Ultrastructural evaluation of 585-nm pulsed-dye laser-treated glottal dysplasia.
ABSTRACT 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.
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ABSTRACT: Objective: Vocal cord mucosectomy using pulsed-dye laser was assessed for its ability to completely remove lesions without deterioration of vocal quality in cases of vocal cord leukoplakia. To confirm the validity of a pulsed-dye laser, we retrospectively analyzed the treatment outcomes of patients who received surgery preceded by pulsed-dye laser and compared these with the outcomes of patients who received vocal cord mucosectomy using CO2 laser. Methods: Between February 2007 and June 2012,36 patients were enrolled. Seventeen patients received vocal cord treatment with a CO2 laser and 19 patients received operation with a pulsed-dye laser. To evaluate voice status, acoustic wave form analysis and electroglottography were done, and voice handicap index was measured before and after the operation. Results: The entire lesion was removed in all patients. Compared to preoperative vocal parameters, the postoperative values for jitter were only improved in the pulsed-dye laser group. On stroboscopic findings, a diminution or lack of mucosal wave was observed in more CO2 laser cases than pulsed-dye laser cases. Significant improvement in voice handicap index results was only observed in the pulsed-dye laser group. Conclusion: Although long-term results with more patients are required to establish the validity of pulsed-dye laser, this study confirmed the merits of pulsed-dye laser for the en-bloc removal of vocal cord leukoplakia and improved voice outcome.Auris Nasus Larynx 06/2014; 41(5). DOI:10.1016/j.anl.2014.05.013 · 1.00 Impact Factor
The Laryngoscope 11/2009; 119(S2):S185 - S212. DOI:10.1002/lary.20712 · 2.03 Impact Factor
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ABSTRACT: OBJECTIVE/HYPOTHESIS: To determine the efficacy of the potassium titanyl phosphate (KTP) laser in lesion reduction, as well as preservation of mucosal wave and glottic closure in a cohort of patients with benign laryngeal pathology across multiple institutions. STUDY DESIGN: Multi-institutional and retrospective. METHODS: One hundred two patients who underwent in-office KTP procedures at multiple academic laryngology practices with at least a single follow-up visit were included. Image analysis was used to quantify vocal fold lesion size before and after treatment. A subset of images was analyzed by expert reviewers to determine the impact of this treatment on glottic closure and mucosal wave. RESULTS: Statistically, when considering all lesions, KTP induced a significant reduction in lesion size. Post hoc analyses revealed some lesion specificity; all lesions decreased in size, with the exception of vocal fold scar. Mucosal wave and glottic closure were improved or unchanged in more than 90% of the patients examined. The inter- and intrarater reliabilities of the lesion quantification method were excellent. CONCLUSIONS: With great care and insight, the KTP laser appears to be a valuable tool for the treatment of various benign laryngeal lesions. Furthermore, KTP laser therapy appears to preserve or improve mucosal wave and glottic closure. The lesion measurement protocol previously described by our group appears to be reliable.Journal of voice: official journal of the Voice Foundation 07/2012; 26(6). DOI:10.1016/j.jvoice.2012.04.003 · 0.94 Impact Factor