To describe the ultrastructural changes occurring within pulsed-dye laser (PDL)-treated glottal tissues.
Nine patients presenting with glottal dysplasia requiring biopsy to rule out microinvasive carcinoma were enrolled in this prospective study. At least two samples were obtained in each case: one from a PDL-treated area and another from a non-PDL-treated area (obtained from a nonphonatory region as an internal control). In some cases, a third sample was obtained from the junction between PDL- and non-PDL-treated areas. All samples were examined with light microscopy (H and E stain) and transmission electron microscopy. Observations were made of morphological changes within the epithelium, epithelial/ superficial lamina propria (SLP) junction, and the lamina propria of tissues treated with the PDL. Eight of nine patients were followed for a period of 9-25 months (mean, 18 months) with two recurrences that were retreated with awake-PDL and followed for an additional 8.3 and 9.5 months without recurrence. Vocal fold appearance returned to normal within 3-4 weeks posttreatment.
Intraepithelial desmosome junctions were preferentially destroyed, and regional blood vessels were coagulated. The PDL consistently caused a separation of epithelial cells away from the basement membrane.
The PDL allowed for both a surgical and a nonsurgical multimodality method for treatment of precancerous lesions with minimal effects on the SLP.
"A digital caliper was used to perform these measurements. These superficial injuries were designed to influence vibration by disrupting the vocal fold cover, which consists of the epithelium, the basement membrane zone, and the superficial lamina propria (Hirano, 1974; Ayala, Selig, Faquin, & Franco, 2007). There has been little quantitative investigation of the depth of the canine vocal fold epithelium, but Garrett, Coleman, and Reinisch (2000) report that the thickness of human epithelium is about 0.05 mm. "
[Show abstract][Hide abstract] ABSTRACT: Digital kymography and vocal fold curve fitting are blended with detailed symmetry analysis of kymograms to provide a comprehensive characterization of the vibratory properties of injured vocal folds.
Vocal fold vibration of 12 excised canine larynges was recorded under uninjured, unilaterally injured, and bilaterally injured conditions. Kymograms were created at 25%, 50%, and 75% of the vocal fold length, and vibratory parameters were compared quantitatively among conditions and were studied with respect to right-left and anterior-posterior symmetries.
Anterior-posterior amplitude asymmetry was found in the bilateral condition. The unilateral condition showed significant right-left amplitude asymmetry, and it showed the lowest right-left phase symmetry among the conditions. In condition comparisons, vertical phase difference did not show significant differences among conditions, whereas amplitudes were significantly different among conditions at all line scan positions and most vocal fold lips. Significant differences in frequency were found among the conditions at all 4 vocal fold lips, with the bilateral condition exhibiting the greatest frequency.
Digital kymography and curve fitting provide detailed information about the vibratory behavior of injured vocal folds. Awareness of vibratory properties associated with vocal fold injury may aid in diagnosis, and the quantitative abilities of digital kymography may allow for objective treatment selection.
Journal of Speech Language and Hearing Research 08/2011; 54(4):1022-38. DOI:10.1044/1092-4388(2010/10-0105) · 2.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe the current support in the literature for in-office surgery using the 585-nm pulsed dye laser.
There are substantial cost savings (US$5000) and patient comfort when in-office surgery is performed with the pulsed dye laser. The pulsed dye laser can be used in the office and operating room to activate aminolevulinic acid for photodynamic treatment of recalcitrant laryngeal keratosis, with long-term eradication of keratosis without the prolonged photosensitivity of previous photodynamic agents. The site of the cleavage plane created in the true vocal fold mucosa has now been elucidated.
The 585-nm pulsed dye laser allows safe, medically effective and cost-effective in-office surgery for a host of laryngeal lesions such as papillomatosis, keratosis, Reinke's edema, granulomas and other vascular lesions. The pulsed dye laser can activate aminolevulinic acid for laryngeal photodynamic therapy. Of the lasers currently in use it has the longest track record of safety and, to the satisfaction of many, continues in service at 23 centers around the world.
Current Opinion in Otolaryngology & Head and Neck Surgery 01/2008; 15(6):387-93. DOI:10.1097/MOO.0b013e3282f19ef2 · 1.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Lasers are a relatively recent addition to laryngeal surgery. Since their invention, laser use and applications have expanded rapidly. In this article, we discuss the benefits and disadvantages of lasers for different procedures, as well as ways to overcome commonly faced clinical problems. The use of lasers in surgery has offered a time- and cost-efficient alternative to cold surgical techniques, and has been used in the treatment of numerous laryngeal pathologies, including stenoses, recurrent respiratory papillomatosis, leukoplakia, nodules, malignant laryngeal disease, and polypoid degeneration (Reinke's edema). However, lasers can incur adjacent tissue damage and vocal fold scarring. These problems can be minimized through understanding the mechanisms by which lasers function and correctly manipulating the parameters under a surgeon's control. By varying fluence, power density, and pulsation, tissue damage can be decreased and lasers can be used with greater confidence. The various types of lasers and their applications to the treatment of specific pathologies are reviewed with the intention of helping surgeons select the best tool for a given procedure. Recent applications of lasers to treat benign laryngeal lesions and severe laryngomalacia demonstrate that additional research must be conducted to realize the full potential of this surgical tool.
Journal of voice: official journal of the Voice Foundation 06/2009; 24(1):102-9. DOI:10.1016/j.jvoice.2008.09.006 · 0.94 Impact Factor
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