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6.2 Case Presentations
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61
laser treatments and reported successful results
although disease regression postoperatively
could not be assessed routinely in all subjects
[22]. Centric et al. also reported the use of
ofce-based PDL in 33 patients, 8 of whom
had RRP, but reported the need for surgical
intervention in the operating room in 81% of
their study group (33 patients) [23]. Hamdan
et al. reported the successful use of the blue
laser (wavelength 445 nm) in a case of RRP
that had complete regression of the lesion at 6
weeks follow-up [24]. Several other cases have
been also treated with similar outcome. Miller
etal. in their cohort of 29 patients with vocal
fold lesions, 48% of whom had RRP, reported
a signicant decrease in VHI-10 score after
therapy [25].
Intralesional injections have gained popularity as an adjuvant therapy in patients with rapid
growth of the RRP and need for frequent surgical interventions [26, 27]. The most common
injected drug with promising long-term results
is cidofovir. Intralesional cidofovir injection has
been shown to increase the interval between
recurrences and to decrease the total number of
surgical interventions needed. The drug is used
at a concentration that varies between 2.5 mg
and 15 mg/ml with a total dose that ranges
between 5.6 and 143mg per injection [28, 29].
The carcinogenic effect of cidofovir adjuvant
therapy remains controversial with no clear consensus on the association between intralesional
injections and increased risk of dysplasia or
malignant transformation [30, 31]. Although
Moore etal found no difference in pre-cidofovir
and post-cidofovir dysplasia in 17 patients with
an average of 4.6 injections per patient and data
for an average of 19.3 months before the rst
cidofovir injection and an average of 45 months
follow-up after the rst injection [32]. They
concluded that cidofovir does not increase dysplasia risk over the time period studied. Other
less used treatment modalities include vascular
endothelial growth factor inhibitors (VEGF),
bevacizumab, indol-3- carbinol, HPV vaccination, and others. The benecial role of vaccination in patients with active disease remains
controversial [33, 34].
6.2 Case Presentations
6.2.1 Case 1: Right Vocal Fold RRP
A 63-year-old man presented to the Voice Clinic
(ALH) with hoarseness and throat irritation of a
few months’ duration. The patient was a heavy
smoker but denied any history of reux, allergy,
or voice abuse. His Voice Handicap Index-10
score on presentation was 6, and perceptual evaluation of his voice revealed grade 1 dysphonia
with no breathiness, strain, or asthenia. On laryngeal examination, he had a right papillomatous
lesion extending from the vocal process to the
mid-third of the membranous vocal fold
(Fig. 6.1). The patient underwent biopsy of the
lesion using the transnasal exible endoscope
with a working channel, and 3 soft tissue specimen measuring 0.4 × 0.2 × 0.2cm in aggregate
were submitted for pathologic examination.
Histologic examination revealed squamous papilloma, negative for dysplasia and malignancy.
The patient underwent ofce-based blue laser
therapy for right vocal fold papilloma using the
400nm glass ber (power 10 W, pulse pause 40
ms, interpole 300 ms). The laser was used in contact and non-contact modes. The cup forceps was
used to remove the necrotic tissues after laser surgery (Fig.6.2, Video 6.1). Four months following
the surgery, the patient had no symptoms, and
Fig. 6.1 An endoscopic view of the larynx showing a
papillomatous lesion involving the right vocal process
through the mid-third vocal fold musculomembranous
portion
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Fig. 6.2 An image of the blue laser glass ber directed to
the site of the lesion (non-contact mode). (Video 6.1 Blue
laser therapy of a right vocal fold papillomatous lesion.
The laser is used in non-contact mode)
(▶ https://doi.org/10.1007/000- anf)
6 Blue Laser Therapy ofRecurrent Respiratory Papillomatosis
patient was a known smoker but denied a history
of reux disease or allergy. The VHI-10 score on
presentation was 15. On perceptual evaluation,
he had grade 3 dysphonia, grade 3 roughness, and
grade 2 breathiness with grade 2 strain. Laryngeal
examination showed a papillomatous lesion
involving the entire right true vocal fold including the vocal process and extending to the anterior commissure (Fig.6.4). The patient also had a
solitary lesion on the laryngeal surface of the epiglottis. He underwent two blue laser therapy
sessions in an ofce setting using non-contact
mode and contact mode (Fig. 6.5, Video 6.2).
Fig. 6.3 Laryngeal examination 4 months following blue
laser therapy showing complete regression of the lesion
complete regression of the lesion was seen on
laryngeal examination (Fig.6.3).
6.2.2 Case 2: Right Vocal Fold RRP
A 68-year-old male smoker presented to the
Voice Clinic (ALH) with a history of persistent
dysphonia following several surgeries performed
over the last 2 years for recurrent respiratory papillomatosis. Medical history was positive for diabetes mellitus type 2 and dyslipidemia. The
Fig. 6.4 An endoscopic view of the larynx showing an
exophytic papillomatous lesion involving the right vocal
fold and extending to the anterior commissure
Fig. 6.5 An image of the in-ofce surgery showing the
blue laser used in a non-contact mode on the superior surface of the vocal fold. Note blanching of the lesion. (Video
6.2 Blue laser therapy of a right vocal fold papillomatous
lesion. Note blanching of the lesion toward the end of
treatment) (▶ https://doi.org/10.1007/000- ane)
6.2 Case Presentations
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Toward the end of the procedure, a cup forceps
was used to remove the necrotic tissue from the
surgical bed (Fig.6.6). Following laser therapy,
0.1–0.2 cc of cidofovir (15 mg/ml) was injected
at the site of the surgery (Fig.6.7). Three months
later, the patient underwent another procedure
using the same technique (Video 6.3). On his last
follow- up, 6 weeks after the second procedure,
the patient had marked improvement in his voice
quality, and laryngeal examination showed
almost complete regression of his laryngeal
lesion (Fig.6.8). His VHI-10 score dropped to 0,
and perceptual evaluation revealed a normal
63
Fig. 6.8 Laryngeal examination 6 weeks after the last
surgical intervention showing almost complete regression
of the lesion
voice. His fundamental frequency increased from
179.5 Hz to 215.8 Hz, his jitter and shimmer
dropped from 1.68 and 7.08, respectively, to
0.453 and 2.78, respectively.
Fig. 6.6 An image showing cup forceps used to clean the
debris of the surgical bed following blue laser therapy.
(Video 6.3 Blue laser therapy of a papillomatous lesion of
the lower lip of the right vocal fold)
(▶ https://doi.org/10.1007/000- and)
Fig. 6.7 Image showing tip of a 25-G needle directed
toward the surgical bed for injection of 0.1–0.2 Cidofovir
(15 mg/ml)
6.2.3 Case 3: Laryngeal RRP
A 53-year-old male patient presented to the Voice
Clinic (ALH) with a history of hoarseness associated with shortness of breath that was worsening
over time. The patient had known recurrent respiratory papillomatosis (RRP) for which he had
undergone multiple microlaryngeal surgeries in
another hospital using cold steel instruments and
carbon dioxide laser. Laryngeal biopsy done previously showed human papilloma virus (HPV) 6
and 11. On presentation the patient had grade 3
dysphonia, grade 3 roughness, and grade 2
breathiness and strain. His VHI-10 score was 19.
His dyspnea index score was 8. Acoustic analysis
was performed and showed fundamental frequency of 165.4 Hz, shimmer percent of 13.14%,
jitter percent of 11.86%, noise-to-harmonic ratio
of 1.27, voice turbulence index of 0.804, and
maximum phonation time of 10.2 s. Laryngeal
examination showed papillomatous lesions occupying the entire laryngeal surface of the epiglottis,
and extending to the aryepiglottic folds, vocal
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6 Blue Laser Therapy ofRecurrent Respiratory Papillomatosis
folds, and subglottic region resulting in narrowing of the airway. The patient was advised to
undergo serial ofce-based blue laser therapy to
widen the glottic opening and facilitate future
surgical intervention in the operating room under
general anesthesia. The patient and the surgeon
reached that consensus given the history of difculty intubation that the patient reported and
which had led to abortion of the surgery that had
been in another hospital prior to his referral. The
patient underwent biopsy of the lesion using the
transnasal exible endoscope with a working
channel, and a soft tissue lesion measuring
0.2 cm was submitted for pathologic examination. Results showed squamous papilloma. This
was followed by blue laser therapy which was
used in contact and non-contact modes (power
10, pulse duration 400 ms, and pulse pause 300
ms) (Figs.6.9 and 6.10).
On follow-up one month later, the patient
reported marked improvement in his voice quality
and breathing. Laryngeal examination showed
regression in the size of the lesion, mainly posteriorly where the surgery had been performed. The
patient was advised to undergo another blue laser
therapy session in addition to intralesion cidofovir injection. On follow-up, the patient had
improvement in his glottic aperture which
allowed intubation for microlaryngeal surgery
under suspension microlaryngoscopy (Fig.6.11).
Fig. 6.10 Image showing blue laser application to RRP
in the subglottic region in a contact mode. Note blanching
of the lesion
Fig. 6.11 Laryngeal image following two sessions of
blue laser therapy in the ofce showing widening of the
airway
Fig. 6.9 A pre-operative view of the larynx showing
extensive disease in the supraglottis with spread of the
papillomatous lesion to the subglottic region. Note narrowing of the airway
6.2.4 Case 4: Bilateral Vocal
FoldRRP
A 42-year-old male patient, non-smoker, known
to be pre-diabetic, presented with history of
hoarseness of few months’ duration associated
with mild dyspnea and frequent episodes of choking, but no dysphagia/odynophagia. On perceptual evaluation, he had grade 3 dysphonia, grade 3
roughness, and grade 1 breathiness and strain. On
laryngeal examination he had papillomatous
lesion involving both vocal folds and the anterior
commissure, with satellite lesions over the medial
surface of the arytenoid on the right side. The
patient underwent suspension microlaryngos-
6.2 Case Presentations
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copy, biopsy of the lesion, and Thulium laser
therapy under general anesthesia. On follow- up 3
weeks after the surgery, he had marked improvement in his voice and breathing. Four months
later, the patient presented with recurrence of his
symptoms and worsening of his voice. Laryngeal
examination showed recurrence of the disease in
both vocal folds. The patient was scheduled for
ofce-based blue laser therapy and cidofovir
injection (Figs.6.12 and 6.13; Video 6.4). The setting used was 10 W, 20 ms pulse duration, and
300 ms pause time. On follow-up, the exam
showed 50% regression in the size of the lesion.
Fig. 6.12 Intraoperative view showing the 400nm blue
laser glass ber aiming at the papillomatous lesion. (Video
6.4 Blue laser therapy of glottic recurrent respiratory papillomatosis. The laser is used in contact and non-contact
mode) (▶ https://doi.org/10.1007/000- ang)
65
Fig. 6.14 An endoscopic image (i-scan) showing the
blue laser beam targeting the base of tongue lesion. Note
the punctate surface of the papilloma
6.2.5 Case 5: Base ofTongue
Papilloma
A 63-year-old man presented to the Voice Clinic
(ALH) for further evaluation of his throat after
being diagnosed incidentally with a base-oftongue papillomatous lesions. The patient is a
non-smoker and had no history of systemic diseases. On presentation, he had a normal voice
and denied any symptoms related to the laryngopharyngeal complex. Repeated laryngeal examination conrmed the presence of a 2 × 2 cm
papillomatous lesion at the base of tongue. The
patient underwent blue laser therapy in an ofce
setting under local anesthesia. The glass ber
was introduced through the working channel of
the exible endoscope, and the laser was used in
a non-contact mode initially to induce blanching
of the lesion and then in a contact mode to ablate
the tissue (Fig.6.14). Examination 3 weeks later
showed complete regression of the lesion.
Fig. 6.13 An image showing the 25-gauge exible needle directed toward the surgical bed for cidofovir
injection
6.2.6 Case 6: Posterior Pharyngeal
Wall Papilloma
A 45-year-old male who presented for routine
follow-up for a previously treated in-ofce) left
vocal fold granuloma (grade 3) was found to have
a papilloma on the posterior pharyngeal wall.
The patient underwent biopsy of the lesion using
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6 Blue Laser Therapy ofRecurrent Respiratory Papillomatosis
the transnasal exible endoscope with a working
channel and one soft tissue lesion measuring 0.3
× 0.3 × 0.2 cm was submitted for pathologic
examination. Results showed squamous papilloma, negative for dysplasia, and malignancy.
The patient underwent ofce-based blue laser for
posterior pharyngeal wall papilloma excision
(Fig. 6.15). Three weeks following the surgery,
the patient had complete regression of the lesion
and a well-healing wound (Fig.6.16).
Fig. 6.15 An image showing the blue laser in a contact
mode on the papillomatous lesion of the posterior pharyngeal wall. The tip of the glass ber can be used to curet the
lesion
6.2.7 Case 7: Posterior Laryngeal
Papilloma
This 60-year-old male with recurrent laryngeal
papillomatosis presented with dysphonia. The
patient had multiple laryngeal surgical
procedures. His laryngeal examination demonstrated posterior laryngeal papilloma
(Fig.6.17).
In the operating room, the posterior laryngeal mass was hard and extended inferiorly for
more than 1/2 cm, arytenoid cartilage motion
was restricted on palpation. Cidofovir was
injected beneath the lesion. The initial incisions have made around the lesion using sharp
instruments. The lesion was dense and hemorrhagic, and the nal cut was made using blue
laser at 10 W, 60 ms pulse time, and 150 ms
pulse pause which eliminated hemorrhage and
produced no char (Figs.6.18 and 6.19). Total
82 joules were used during the procedure. Both
arytenoids were freely mobile at the end of the
surgery (Fig. 6.20, Video 6.5). No papilloma
recurrence 3 months after the surgery
(Fig.6.21).
Fig. 6.16 An endoscopic view of the posterior pharyngeal wall 3 months following surgery showing complete
regression of the papillomatous lesion
Fig. 6.17 Intraoperative surgical view showing posterior
laryngeal mass. (Video 6.5 Surgical video showing posterior laryngeal papilloma resection using blue laser)
(▶ https://doi.org/10.1007/000- anh)
6.2 Case Presentations
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Fig. 6.18 Intraoperative views showing blue laser using
to resect the laryngeal papilloma
67
Fig. 6.20 Intraoperative view showing complete papilloma resection
Fig. 6.19 Intraoperative views showing blue laser using
to resect the laryngeal papilloma
Fig. 6.21 Laryngeal examination showing no papilloma
recurrence 3 months after the surgery
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6 Blue Laser Therapy ofRecurrent Respiratory Papillomatosis
6.3 Surgical Steps inOceBased Blue Laser Therapy
ofRRP
Step 1: The patient is seated in the upright position in a standard examination chair. A pad
behind his or her head may be placed to stabilize
the head during the procedure.
Step 2: Topical anesthesia to the larynx and
pharynx is applied using a transnasal, transoral,
or percutaneous cervical approach.
Step 3: A exible laryngoscope with a working channel and a side-port suction is introduced
through the nasal cavity to perform indirect
laryngoscopy.
Step 4: The laser glass ber is introduced
through the working channel until the tip of the
ber is seen at the end of the endoscope. Note that
the introduction of the glass ber is done while the
scope is not exed to avoid injury to the working
channel. The glass ber can be introduced when
the exible endoscope is either in the nasal cavity
or before inserting the endoscope in the nose.
Step 5: The exible endoscope with the glass
ber is introduced through the nasopharynx, oropharynx, and hypopharynx until the targeted
lesion is observed.
Step 6: The glass ber is pushed more distally
and directed toward the site of the lesion.
Step 7: The laser is used in the non-contact
mode and contact mode.
Step 8: Toward the end of the laser therapy, a
cup forceps may be introduced through the working channel of the endoscope to remove necrotic
tissue in the surgical bed.
Step 9: Cidofovir solution at a concentration
that varies between 2.5 and 15 mg/ml may be
injected in the bed of the lesion using a 25-guage
exible needle that is inserted through the working channel of the endoscope. Alternatively, a
transoral needle may be used under exible
laryngoscopic guidance.
References
1. Wiatrak BJ, Wiatrak DW, Broker TR, Lewis
L.Recurrent respiratory papillomatosis: a longitudinal study comparing severity associated with human
papilloma viral types 6 and 11 and other risk factors in a large pediatric population. Laryngoscope.
2004;114(S104):1–23.
2. Buchinsky FJ, Valentino WL, Ruszkay N, Powell E,
Derkay CS, Seedat RY, etal. Age at diagnosis, but not
HPV type, is strongly associated with clinical course
in recurrent respiratory papillomatosis. PLoS One.
2019;14(6):e0216697.
3. McKaig RG, Baric RS, Olshan AF. Human papillomavirus and head and neck cancer: epidemiology and molecular biology. Head Neck.
1998;20(3):250–65.
4. Syrjanen S, Puranen M. Human papillomavirus infections in children: the potential role of
maternal transmission. Crit Rev Oral Biol Med.
2000;11(2):259–74.
5. Formánek M, Jančatová D, Komínek P, Matoušek
P, Zeleník K. Laryngopharyngeal reux and herpes simplex virus type 2 are possible risk factors
for adult-onset recurrent respiratory papillomatosis
(prospective case–control study). Clin Otolaryngol.
2017;42(3):597–601.
6. Gallagher TQ, Derkay CS. Recurrent respiratory
papillomatosis: update 2008. Curr Opin Otolaryngol
Head Neck Surg. 2008;16(6):536–42.
7. Ruiz R, Achlatis S, Verma A, Born H, Kapadia F,
Fang Y, et al. Risk factors for adult-onset recurrent respiratory papillomatosis. Laryngoscope.
2014;124(10):2338–44.
8. Kashima HK, Shah F, Lyles A, Glackin R,
Muhammad N, Turner L, et al. A comparison of
risk factors in juvenile-onset and adult-onset recurrent respiratory papillomatosis. Laryngoscope.
1992;102(1):9–13.
9. Sataloff RT. Structural abnormalities of the larynx.
In: Sataloff RT, editor. Professional voice: the science and art of clinical care, 3-volume set. San Diego:
Plural Publishing; 2017. p.1533–86.
10. Tjon Pian Gi RE, Halmos GB, van Hemel BM, den
Heuvel ER, van der Laan BF, Plaat BE, etal. Narrow
band imaging is a new technique in visualization of
recurrent respiratory papillomatosis. Laryngoscope.
2012;122(8):1826–30.
11. Sataloff RT, Farhad C, Shruti J.Atlas of endoscopic
laryngeal surgery. New Delhi: JP Medical Ltd; 2011.
12. Dedo HH, Yu KC. CO2 laser treatment in 244
patients with respiratory papillomas. Laryngoscope.
2001;111(9):1639–44.
13. Crockett DM, McCabe BF, Shive CJ.Complications
of laser surgery for recurrent respiratory papillomatosis. Ann Otol Rhinol Laryngol. 1987;96(6):639–44.
14. Valdez TA, McMillan K, Shapshay SM.A new laser
treatment for vocal cord papilloma—585-nm pulsed
dye. Otolaryngology. 2001;124(4):421–5.
15. Burns JA, Zeitels SM, Akst LM, etal. 532nm pulsed
potassium-titanyl-phosphate laser treatment of
laryngeal papillomatosis under general anesthesia.
Laryngoscope. 2007;117(8):1500–4.
16. Burns JA, Zeitels SM, Akst LM, Broadhurst MS,
Hillman RE, Anderson R.Effects of 532nm pulsedKTP laser parameters on vessel ablation in the avian
References
https://t.me/medicina_free
69
chorioallantoic membrane: implications for vocal fold
mucosa. Laryngoscope. 2007;117(2):220–5.
17. Kuet ML, Pitman MJ. Photoangiolytic laser treatment of recurrent respiratory papillomatosis: a scaled
assessment. J Voice. 2013;27(1):124–8.
18. Balouch B, Ranjbar PA, Alnouri G, Al Omari AI,
Martha V, Brennan M, etal. Surgical outcome of lowpower- density blue laser for vascular lesions of the
vocal fold. J Voice. 2022;2022:S0892.
19. 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.
20. Mouadeb DA, Belafsky PC. In-ofce laryngeal
surgery with the 585nm pulsed dye laser (PDL).
Otolaryngology. 2007;137(3):477–81.
21. Koufman JA, Rees CJ, Frazier WD, Kilpatrick LA,
Wright SC, Halum SL, etal. Ofce-based laryngeal
laser surgery: a review of 443 cases using three wavelengths. Otolaryngology. 2007;137(1):146–51.
22. 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.
23. Centric A, Hu A, Heman-Ackah YD, Sataloff
RT. Ofce-based pulsed-dye laser surgery for
laryngeal lesions: a retrospective review. J Voice.
2014;28(2):262.
24. Hamdan AL, Ghanem A. Un-sedated ofce-based
application of blue laser in vocal fold lesions. J Voice.
2021;2021:S0892.
25. Miller BJ, Abdelhamid A, Karagama Y.Applications
of ofce-based 445nm blue laser transnasal exible
laser surgery: a case series and review of practice. Ear
Nose Throat J. 2021;100(1):105–12.
26. Derkay CS.Task force on recurrent respiratory papillomas: a preliminary report. Arch Otolaryngol Head
Neck Surg. 1995;121(12):1386–91.
27. Schraff S, Derkay CS, Burke B, Lawson L.American
Society of Pediatric Otolaryngology members' experience with recurrent respiratory papillomatosis and the
use of adjuvant therapy. Arch Otolaryngol Head Neck
Surg. 2004;130(9):1039–42.
28. Soma MA, Albert DM. Cidofovir: to use or not
to use? Curr Opin Otolaryngol Head Neck Surg.
2008;16(1):86–90.
29. Fusconi M, Grasso M, Greco A, Gallo A, Campo
F, Remacle M, et al. Recurrent respiratory papillomatosis by HPV: review of the literature and update
on the use of cidofovir. Acta Otorhinolaryngol Ital.
2014;34(6):375.
30. Wemer RD, Lee JH, Hoffman HT, Robinson RA,
Smith RJ. Case of progressive dysplasia concomitant with intralesional cidofovir administration for
recurrent respiratory papillomatosis. Ann Otol Rhinol
Laryngol. 2005;114(11):836–9.
31. Broekema FI, Dikkers FG.Side-effects of cidofovir in
the treatment of recurrent respiratory papillomatosis.
Eur Arch Otorhinolaryngol. 2008;265(8):871–9.
32. Moore JE, Garcia A, Sanyal S, Saunders S, Portnoy JE,
Hu A, etal. Degrees of dysplasia based on viral typing
in patients with cidofovir use and recurrent respiratory papillomatosis. J Voice. 2013;27(6):765–8.
33. Joura EA, Kjaer SK, Wheeler CM, Sigurdsson K,
Iversen OE, Hernandez-Avila M, etal. HPV antibody
levels and clinical efcacy following administration
of a prophylactic quadrivalent HPV vaccine. Vaccine.
2008;26(52):6844–51.
34. Young DL, Moore MM, Halstead LA.The use of the
quadrivalent human papillomavirus vaccine (gardasil)
as adjuvant therapy in the treatment of recurrent respiratory papilloma. J Voice. 2015;29(2):223–9.
Blue Laser Therapy ofVocal Fold
https://t.me/medicina_free
Leukoplakia
7
7.1 Introduction
Vocal fold leukoplakia is dened as a whitish discoloration/plaque of the vocal fold. The estimated annual prevalence is 4.2 per 100,000 with
a male predilection [1, 2]. When present, leukoplakia denotes a pathologic transformation of the
underlying mucosa of the vocal fold which normally is non-keratinizing stratied epithelium.
The histologic changes may vary from cellular
hyperplasia to dysplasia to carcinoma. In a review
by the French Society of Phoniatrics and
Laryngology, vocal fold leukoplakia and dysplasia are lumped together to designate “epithelial
hyperplastic laryngeal lesions” (EHLL) [3]. In
2017, the WHO classication dichotomized these
lesions as low-grade vs. high-grade reecting the
lesion’s potential for malignant transformation
[4]. Low-grade dysplasia is considered as an
abnormal reactive lesion with no cellular atypia,
whereas high-grade dysplasia harbors atypical
cellular changes such as hyperchromatic nuclei
and atypic mitosis. According to numerous studies, it is estimated that around 50% of vocal fold
leukoplakia contains dysplastic and/or malignant
cells [5–7]. In a review of 2188 cases, Isenberg
Supplementary Information The online version contains supplementary material available at https://doi.
org/10.1007/978- 3- 031- 35283- 6_7. The videos can be
accessed individually by clicking the DOI link in the
accompanying gure caption or by scanning this link with
the SN More Media App.
etal. reported severe dysplasia/carcinoma in situ
(CIS) in 15.2% of the cases, and mild/moderate
dysplasia in almost one-third of the cases [5]. It is
important to note that the likelihood of malignant
transformation increases with the degree of dysplasia, but that lesions with no dysplasia at the
time of diagnosis still carry the risk of malignant
transformation [7].
Several predisposing factors for malignant
transformation of vocal fold leukoplakia have
been described in the literature, the most important
of which are poor vocal hygiene and smoking. It is
estimated that two-thirds of patients with laryngeal leukoplakia are smokers, and the risk of
malignant transformation increases with the duration of smoking [1]. In a case study of 96 patients
with laryngeal cancer, Vaezi et al. found that
smoking and alcohol were signicant risk factors
for malignant transformation with an odd ratio of
5.46 and 1.97, respectively [8]. Similarly, laryngopharyngeal reux disease (LPR) has been incriminated in laryngeal cancer and in the progression of
leukoplakia to cancer [9, 10]. In a review on the
prevalence of laryngopharyngeal reux (LPR) in
113 patients with dysphonia, Koufman et al.
reported abnormal 24-hour pH monitoring in
almost half the cases. Four of the six patients with
vocal fold carcinoma in their study group had LPR
[9]. Chen etal. investigated the pathogenic role of
reux in 63 patients with laryngeal and pharyngeal
cancer and reported abnormal 24-hour pH monitoring results in 54% of their cohort [10]. Several
© 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_7
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