass . . . . . . . . . . . . . . . . . . . . . . . . 23
3.2.8 Surgical Steps in Ofce-Based Blue Laser
Therapy of Vocal Fold Varices and Ectasias . . . . . . . . 25
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
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4 Blue Laser Therapy of Exudative Lesions
of the Vocal Folds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
4.1 Blue Laser Therapy of Vocal Fold Polyps . . . . . . . . . . . . . . . . 27
4.1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
4.1.2 Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
4.2 Blue Laser Therapy of Reinke’s Edema . . . . . . . . . . . . . . . . . 35
4.2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
4.2.2 Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
4.3 Blue Laser Therapy of Vocal Fold Cysts . . . . . . . . . . . . . . . . . 40
4.3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
4.3.2 Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
4.4 Surgical Steps in Ofce- Based Blue Laser Therapy
of Exudative Lesions of the Vocal Folds
. . . . . . . . . . . . . . . . . 44
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
5 Blue Laser Therapy of Vocal Process Granuloma . . . . . . . . . . . . 49
5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
5.2 Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
5.2.1 Case 1: Right Superior Surface Vocal Fold
Granuloma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
5.2.2 Case 2: Extruded Right Vocal Fold Implanted
Fascia and Granuloma . . . . . . . . . . . . . . . . . . . . . . . . . 52
5.2.3 Case 3: Left Posterior Vocal Fold Granuloma . . . . . . . 53
5.2.4 Case 4: Left Vocal Process Granuloma . . . . . . . . . . . . 55
5.2.5 Case 5: Left Vocal Process Granuloma . . . . . . . . . . . . 56
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Contents
6 Blue Laser Therapy of Recurrent Respiratory
Papillomatosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
6.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
6.2 Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
6.2.1 Case 1: Right Vocal Fold RRP . . . . . . . . . . . . . . . . . . . 61
6.2.2 Case 2: Right Vocal Fold RRP . . . . . . . . . . . . . . . . . . . 62
6.2.3 Case 3: Laryngeal RRP . . . . . . . . . . . . . . . . . . . . . . . . 63
6.2.4 Case 4: Bilateral Vocal Fold RRP . . . . . . . . . . . . . . . . 64
6.2.5 Case 5: Base of Tongue Papilloma. . . . . . . . . . . . . . . . 65
6.2.6 Case 6: Posterior Pharyngeal Wall Papilloma . . . . . . . 65
6.2.7 Case 7: Posterior Laryngeal Papilloma . . . . . . . . . . . . 66
6.3 Surgical Steps in Ofce- Based Blue Laser Therapy
of RRP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
7 Blue Laser Therapy of Vocal Fold Leukoplakia . . . . . . . . . . . . . . 71
7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
7.2 Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
7.2.1 Case 1: Left Vocal Fold Leukoplakia . . . . . . . . . . . . . . 73
7.2.2 Case 2: Right Vocal Fold Low-Grade Dysplasia . . . . . 74
7.2.3 Case 3: Right Vocal Fold High-Grade Dysplasia . . . . . 75
7.2.4 Case 4: Right Vocal Fold Mild-Moderate Dysplasia . . . . 77
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