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Contents
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xi
7.2.5 Case 5: Right Vocal Fold Leukoplakia . . . . . . . . . . . . . 78
7.2.6 Case 6: Right Anterior Vocal Fold Leukoplakia . . . . . 79
7.3 Surgical Steps in Ofce- Based Blue Laser Therapy of
Vocal Fold Leukoplakia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
8 Blue Laser Therapy of Vocal Fold Scars . . . . . . . . . . . . . . . . . . . . 83
8.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
8.2 Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
8.2.1 Case 1: Left Fibrotic Vocal Fold Mass . . . . . . . . . . . . . 84
8.2.2 Case 2: Left Vocal Fold Fibrotic Mass . . . . . . . . . . . . . 85
8.2.3 Case 3: Left Vocal Fold Scar . . . . . . . . . . . . . . . . . . . . 86
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
9 Blue Laser Therapy of Laryngeal Stenosis . . . . . . . . . . . . . . . . . . 89
9.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
9.2 Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
9.2.1 Case 1: Anterior Commissure Sub-Cordial Web . . . . . 91
9.2.2 Case 2: Posterior Supraglottic Stenosis . . . . . . . . . . . . 93
9.2.3 Case 3: Posterior Glottic Scar . . . . . . . . . . . . . . . . . . . 94
9.2.4 Case 4: Anterior Laryngeal Vocal Fold Web . . . . . . . . 95
9.2.5 Case 5: Subglottic Stenosis . . . . . . . . . . . . . . . . . . . . . 96
9.2.6 Case 6: Tracheotomy Stoma Stenosis . . . . . . . . . . . . . 98
9.2.7 Case 7: Subglottic and Posterior Glottic Stenosis . . . . 99
9.2.8 Case 8: Subglottic Stenosis . . . . . . . . . . . . . . . . . . . . . 100
9.2.9 Case 9: Anterior Glottic Web . . . . . . . . . . . . . . . . . . . . 100
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
10 Rare Applications of Blue Laser Therapy in Laryngology . . . . . 103
10.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
10.2 Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
10.2.1 Case 1: Blue Laser Partial Cordectomy . . . . . . . . . . 103
10.2.2 Case 2: Pharyngeal Neuroendocrine Tumor . . . . . . . 104
10.2.3 Case 3: Left False Vocal Fold Mass . . . . . . . . . . . . . 105
10.2.4 Case 4: Vocal Fold Incision for Homograft Fascia . . .106
10.2.5 Case 5: Extruded Fascia Lata . . . . . . . . . . . . . . . . . . 107
10.2.6 Case 6: Right Laryngocele . . . . . . . . . . . . . . . . . . . . 108
10.2.7 Case 7: Medial Arytenoidectomy . . . . . . . . . . . . . . . 110
10.2.8 Case 8: Right False Vocal Fold Mass . . . . . . . . . . . . 111
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
About the Authors
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Abdul-Latif Hamdan, MD, EMBA, FACS is currently a Professor of
Otolaryngology, Head and Neck Surgery, Head of the Division of Laryngology
and Director of “Hamdan Voice Unit” at the American University of Beirut
Medical Center (AUBMC), and Adjunct Professor at the Department of the
Otolaryngology, Head and Neck Surgery, Drexel University College of
Medicine. He is the founder of the “Hamdan Voice and Swallowing Unit” at
AUBMC, the Lebanese Voice Association, the “Hamdan International Award”
at the Voice Foundation, and the Voice Foundation Lebanon chapter. He is the
author of 170 publications and 8 books.
Robert Thayer Sataloff, MD, DMA, FACS is Professor and Chair,
Department of Otolaryngology-Head and Neck Surgery and Senior Associate
Dean for Clinical Academic Specialties, Drexel University College of Medicine.
Dr. Sataloff is Director of Otolaryngology and Communication Sciences
Research at the Lankenau Institute for Medical Research and Director of
Otolaryngology Education at Lankenau Medical Center. He also holds Adjunct
Professorships in the Departments of Otolaryngology-Head and Neck Surgery
at Thomas Jefferson University, Temple University, and the Philadelphia College
of Osteopathic Medicine, and he is on the faculty of the Academy of Vocal Arts.
He serves as Conductor of the Thomas Jefferson University Choir. Dr. Sataloff
is also a professional singer and singing teacher. He holds an undergraduate
degree from Haverford College in Music Theory and Composition; graduated
from Jefferson Medical College, Thomas Jefferson University; received a Doctor
of Musical Arts in Voice Performance from Combs College of Music; and he
completed Residency in Otolaryngology-Head and Neck Surgery and a
Fellowship in Otology, Neurotology and Skull Base Surgery at the University of
Michigan. Dr. Sataloff is Chair of the Boards of Directors of the Voice Foundation
and of the American Institute for Voice and Ear Research. He also has served as
Chair of the Board of Governors of Graduate Hospital; President of the American
Laryngological Association, the International Association of Phonosurgery, the
Pennsylvania Academy of Otolaryngology-Head and Neck Surgery, and the
American Society of Geriatric Otolaryngology; and in numerous other leadership positions. Dr. Sataloff is Editor-in-Chief of the Journal of Voice; Editor
Emeritus of Ear, Nose and Throat Journal; Associate Editor of the Journal of
Singing; on the Editorial Board of Medical Problems of Performing Artists, and
is an editorial reviewer for numerous otolaryngology journals. He is a member
of the Editorial Panel of the AMA Guides to the Evaluation of Permanent
Impairment. Dr. Sataloff has written over 1000 publications including 72 books,
and he has been awarded more than $5 million in research funding. His H-index
xiii
xiv
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is 45 (as of January 2023). He has invented more than 75 laryngeal microsurgical instruments distributed currently by Integra Medical, ossicular replacement
prostheses produced by Grace Medical, and a novel laryngeal prosthesis (patent
pending). He holds a patent on a unique thyroplasty implant. His medical practice is limited to care of the professional voice and to otology/neurotology/skull
base surgery. Dr. Sataloff has developed numerous novel surgical procedures
including total temporal bone resection for formerly untreatable skull base
malignancy, laryngeal microap and mini-microap procedures, vocal fold
lipoinjection, vocal fold lipoimplantation, and others. Dr. Sataloff is recognized
as one of the founders of the eld of voice, having written the rst modern comprehensive article on care of singers, and the rst chapter and book on care of the
professional voice, as well as having inuenced the evolution of the eld through
his own efforts and through the Voice Foundation for over four decades. Dr.
Sataloff has been recognized by Best Doctors in America (Woodward White
Athens) every year since 1992, Philadelphia Magazine since 1997, and Castle
Connolly’s “America’s Top Doctors” since 2002.
Omar Ramadan, MD , is a fellow at Drexel University College of
Medicine in Laryngology/Care of the Professional Voice. He was born and
raised in Homs, Syria. He received his medical degree from Al-Baath
University. He completed Otolaryngology- Head and Neck Surgery residency
at Damascus University. He practiced general otolaryngology in Syria,
Jordan, and Kuwait. He completed Rhinology fellowship at St. Elizabeth’s
Medical Center in Boston, Massachusetts.
About the Authors
Daniel Eichorn, DO is a resident physician in the Department of
Otolaryngology-Head and Neck Surgery, at the Philadelphia College of
Osteopathic Medicine. He has been a student of laryngology with Dr. Robert
Sataloff.
MaryJ.Hawkshaw, BSN, RN, CORLN, FCPP is a Research Professor
and Vice Chair for Academic Initiatives in the Department of OtolaryngologyHead and Neck Surgery at Drexel University College of Medicine. She has
been associated with Dr. Robert Sataloff, Philadelphia Ear, Nose & Throat
Associates and the American Institute for Voice & Ear Research (AIVER)
since 1986. Ms. Hawkshaw graduated from Shadyside Hospital School of
Nursing in Pittsburgh, Pennsylvania, and received a Bachelor of Science
degree in Nursing from Thomas Jefferson University in Philadelphia. In addition to her specialized clinical activities, she has been involved extensively in
research and teaching. She mentors medical students, residents, and laryngology fellows and has been involved in teaching research, writing, and editing
for over three decades. In collaboration with Dr. Sataloff, she has coauthored
185 articles, 108 book chapters, and 20 textbooks. She is on the Editorial
Boards of the Journal of Voice and Ear, Nose and Throat Journal. She has
served as Secretary/Treasurer of AIVER since 1988 and was named Executive
Director of AIVER in January 2000. She has served on the Board of Directors
of the Voice Foundation since 1990. Ms. Hawkshaw has been an active member of the Society of Otorhinolaryngology and Head-Neck Nurses since
1998. She is recognized nationally and internationally for her extensive contributions to care of the professional voice.
Introduction
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1
1.1 Vascular Lasers
The safety and efcacy of “vascular lasers” have
been established, and two have been used widely
in the larynx. They are the pulsed-dye laser
(PDL) (585-nm) and the pulsed-KTP laser (532nm). Manufacture of both has been discontinued.
The blue laser (445-nm) is being used clinically
and appears to have advantages over the pulseddye laser and the pulsed-KTP laser.
1.1.1 Pulsed-Dye Laser
The 585-nm PDL has been used to treat vocal
fold disease. It was recognized by 1981 that dye
lasers could be used to damage microvasculature
[1]. Pulsed-dye lasers can be used through a exible laryngoscope in an ofce setting or in the
operating room. Typically, the laser is passed
through a 1-mm ber and delivers a spot size of
1–2mm. Typical settings included up to 0.85J/
pulse, with a 450-μs pulse width, a 1Hz repetition rate, and a uency of 19–76Joules per square
centimeter (J/cm2). Treatment was tolerated well.
In addition to treating abnormal vasculature, the
PDL was used for papilloma [2, 3] and dysplasia
[4, 5]. PDL is safe and effective for vascular
lesions, and it also was useful in treatment in the
ofce of carefully selected papilloma and dysplasia because it can avoid a general anesthesia. The
patients are treated as outpatients with topical
anesthesia. For recurrent laryngeal papilloma, it
was useful. KTP (other than pulsed-KTP),
Thulium: YAG laser, and the CO2 laser delivered
via OmniGuide and FibreLase may cut much
more deeply. It is also possible during the same
procedure for papilloma to inject Cidofovir with
an indirect or direct endoscopic needle. However,
as with any other laser, complications occurred.
Hemorrhage from the vessels being treated was
not rare. The prevalence of this complication was
minimized by controlling the distance of the ber
from the lesion, and by treating vascular abnormalities starting with peripheral vessels, and
working toward the more engorged portions of
the lesions. However, even with the best technique, bleeding occurred occasionally. The PDL
was a “no-touch” laser that was useful for laryngeal treatment both in the ofce and the operating
room settings [2, 6–17].
1.1.2 KTP (Potassium, Titanyl,
Phosphate) Crystal Laser
The KTP/532 is an Nd-YAG laser. Its potential
for use in surgery increased through two important improvements: doubling of the frequency of
the wavelength and point of contact. Frequency
doubling offers a technique to change the output
wavelength from 1064nm (infrared) to 532nm
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023
A.-L. Hamdan et al., Blue Laser Surgery in Laryngology,
https://doi.org/10.1007/978-3-031-35283-6_1
1
2
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1 Introduction
(green) by means of a special crystal that combines 2 infrared photons into 1 green photon. A
conical sapphire at the end of an optical ber
reects the laser beam to a sharp focal point at its
tip. The temperature of the tip rises to several
hundred degrees Celsius and, in contact mode,
provides almost a pure cutting effect. The KTP
laser is transmitted through clear uids and
structures. It does not vaporize the tissues well.
It usually has a 200-nm spot size when delivered
through ber optic channels in endoscopes
(available bers range from 0.2 to 0.6 mm in
diameter). It can be used through the microscope. Perkins developed the KTP laser for otosclerosis, before it was used in the larynx [18].
Since 1986, KTP/532 has been used commonly
for treatment of laryngeal pathology. Its green
beam can be passed through the exible channel
of a exible endoscope. There are many indications; however, in our hands, the thermal damage
from continuous delivery sometimes is more
substantial than with the CO2 laser, and usually
we use KTP only in a pulsed mode for vascular
lesions. Pulsed- KTP laser has been used for
treatment of vascular lesions of the vocal fold, in
a manner similar to the pulsed-dye laser (see
above). The pulsed- KTP laser has a wavelength
of 532 nm. The KTP wavelength at 532 nm
appears superior to the pulsed-dye laser which
emits at 585nm. The 532-nm KTP wavelength is
more strongly absorbed by oxyhemoglobin than
the 585 PDL wavelength and is therefore less
likely to cause bleeding from the vessels being
treated. Often, the KTP laser is used with a longer pulse duration (15ms) than the PDL (5ms)
which also may contribute to decreased prevalence of bleeding. However, its tissue effects are
different from the PDL, and it may be more
likely to cause injury and stiffness of tissues
adjacent to the blood vessels being treated, especially if the surgeon uses it with technique
learned during PDL, rather than with the slightly
different distances and power densities appropriate to KTP use. The KTP laser also can be used
either in an outpatient setting or in the operating
room. It is delivered through a ber. Typical settings are about 525–750mJ/pulse, with a 2-Hz
repetition rate using a 0.4-mm ber, resulting in
a uence of about 20–80J/cm2. KTP is used in a
“near-touch” mode. However, much skill and
experience are required to maintain a constant
“near-touch distance” from the target, to achieve
maximum vascular effect while minimizing
adjacent tissue response. The pulsed- KTP laser
has been advocated for treatment of vascular
lesions, as well as for treatment of papillomatosis and dysplasia [19–30]. The pulsed- KTP laser
has FDA approval since Nov. 17, 2003.
1.1.3 Blue Laser
The WOLF TruBlue (A.R.C. Laser, Nuremberg,
Germany) emits laser light with a wavelength of
445nm. This wavelength is in the blue spectrum;
and, compared with other laser devices discussed
above, it has the highest absorption in hemoglobin and greater absorption in melanin/pigment.
The scattering in tissue is pronounced, resulting
in advantageous characteristic properties for the
wavelength. Surgeons should be familiar with
absorption characteristics associated with lasers
of various wavelengths (Fig.1.1). Other companies have started to produce blue lasers; but at the
time of writing of this book, the authors “experience” has been with the devices identied above.
Due to the high absorption in hemoglobin,
melanin and pigment, the Blue can be operated at
substantially reduced power densities compared
to KTP and diode lasers. So, the energy delivered
into adjacent tissue is lower, and thermal stresses
and necrosis zones are minimized [31]. It also
has almost complete transparency in water, i.e.
cellular uids. This results in high selectivity
between different types of tissue which ensures a
high degree of precision in targeting vessels or
pigmented lesions while minimizing laser effect
on adjacent tissue.
The typical scattering effect results in relatively small penetration depth in tissue. This is a
major advantage for the treatment of vocal folds,
since tiny vessels, papilloma, or granuloma can
be treated selectively, while the underlying tissue
of the vocal folds should remain unaffected. CO2
laser also features low penetration depth due to
its high absorption in water, but it does not distin-
1.2 Patient Selection andTolerance inOce-Based Laryngeal Laser Surgery
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3
Fig. 1.1 Absorption characteristics of lasers of various wavelengths. (Courtesy of A.R.C.Laser GmbH)
guish between pigmented and non-pigmented tissue; and, unlike Blue laser, CO2 laser causes
indiscriminate damage to tissues regardless of
pigment. This has resulted in limitations in the
use of CO2 on the vocal folds that have been recognized for decades. Care must be exercised not
to use Blue laser at power densities that are too
low because of recurrence of vessels despite
apparent ablation in the operating room [32]. Six
Watts with 40 ms pulse duration and 300 ms
pulse pause seems to work well for vessels, and
higher settings allow the Blue laser to function
well as a cutting instrument. It can be used as notouch or touch.
1.1.4 Summary
Vascular lasers are invaluable for treatment of
laryngeal pathology. It is essential for surgeons to
be familiar with absorption characteristics of
lasers of various wavelengths. Especially for sur-
geons who have used PDL and KTP, it is important to recognize that lasers of different
wavelengths (including Blue lasers) behave differently, and modications in power density and
surgical technique are required. Vascular lasers
work well in the operating room and for in-ofce
surgery.
1.2 Patient Selection
andTolerance inOceBased Laryngeal Laser
Surgery
Most laryngeal surgery has been performed in
an operating room under general anesthesia.
Recently, an increasing number of cases is
being performed in an ofce setting. This can
have many advantages. However, not all
patients are suitable for ofce-based laryngeal
surgery. Pre- operative screening for healthrelated issues and morbidities has been advo-
4
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1 Introduction
cated by many authors to reduce the risk of
intraoperative complications and to improve
patients’ safety. In 2010, Yung and Courey
investigated the hemodynamic changes in 31
patients who underwent in-ofce laryngeal
procedures and reported a statistically signicant increase in diastolic blood pressure by
18.5 mm, and in heart rate by 14.6 beats per
minute. There was also a signicant decrease
in oxygen saturation that did not decline below
94%. The authors encouraged hemodynamic
monitoring during ofce-based surgery [33].
In 2012, Morrison et al. concurred with the
ndings of Yung and Courey and reported a
mean increase in systolic blood pressure by
26.2+20.9 and in diastolic blood pressure by
13.9+13.8mmHg in a cohort of 100 patients.
The authors noted higher frequency of these
hemodynamic changes in patients above the
age of 50 years and recommended intraoperative monitoring of those patients [34]. Madden
etal. established pre- procedure hemodynamic
parameters to help identify patients at risk for
cardiovascular events during in-ofce laryngeal surgery by asking patients to complete a
screening tool that included questions related
to metabolic equivalent tests (METs). Common
examples of these tests included walking
briskly and being able to climb two ights of
stairs [35].
With proper patient selection considering age
and associated morbidities, the overall completion of ofce-based laryngeal surgery ranges
between 92% and 100% [3, 13, 36]. In 2004,
Zeitels et al. reported their experience in 51
patients with laryngeal papilloma and/or dysplasia of the vocal folds who were treated in-ofce
using the pulsed-dye laser (PDL) and noted
incompletion of the procedure in only 5 cases [3].
In 2007, Koufman etal. reviewed their experience in 443 in-ofce laser surgery cases using
different types of lasers and reported incompletion of the surgery in only one patient who had a
vasovagal episode [13]. In 2012, Young et al.
conducted a multi-institutional survey that
included 154 patients, 19% of whom had laser
therapy and reported an overall completion rate
of 92%. The patients’ average discomfort score
was 37 on a scale of 0–100, with 100 being the
most discomfort. Patients reported that they
would undergo the procedure again and would
recommend it to another patient in 93% and 96%
of the cases, respectively [36].
Understanding the factors that contribute to
success or failure of ofce-based laryngeal surgery is crucial. These have been analyzed by
many investigators and stratied as patientrelated factors and procedure-related factors.
1.2.1 Patient-Related Factors
Thorough consideration should be given to
patient-related factors in the selection process
for ofce-based laryngeal surgery. Based on
numerous reports, the most important factor is
patient’s tolerance and/or threshold for pain
and gagging. Despite the use of good anesthetic technique in the upper airway, patients
with poor tolerance secondary to a strong gag
reex and/or low threshold for pain commonly
end up having an incomplete procedure. In
2006, Zeitels et al. conducted a prospective
review of 72 cases of ofce- based KTP laser
therapy for glottal dysplasia or papilloma and
reported abandoning the procedure in 2 cases,
1 of which was due to poor patient tolerance
[19]. In 2006, Rees et al. conducted a phone
survey of 89 patients who had undergone
ofce-based PDL surgery mainly for laryngeal
papilloma and reported a comfort score of 7.4
with 10 being the worst pain and an adjusted
pain level of 2.6/10. Thirteen percent of
patients who were surveyed preferred operating room treatment [16]. In 2010, Halum and
Moberly investigated pain discomfort during
and after surgery in 10 patients who underwent
ofce- based laser therapy using PDL or carbon
dioxide (CO2) and reported an average pain
score of 2.0 on a scale of 0–10. The laryngeal
pathology treated most was RRP [37]. In 2013,
Centric et al. reviewed their experience in
ofce-based PDL therapy of laryngeal lesions
in 33 patients and reported a tolerance rate of
97%. One patient with vocal process granuloma developed an anxiety attack and could
1.2 Patient Selection andTolerance inOce-Based Laryngeal Laser Surgery
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5
not proceed with the surgery. No complications
were noted in their study group [5].
Several authors also investigated the demographic characteristics of patients in attempt
to improve our understanding of the key success factors in office-based laryngeal surgery.
In 2020, Whited et al. reviewed 292 awake
upper airway procedures that included KTP
laser application among other types of surgeries. Patients’ demographic characteristics such
as age, gender, and body mass index (BMI)
did not affect the completion rate or pain.
However when combined with psychiatric illnesses they did. The completion rate varied
between 98.7% and 99% depending on
whether it was a first-time procedure or a
repeated procedure [38]. In 2021, Zheng etal.
reviewed the factors associated with tolerance
in 56 patients with various types of laryngeal
pathology who underwent in-office laser surgery using the KTP laser [39]. The authors
noted that the tolerance scores were lower in
patients who were current or former smokers,
and in patients with asthma or chronic obstructive pulmonary disease (COPD). That was
attributed to increased sensitivity of the laryngeal mucosa, mucus hypersecretion, and vocal
fold dysfunction which is known to be more
prevalent in patients with lower airway diseases [40–42]. The authors also noted that
patients with posterior lesions or multiple
lesions had lower scores than those with
lesions of the vocal folds or with a single
lesion. This was ascribed to the higher density
of sensory receptors in the posterior larynx
which makes it easier to elicit laryngeal adductor reflex as a protective mechanism [43]. This
agrees with the strong negative correlation
that was present between tolerance scores and
vocal fold movement, swallowing and aberrant strikes of laser. Moreover, patients with
RRP, Reinke’s edema, and dysplasia had lower
tolerance score than those with vocal fold polyps and cysts probably because these latter are
isolated rather than more intensive or diffuse
lesions. Interestingly, BMI, age, and gender
did not correlate significantly with tolerance.
Pre-operative patient counseling and education based on the above are very helpful in
improving patients’ tolerance and cooperation,
although this strategy may not succeed in all
cases.
1.2.2 Procedure-Related Factors
In addition to patient-related factors, there are
procedure-related factors that affect the success
of ofce-based laryngeal surgery. One is the limited angulation of the laser glass ber [44]. In
ofce-based laser surgery, the glass ber usually
is introduced through the working channel of the
exible endoscope and advanced with the endoscope toward the site of lesion. The laser is then
applied in non-contact or contact mode to cauterize, vaporize, or selectively photoangiolyse
the submucosal vasculature of the lesion. The
energy delivered during surgery is affected
markedly by the direction of the laser beam. It is
markedly less when the laser beam is tangential
to the lesion rather than perpendicular. Another
procedure- related factor that may affect completion of in- ofce laser surgery is the extent of disease. When the lesion extends to the subglottic
region, there may be limited access to the disease. In an ofce setting in 2004, Zeitels etal.
reviewed 51 patients with laryngeal papilloma or
dysplasia of the vocal folds treated in-ofce
using the PDL and noted poor exposure as a
cause of incomplete surgery [3]. Other procedure-related factors include breaking of the laser
glass ber. In the review of 443 cases by
Koufman etal., 1 patient had a ber tip break
[13].
In in-ofce surgery in which the laser ber
angle through the exible laryngoscope is not
satisfactory, completing the surgery in the operating room at a later date is not the only option.
Transoral laser surgery can be performed by
passing the laser ber through a curved suction
or a cannula. The different angles achieved
(compared with the exible endoscope) may
permit access to the lesion and completion of
surgery.
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1 Introduction
1.2.3 Summary
Vascular lasers can be invaluable in managing
laryngeal disorders. The blue laser has many
advantages over its predecessors, but surgeons
must be familiar with the behavior of lasers of
different wavelengths; and surgical technique
must be adjusted in accordance with the details of
laser performance and tissue interaction. Laser
surgery can be performed well in the ofce or in
the operating room. Both settings offer advantages and disadvantages, and decisions about
where surgery should be performed need to be
made based on each patient’s conditions, needs,
wants, and tolerance.
Acknowledgement The authors are grateful to Nils
Hoffmann for assistance with and review of this chapter.
References
1. Rox Anderson R, Parrish JA.Microvasculature can be
selectively damaged using dye lasers: a basic theory
and experimental evidence in human skin. Lasers
Surg Med. 1981;1(3):263–76.
2. Cohen JT, Koufman JA, Postma GN.Pulsed-dye laser
in the treatment of recurrent respiratory papillomatosis of the larynx. Ear Nose Throat J. 2003;83(8):558.
3. Zeitels SM, Burns JA, Franco RA Jr, Hillman RE,
Dailey SH, Anderson RR.Ofce-based treatment of
glottal dysplasia and papillomatosis with the 585nm pulsed dye laser and local anesthesia. Ann Otol
Rhinol Laryngol. 2004;113(4):265–76.
4. Franco RA Jr, Zeitels SM, Farinelli WA, Faquin W,
Anderson RR. 585-nm pulsed dye laser treatment
of glottal dysplasia. Ann Otol Rhinol Laryngol.
2003;112(9):751–8.
5. Centric A, Hu A, Heman-Ackah YD, Divi V, Sataloff
RT. Ofce-based pulsed-dye laser surgery for
laryngeal lesions: a retrospective review. J Voice.
2014;28(2):262.e9.
6. Strong MS, Jako GJ. Laser surgery in the larynx.
Early clinical experience with continuous CO2 laser.
Ann Otol Rhinol Laryngol. 1972;81:791–8.
7. Ihenachor EJ, Dewan K, Chhetri D.Pulsed dye laser
treatment of primary cryptococcal laryngitis: a novel
approach to an uncommon disease. Am J Otolaryngol.
2016;37(6):572–4.
8. Kim HT, Baizhumanova AS.Is recurrent respiratory
papillomatosis a manageable or curable disease?
Laryngoscope. 2016;126(6):1359–64.
9. Park YM, Jo KH, Hong HJ, Choi HS. Phonatory
outcome of 585 nm/pulsed-dye laser in the manage-
ment of glottic leukoplakia. Auris Nasus Larynx.
2014;41(5):459–63.
10. Itani MH, Fakih H. Response of facial haemangioma to oral propranolol. BMJ Case Rep.
2009;2009:bcr0120091476.
11. Gallagher TQ, Derkay CS. Recurrent respiratory
papillomatosis: update 2008. Curr Opin Otolaryngol
Head Neck Surg. 2008;16(6):536–42.
12. Franco RA Jr. In-ofce laryngeal surgery with the
585-nm pulsed dye laser. Curr Opin Otolaryngol
Head Neck Surg. 2007;15(6):387–93.
13. Koufman JA, Rees CJ, Frazier WD, Kilpatrick LA,
Wright SC, Halum SL, et al. Ofce-based laryngeal laser surgery: a review of 443 cases using
three wavelengths. Otolaryngol Head Neck Surg.
2007;137(1):146–51.
14. Franco RA Jr. Aminolevulinic acid 585 nm pulsed
dye laser photodynamic treatment of laryngeal keratosis with atypia. Otolaryngol Head Neck Surg.
2007;136(6):882–7.
15. Zeitels SM, Burns JA. Ofce-based laryngeal laser
surgery with local anesthesia. Curr Opin Otolaryngol
Head Neck Surg. 2007;15(3):141–7.
16. Rees CJ, Halum SL, Wijewickrama RC, Koufman
JA, Postma GN.Patient tolerance of in-ofce pulsed
dye laser treatments to the upper aerodigestive tract.
Otolaryngol Head Neck Surg. 2006;134(6):1023–7.
17. Mcmillan K, Shapshay SM, McGilligan JA, Wang Z,
Rebeiz EE.A 585-nanometer pulsed dye laser treatment of laryngeal papillomas: preliminary report.
Laryngoscope. 1998;108(7):968–72.
18. Perkins RC. Laser stapedotomy for otosclerosis.
Laryngoscope. 1980;90:228–40.
19. Zeitels SM, Akst LM, Burns JA, Hillman RE,
Broadhurst MS, Anderson RR. Ofce-based 532nm pulsed KTP laser treatment of glottal papillomatosis and dysplasia. Ann Otol Rhinol Laryngol.
2006;115(9):679–85.
20. Mallur PS, Johns MM III, Amin MR, Rosen
CA.Proposed classication system for reporting 532nm pulsed potassium titanyl phosphate laser treatment effects on vocal fold lesions. Laryngoscope.
2014;124(5):1170–5.
21. Zeitels SM, Burns JA. Ofce-based laryngeal laser
surgery with the 532-nm pulsed- potassium-titanylphosphate laser. Curr Opin Otolaryngol Head Neck
Surg. 2007;15(6):394–400.
22. Murono S, Nakanishi Y, Tsuji A, Endo K, Kondo S,
Wakisaka N, etal. Trends in the management of recurrent respiratory papillomatosis in Japan. Auris Nasus
Larynx. 2015;42(3):218–20.
23. Zeitels SM, Burns JA.Oncologic efcacy of angiolytic KTP laser treatment of early glottic cancer. Ann
Otol Rhinol Laryngol. 2014;123(12):840–6.
24. Deviprasad D, Pujary K, Balakrishnan R, Nayak
DR. KTP laser in laryngeal amyloidosis: ve cases
with review of literature. Indian J Otolaryngol Head
Neck Surg. 2013;65(Suppl 1):36–41.
25. Barbu AM, Burns JA, Lopez-Guerra G, LandauZemer T, Friedman AD, Zeitels SM.Salvage endo-
References
https://t.me/medicina_free
7
scopic angiolytic KTP laser treatment of early glottic
cancer after failed radiotherapy. Ann Otol Rhinol
Laryngol. 2013;122(4):235–9.
26. Childs LF, Rickert S, Wengerman OC, Lebovics R,
Blitzer A. Laryngeal manifestations of relapsing
polychondritis and a novel treatment option. J Voice.
2012;26(5):587–9.
27. Wojdas A, Szczygielski K, Kosek J, Ratajczak J,
Jurkiewiczc D.The application of KTP laser in otolaryngology- 3 years’ experience. Otolaryngol Pol.
2011;65(4):281–4.
28. Mallur PS, Branski RC, Amin MR. 532- nanometer
potassium titanyl phosphate (KTP) laser-induced
expression of selective matrix metalloproteinases (MMP) in the rat larynx. Laryngoscope.
2011;121(2):320–4.
29. Mallur PS, Amin MR, Saltman BE, Branski RC. A
model for 532-nanometer pulsed potassium titanyl
phosphate (KTP) laser-induced injury in the rat larynx. Laryngoscope. 2009;119(10):2008–13.
30. Balouch B, Yeakel H, Alnouri G, Brennan M,
Martha V, Sataloff RT. Surgical outcome of potassium-titanyl-phosphate (KTP) laser photocoagulation for vocal fold vascular lesions. J Voice. 2021
Jun 24. Published online ahead of print.
31. Lin RJ, Iakolev V, Streutker C, Lee D, Al-Ali M,
Anderson J. Blue light laser results in less vocal
fold scarring compared to KTP laser in normal rat vocal folds. Laryngoscope. 2021;131(4):
853–8.
32. Balouch B, Ranjbar P, Alnouri G, Omari A, Martha
V, Brennan M, Sataloff RT. Surgical outcome of lowpower-density blue laser for vascular lesions of the
vocal fold. J Voice. 2022 Jun 30. Published online
ahead of print.
33. Yung KC, Courey MS.The effect of ofce-based exible endoscopic surgery on hemodynamic stability.
Laryngoscope. 2010;120(11):2231–6.
34. Morrison MP, O’Rourke A, Dion GR, Eller RL,
Weinberger P, Postma GN. Hemodynamic changes
during otolaryngological ofce-based exible endoscopic procedures. Ann Otol Rhinol Laryngol.
2012;121(11):714–8.
35. Madden LL, Ward J, Ward A, Young VN, Smith
LJ, Lott DG, et al. A cardiovascular prescreening protocol for unmonitored in-ofce laryngology procedures. Laryngoscope. 2017;127(8):
1845–9.
36. Young VN, Smith LJ, Sulica L, Krishna P, Rosen
CA. Patient tolerance of awake, in-ofce laryngeal procedures: a multi-institutional perspective.
Laryngoscope. 2012;122(2):315–21.
37. Halum SL, Moberly AC.Patient tolerance of the exible CO2 laser for ofce-based laryngeal surgery. J
Voice. 2010;24(6):750–4.
38. Whited CW, Lubin J, Marka N, Koszewski IJ, Hoffman
MR, Schoeff S, etal. Pain experience and tolerance of
awake in-ofce upper airway procedures: inuencing
factors. Laryngoscope. 2021;131(5):E1580–8.
39. Zheng M, Arora N, Bhatt N, O’Dell K, Johns
M III. Factors associated with tolerance for inofce laryngeal laser procedures. Laryngoscope.
2021;131(7):E2292–7.
40. Low K, Ruane L, Uddin N, Finlay P, Lau KK, Hamza
K, etal. Abnormal vocal cord movement in patients
with and without airway obstruction and asthma
symptoms. Clin Exp Allergy. 2017;47(2):200–7.
41. Fretzayas A, Moustaki M, Loukou I, Douros
K. Differentiating vocal cord dysfunction from
asthma. J Asthma Allergy. 2017;10:277.
42. Leong P, Ruane LE, Phyland D, Koh J, MacDonald
MI, Baxter M, etal. Inspiratory vocal cord closure in
COPD.Eur Respir J. 2020;55(5):1901466.
43. Sinclair CF, Téllez MJ, Ulkatan S.Human laryngeal
sensory receptor mapping illuminates the mechanisms
of laryngeal adductor reex control. Laryngoscope.
2018;128(11):E365–70.
44. Woo P. Ofce-based laryngeal procedures.
Otolaryngol Clin North Am. 2006;39(1):111–33.
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