Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4634_Библиотеки_им_академика_М_И_Перельмана
.pdf
72
https://t.me/medicina_free
7 Blue Laser Therapy ofVocal Fold Leukoplakia
genetic markers also have been identied in
patients with vocal fold leukoplakia. The most
important of these are CTNNB1 and CDKN2A, in
addition to other genes involved in cell proliferation and control such as p53 [11].
The clinical presentation of patients with
vocal fold leukoplakia is not uniform and can be
misleading. Patients may be asymptomatic or
may complain of a change in voice quality involving clarity (hoarseness), timber, pitch, or loudness. Other common symptoms include voice
fatigue, throat clearing, although these may be
associated with other than caused by leukoplakia.
Direct or indirect laryngoscopy is essential for
diagnosis. The location and morphologic appearance of the lesion vary across patients and
throughout the course of the disease [1]. In 2019,
Chen et al. proposed a classication for vocal
fold leukoplakia based on the morphologic
appearance of the lesion. The authors noted a
lower prevalence of dysplasia and carcinoma in
at and smooth lesions (32% and 0%, respectively) in comparison to rough and elevated
lesions (99% and 30.6%, respectively) [12]. A
classication of the different vascular patterns of
these lesions using narrow band imaging also has
been proposed to improve early detection of
laryngeal cancer [13]. In a review of 85 patients
with suspected laryngeal cancerous or precancerous lesions, Ni etal. reported the sensitivity and
specicity of narrow band imaging in differentiating malignant from non-malignant lesions to be
88.9% and 93.2%, respectively [13]. Similarly,
videostroboscopic examination has been shown
to help in assessing the thickness of the lesion
and progression of disease [14–17]. In a systematic review and meta-analysis on the role of videostroboscopy in predicting early glottic cancer
in 307 patients with vocal fold cancer or premalignant lesions, Mehlum etal. reported a sensitivity of 86–100% and specicity of 7–93%
[16]. A decrease or absence of mucosal waves
during phonation is usually suggestive of tumor
invasion to the deeper layers of the vocal fold,
although it is not exclusive to cancer and may be
associated with other causes such as inammation and scar. Rzepakowska etal. noted absence
of mucosal waves in 48% of patients with vocal
fold invasive cancer and abnormal mucosal
waves in 18–23% of those with dysplasia [17].
The treatment of vocal fold leukoplakia varies
with the severity and course of the disease. Several
therapeutic options have been described. Behavioral
modications and improvement in vocal hygiene
have been shown to be helpful in selected cases. In
a cohort of 20 patients with vocal fold leukoplakia,
Gao etal. reported improvement in symptoms and
disappearance of the lesion following three weeks
of conservative therapy [18]. To help determine the
extent of the lesion, zones of induration, and depth
of inltration, palpation, and excision under suspension microlaryngoscopy using cold steel instruments and/or lasers is advocated [19, 20]. The
excision can be therapeutic if the lesion is small
and excised in total, or diagnostic to be followed by
more extensive surgery if needed, based on pathology. The benet of serial excision in reducing the
risk of malignant transformation remains controversial. Schweinfurth etal. reported overall disease
regression following serial excisions using the
microap technique in patients with vocal fold leukoplakia. Only one of the 20 patients with severe
dysplasia or CIS had progression of the disease
[19]. Kono etal. reported the oncologic efcacy of
phonosurgical resection of precancerous laryngeal
leukoplakia in 10 patients with severe dysplasia.
The authors advocated aggressive surgical intervention despite the potential worsening of voice
[21]. However, Ahn et al. refuted the hypothesis
that serial excision of dysplastic lesions decreases
the risk of malignant transformation or worsening
of the grade of dysplasia. In their longitudinal
review of 55 patients who underwent serial fullthickness microap excisions of vocal fold dysplasia, the authors noted an increase in the odds of
having the same or higher grade of pathology [22].
The recent advances in technology led to a
shift in the treatment of vocal fold leukoplakia
from the operating room to the clinic, with comparable results being reported. In 2006, Zeitels
etal. reported 75% disease regression following
potassium titanyl phosphate (KTP) laser therapy
in almost two-thirds of his cohort [23]. In 2007,
Koufman etal. reviewed their experience with the
use of different lasers in treating 79 patients with
glottal dysplasia in an ofce setting and reported
7.2 Case Presentations
https://t.me/medicina_free
partial or complete disease regression in most of
the cases [24]. In 2017, Koss etal. reported partial
or complete response following ofce-based laser
treatment in 67.4% of patients with vocal fold leukoplakia [25]. The study group consisted of 46
patients with vocal fold leukoplakia who were
treated using either KTP laser or pulsed-dye laser
(PDL). Similar results have been reported using
the blue laser with a wavelength of 445 nm.
Hamdan etal. described the use of blue laser in a
cohort of 11 patients with vocal fold lesions which
included cases of leukoplakia and reported complete regression of the lesion following a single
therapy session [26]. Similarly, Miller et al.
reported the successful use of ofce-based blue
laser therapy in 29 patients with different vocal
fold pathology, 14% of whom had suspected
malignancy. The authors did not specify whether
the patients had vocal fold leukoplakia [27].
7.2 Case Presentations
73
Fig. 7.1 Laryngeal examination showing leukoplakia
involving two-thirds of the left true vocal fold. The lesion
has a rough, elevated surface with irregular margins.
(Video 7.1 Laryngeal videostroboscopic examination
showing left vocal fold leukoplakia involving almost half
the vocal fold. Note the decrease in mucosal waves on the
left side and incomplete closure of the vocal folds during
phonation) (▶ https://doi.org/10.1007/000- ann)
7.2.1 Case 1: Left Vocal Fold
Leukoplakia
A 70-year-old male heavy smoker presented to
the voice unit (ALH) with history of hoarseness
and voice fatigue of a few years' duration.
Associated symptoms included frequent throat
clearing and difculty projecting his voice. The
patient denied any history of phonotrauma,
known reux disease or allergy. His Voice handicap Index-10 (VHI-10) score on presentation was
6. Perceptual evaluation revealed grade 2 dys-
phonia, grade 2 roughness, grade 1 breathiness,
and no straining. On laryngeal examination, he
had a whitish lesion occupying the anterior twothirds of the left vocal fold. The lesion was elevated with a rough surface (Fig.7.1). Laryngeal
videostroboscopy showed decrease in mucosal
waves at the site of the lesion with asymmetry
and incomplete closure of the vocal folds during
phonation (Video 7.1). The patient underwent
biopsy of the lesion using the exible endoscope
with a working channel and a soft tissue lesion
measuring 0.5 × 0.2 × 0.2cm was submitted for
pathologic examination. The results showed
Fig. 7.2 An image of blue laser glass ber 400 nm
applied in a non-contact mode to the lesion. (Video 7.2
Blue laser therapy of left vocal fold leukoplakia. The laser
is used in contact and non-contact mode)
(▶ https://doi.org/10.1007/000- ank)
squamous mucosa with hyperkeratosis, parakeratosis, acanthosis, papillomatosis, and mild acute
and chronic inammation. It was negative for
high-grade dysplasia and malignancy. Because of
his persistent symptoms and the known risk of
malignant transformation in smokers, the patient
underwent ofce-based blue laser therapy for his
lesion under local anesthesia (power 10 W, pulse
duration 10 ms, pulse pause 300 ms) (Fig.7.2,
74
https://t.me/medicina_free
7 Blue Laser Therapy ofVocal Fold Leukoplakia
Video 7.2). Two weeks following the surgery, the
patient presented with persistent hoarseness.
Laryngeal examination showed exudate-like
lesion at the site of the surgery (Fig.7.3). The
patient was reassured and advised to come back
in 6 weeks. On follow-up there was complete
regression of the lesion with marked improvement in voice quality. Laryngeal videostroboscopic examination revealed marked improvement
in mucosal waves with complete closure of the
vocal folds during phonation (Fig. 7.4, Video
7.3).
7.2.2 Case 2: Right Vocal Fold
Low-Grade Dysplasia
A 75-year-old male heavy smoker presented to
the voice unit (ALH) with history of hoarseness
of a few years’ duration. There was no history of
dyspnea, aspiration, or dysphagia. The patient
reported a history of voice overuse and abuse.
Medical history was negative for any systemic
diseases including reux disease and allergy. His
VHI-10 score on presentation was 3, and on perceptual evaluation he had grade 3 dysphonia,
grade 3 roughness with grade 1 breathiness and
grade 1 straining. Laryngeal examination showed
right vocal fold leukoplakia occupying more than
half of the vocal fold (Fig.7.5). Laryngeal videostroboscopy showed absent mucosal waves at the
site of the lesion with incomplete closure of the
vocal fold during phonation. The patient underwent ofce-based laryngeal biopsy and a 0.4 ×
0.3 × 0.2cm specimen was submitted for patho-
logic examination (Fig.7.6). Pathology showed
acanthosis and hyperkeratosis with low-grade
squamous dysplasia. The patient underwent blue
laser therapy using the 400nm berglass via the
transnasal approach (Fig.7.7). Both non-contact
Fig. 7.3 Laryngeal examination 2 weeks after blue laser
therapy showing whitish exudates at the site of the surgery
with inammatory reaction
Fig. 7.4 Laryngeal examination 2 months post-blue laser
therapy showing complete regression of the lesion. (Video
7.3 Laryngeal videostroboscopic examination 2 months
following surgery showing complete regression of the
lesion with normal mucosal waves)
(▶ https://doi.org/10.1007/000- anm)
Fig. 7.5 Endoscopic view of the larynx using a 70-degree
telescope showing a whitish lesion occupying 2/3 of the
vocal fold. Note that the lesion is elevated and has a rough
surface
7.2 Case Presentations
https://t.me/medicina_free
Fig. 7.6 Endoscopic view of right vocal fold biopsy
under topical laryngeal anesthesia to the larynx while the
patient was awake in an ofce setting
75
Fig. 7.8 Endoscopic view of the vocal folds during inhalation 3 months after blue laser surgery. Note complete
regression of the lesion
7.2.3 Case 3: Right Vocal Fold
High-Grade Dysplasia
A 74-year-old female smoker presented to the
voice unit (ALH) with history of dysphonia of a
few months' duration. The patient had been seen
by an outside physician who performed a suspension microlaryngoscopy and biopsy of a right
vocal fold lesion. Pathologic examination
revealed high-grade dysplasia. According to the
Fig. 7.7 Endoscopic view of blue laser therapy in contact
mode using 400nm glass ber via the transnasal route.
(Video 7.4 Laryngeal endoscopic view showing blue laser
therapy of a right vocal fold leukoplakia. The laser is used
in non-contact and contact mode)
(▶ https://doi.org/10.1007/000- anj)
referring physician, the exposure of the larynx
was difcult; and for that reason, the patient was
referred to our care for further evaluation and
biopsy of the anterior commissure. On presentation her VHI-10 score was 2, and she had grade
2 dysphonia, grade 2 roughness, with grade 1
and contact modes were used. Toward the end of
laser ablation of the lesion, a cup forceps was
used to remove the necrotic tissues from the surgical bed (Video 7.4). Follow-up examination 6
weeks following surgery showed complete
regression of the lesion with improvement in
mucosal waves on videostroboscopic examination (Fig. 7.8). Acoustic analysis showed
improvement in shimmer (7.07 vs. 4.04), jitter
(0.67 vs. 0.58), noise to harmonic ratio (0.132 vs.
0.125), voice turbulence index (0.048 vs. 0.027).
Maximum phonation time (MPT) increased from
14.4 s to 22.2 s.
breathiness and no straining. Laryngeal exami-
nation using the exible nasopharyngoscope
showed a whitish lesion occupying the entire
right vocal fold and reaching the anterior com-
missure. The free margin of the right vocal fold
was irregular. Both vocal folds were mobile
(Fig. 7.9). The patient underwent ofce-based
biopsy of the anterior commissure which
revealed hyperkeratosis and hyper-granulosis
with no evidence of malignancy (Fig. 7.10,
Video 7.5). She later underwent blue laser ther-
apy (Power 10 W, pulse duration 10 ms, pulse
pause 300 ms) of the right vocal fold using both
76
https://t.me/medicina_free
Fig. 7.9 Laryngeal endoscopic view showing a whitish
lesion occupying the entire vocal fold with irregular margins. Note that the lesion reaches the anterior
commissure
7 Blue Laser Therapy ofVocal Fold Leukoplakia
Fig. 7.11 Endoscopic view of the larynx showing the
laser glass ber in a contact mode against the lesion.
(Video 7.6 Videorecording showing blue laser therapy of
a right vocal fold lesion)
(▶ https://doi.org/10.1007/000- anq)
Fig. 7.10 Endoscopic view of the larynx showing cup
forceps biopsy of the lesion at the anterior one-third of the
right vocal fold. (Video 7.5 Ofce-based laryngeal biopsy
of a right vocal fold lesion)
(▶ https://doi.org/10.1007/000- anp)
contact and non- contact mode (Fig.7.11, Video
7.6). Three months following therapy, the patient
had marked improvement in voice quality with
complete regression of the lesion. Her VHI-10
was 0. On perceptual evaluation she had grade 0
dysphonia and roughness with no breathiness or
straining. Her fundamental frequency increased
Fig. 7.12 An image of laryngeal videostroboscopy 3
months following surgery showing complete closure of
the vocal fold during phonation, with mild edema of the
right vocal fold. (Video 7.7 Laryngeal videostroboscopic
examination showing complete regression of the lesion
with complete closure of the vocal folds during phonation.
Mild residual edema is seen in the right vocal fold)
(▶ https://doi.org/10.1007/000- anr)
from 220.9Hz to 235. 8 Hz, and her maximum
phonation time increased from 14.46 s to 22.2 s.
Laryngeal videostroboscopic examination
showed improvement in mucosal waves on the
right side and complete closure of the vocal folds
during phonation (Figs. 7.12 and 7.13; Video
7.7).
7.2 Case Presentations
https://t.me/medicina_free
Fig. 7.13 An image of the vocal folds during abduction 4
months following surgery showing complete regression of
the lesion
7.2.4 Case 4: Right Vocal Fold
Mild-Moderate Dysplasia
77
Fig. 7.14 Laryngeal examination showing a fungating
elevated lesion involving the anterior half of the right
vocal fold with erythema and irregular edges
A 57-year-old female heavy smoker was referred
to the voice unit (ALH) because of progressive
worsening of her voice over the preceding 2
years. The patient denied any history of voice
abuse or misuse, or history of reux disease. A
month prior to her referral, she had undergone
suspension microlaryngoscopy and biopsy of a
right vocal fold lesion which revealed mild-tomoderate dysplasia. Her VHI-10 at the time presentation to the voice unit was 6. On laryngeal
examination she had right vocal fold whitish
lesion involving the anterior one half of the
vocal fold (Fig.7.14). A repeated biopsy done
under local anesthesia in an ofce setting
showed minimal nuclear atypia and rare dyskeratotic cells with evidence of acute inammatory changes (Fig.7.15). The patient underwent
unsedated, ofce-based blue laser therapy of her
right vocal fold lesion using 400nm glass ber
that was introduced through the working channel of the exible endoscope. The laser was
Fig. 7.15 An image showing biopsy of the right vocal
fold via a cup forceps introduced through the working
channel of exible endoscope using the transnasal
approach
used in a contact and non-contact mode
(Fig. 7.16). On follow- up six weeks later, the
patient had marked improvement in her voice
quality with complete regression of the lesion
(Fig. 7.17). Her VHI-10 score dropped to 3.
There was reduction in the noise-to-harmonic
ratio (0.12 vs. 0.09) and voice turbulence index
(0.04 vs. 0.02) with an increase in maximum
phonation time (11.24 s vs. 13 s).
78
https://t.me/medicina_free
Fig. 7.16 Image of blue laser glass ber aiming at the
right vocal fold lesion. Note the bleeding due to the biopsy
of the lesion taken at the same setting
7 Blue Laser Therapy ofVocal Fold Leukoplakia
Fig. 7.18 Endoscopic view of the larynx showing a whit-
ish lesion (blue arrow) on the upper surface of the right
vocal fold. The lesion was at and had a smooth surface
Fig. 7.17 Image of the laryngeal examination six weeks
following blue laser therapy of the right vocal fold lesion.
Note complete regression of the disease
7.2.5 Case 5: Right Vocal Fold
Leukoplakia
A 57-year-old male professional voice user with
no prior history of smoking or reux disease presented to the Voice Unit with a history of mild
change in voice quality of a few weeks’ duration.
The patient denied any other symptoms related to
the laryngopharyngeal complex. His VHI-10
score at presentation was 10. On perceptual evaluation, he had grade 1 dysphonia. The patient had
a squamous cell carcinoma in situ of the right
vocal fold diagnosed 10 years ago prior to his
Fig. 7.19 An image showing the blue laser beam in a
non-contact mode aiming at the site of the lesion. Note the
aberrant vascular lesion anterior to the whitish plaque
current presentation for which he had undergone
type 1 cordectomy, and 5 years later another laser
therapy for a recurrence of his lesion. On laryn-
geal examination the patient had a whitish lesion
on the mid-third of the right vocal fold. The
lesion was at and had a smooth surface
(Fig. 7.18). A biopsy taken under suspension
microlaryngoscopy showed squamous epithe-
lium with nuclear atypia representing low-grade
dysplasia. The specimen was negative for high-
grade dysplasia and carcinoma. The patient was
offered unsedated in-ofce blue laser therapy
which was uneventful and tolerated well by the
patient. The laser was used in a non-contact mode
(Fig. 7.19). On follow-up, the patient had
7.2 Case Presentations
https://t.me/medicina_free
Fig. 7.20 Postoperative image of the vocal folds 3 weeks
after treatment showing regression of the lesion. Note also
the regression of the submucosal vessel seen
pre-operatively
79
leukoplakia had shown no malignancy or severe
dysplasia. Leukoplakia was observed over sev-
eral years with no improvement. Due to his heart
condition, the decision was made to do in-ofce
leukoplakia vaporization with blue laser. Good
visualization was obtained with exible laryngo-
scope (anterior right vocal fold leukoplakia)
(Figs.7.21 and 7.22). Blue laser was used in con-
tact and non-contact mode at 4 W, 40 ms pulse
duration, 300 ms pulse pause to vaporize the leu-
koplakia (Fig.7.23). Leukoplakia was vaporized
totally (Fig.7.24). Leukoplakia had not recurred
1 year after the procedure (Fig.7.25).
improvement in his voice quality with a drop in
his VHI-10 score from 10 to 6. On perceptual
evaluation, he had a normal voice with grade 0
dysphonia. This was accompanied by a decrease
in jitter (0.76 vs. 0.42) and shimmer (3.20 vs.
2.80) and an increase in his maximum phonation
time by 5 s (Fig.7.20).
7.2.6 Case 6: Right Anterior Vocal
Fold Leukoplakia
A 96-year-old male with history of multiple
facial basal cell carcinoma excision, coronary
artery disease, and atrial brillation using coumadin presented with dysphonia. The laryngeal
examination demonstrated glottic insufciency,
right superior laryngeal palsy, reux laryngitis,
laryngeal tremor, and multiple leukoplakia. The
patient had bilateral thyroplasty and fat injection
of the right vocal fold and previous biopsies of
Fig. 7.21 Laryngeal examination showing right anterior
vocal fold leukoplakia
Fig. 7.22 Endoscopic view showing right anterior
leukoplakia
80
https://t.me/medicina_free
7 Blue Laser Therapy ofVocal Fold Leukoplakia
Fig. 7.23 In-ofce endoscopic view showing blue laser
was used to vaporize the right anterior leukoplakia
Fig. 7.24 Endoscopic nal surgical view
Fig. 7.25 Laryngeal examination showing no recurrence
1 year after the laser procedure
7.3 Surgical Steps inOceBased Blue Laser Therapy
ofVocal Fold Leukoplakia
Step 1: The patient is seated in the upright position in a standard examination chair commonly
used in otolaryngology practice. 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 the transnasal, transoral,
or percutaneous cervical approach.
Step 3: A exible laryngoscope with a working channel and a side-port suction (ideal but is
not essential in most cases) is introduced through
the nasal cavity to perform indirect
laryngoscopy.
References
https://t.me/medicina_free
81
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 the
working channel. The glass ber can be introduced when the exible endoscope is either in the
nasal cavity or usually before inserting the endoscope into 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 further and
directed toward the site of the lesion.
Step 7: The laser is used in the non-contact
mode and contact mode.
Step 8: In selected cases in which the lesion is
bulky, the glass ber can be used to curet the
ablated tissue.
References
1. Park JC, Altman KW, Prasad VM, Broadhurst M, Akst
LM. Laryngeal leukoplakia: state of the art review.
Otolaryngology. 2021;164(6):1153–9.
2. Montgomery J, White A.A decade of laryngeal dysplasia in Paisley, Scotland. Eur Arch Otorhinolaryngol.
2012;269(3):947–51.
3. Garrel R, Coste EU, Costes-Martineau V, Woisard
V, Atallah I, Remacle M. Vocal-fold leukoplakia and dysplasia. Mini-review by the French
Society of Phoniatrics and Laryngology (SFPL).
Eur Ann Otorhinolaryngol Head Neck Dis.
2020;137(5):399–404.
4. Gale N, Poljak M, Zidar N.Update from the 4th edition of the World Health Organization classication of
head and neck tumours: what is new in the 2017 WHO
blue book for tumours of the hypopharynx, larynx,
trachea and parapharyngeal space. Head Neck Pathol.
2017;11(1):23–32.
5. Isenberg JS, Crozier DL, Dailey SH.Institutional and
comprehensive review of laryngeal leukoplakia. Ann
Otol Rhinol Laryngol. 2008;117(1):74–9.
6. Cui W, Xu W, Yang Q, Hu R. Clinicopathological
parameters associated with histological background
and recurrence after surgical intervention of vocal
cord leukoplakia. Medicine. 2017;96:22.
7. Gale N, Michaels L, Luzar B, Poljak M, Zidar N,
Fischinger J, et al. Current review on squamous
intraepithelial lesions of the larynx. Histopathology.
2009;54(6):639–56.
8. Vaezi MF, Qadeer MA, Lopez R, Colabianchi
N. Laryngeal cancer and gastroesophageal
reux disease: a case-control study. Am J Med.
2006;119(9):768–76.
9. Koufman JA, Amin MR, Panetti M. Prevalence of
reux in 113 consecutive patients with laryngeal and
voice disorders. Otolaryngology. 2000;123(4):385–8.
10. Chen MY, Ott DJ, Casolo BJ, Moghazy KM, Koufman
JA.Correlation of laryngeal and pharyngeal carcinomas and 24-hour pH monitoring of the esophagus and
pharynx. Otolaryngology. 1998;119(5):460–2.
11. Marcos CÁ, Alonso-Guervós M, Prado NR, Gimeno
TS, Iglesias FD, Hermsen M, etal. Genetic model of
transformation and neoplastic progression in laryngeal epithelium. Head Neck. 2011;33(2):216–24.
12. Chen M, Li C, Yang Y, Cheng L, Wu H.A morphological classication for vocal fold leukoplakia. Braz
J Otorhinolaryngol. 2019;85:588–96.
13. Ni XG, He S, Xu ZG, Gao L, Lu N, Yuan Z, etal.
Endoscopic diagnosis of laryngeal cancer and precancerous lesions by narrow band imaging. J Laryngol
Otol. 2011;125(3):288–96.
14. Li J, Xu W, Cheng LY. Application of stroboscopy
and narrow band imaging endoscopy in the diagnosis
of vocal cord leukoplakia. Chin J Otorhinolaryngol
Head Neck Surg. 2017;52(11):806–11.
15. El-Demerdash A, Fawaz SA, Sabri SM, Sweed
A, Rabie H. Sensitivity and specicity of stroboscopy in preoperative differentiation of dysplasia
from early invasive glottic carcinoma. Eur Arch
Otorhinolaryngol. 2015;272(5):1189–93.
16. Mehlum CS, Rosenberg T, Groentved AM, Dyrvig
AK, Godballe C. Can videostroboscopy predict
early glottic cancer? A systematic review and metaanalysis. Laryngoscope. 2016;126(9):2079–84.
17. Rzepakowska A, Sielska-Badurek E, OsuchWójcikiewicz E, Sobol M, Niemczyk K. The predictive value of videostroboscopy in the assessment
of premalignant lesions and early glottis cancers.
Otolaryngol Pol. 2017;71:14–8.
18. Gao XW, Huang YW, Liu LY, Ouyang J. Use videostrobokymography to quantitatively analyze the
vibratory characteristics before and after conservative
medical treatment of vocal fold leukoplakia. J Voice.
2016;30(2):215–20.
19. Schweinfurth JM, Powitzky E, Ossoff RH.Regression
of laryngeal dysplasia after serial microap excision.
Ann Otol Rhinol Laryngol. 2001;110(9):811–4.
20. Khan K. Professional voice: the science and art of
clinical care. J Laryngol Otol. 2018;132(1):92–3.
21. Kono T, Saito K, Yabe H, Ogawa K. Phonosurgical
resection using submucosal infusion technique for
Соседние файлы в папке Библиотека им академика М.И. Перельмана