Ultrastructural Evaluation of 585-nm Pulsed-Dye Laser-Treated Glottal Dysplasia

ArticleinJournal of Voice 21(1):119-26 · February 2007with6 Reads
DOI: 10.1016/j.jvoice.2005.08.015 · Source: PubMed
Abstract
To describe the ultrastructural changes occurring within pulsed-dye laser (PDL)-treated glottal tissues. Prospective. 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.
    • "Essentially, there are three fundamental effects of laser on living tissue: photoacoustic, photothermal, and photochemical effects. According to the ultrastructural evaluation made by Ayala et al. , the photoacoustic and photothermal effects of the PDL create a cleavage plane, specifically between the LL and LD of the BMZ [20]; thus, the PDL treatment would cause the mucosal epithelium to separate and elevate above the lesion within the polyp-containing vocal fold. Therefore, from this effect, not only could the epithelium be easily " peeled off " from the surface of the polyp, achieving enhanced precision of cold instrumental dissection and selective extraction of the polyp, but the allimportant cover layer of the vocal fold could also be preserved with appropriate wound healing, allowing the reestablishment of normal mucosal wave vibration and phonation after the surgery. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective . Conventional surgical techniques of laryngomicrosurgery (LMS) on hemorrhagic vocal polyps are often difficult due to obscuration of the surgical field by inadvertent bleeding from the lesion, and there are often significant amounts of mucosal epithelium loss. Here, we introduce our surgical technique using pulsed dye laser (PDL), which can effectively resect the polyp with vocal fold mucosa preservation. Methods . Patients who were diagnosed with hemorrhagic vocal polyp and who were surgically managed using PDL from March 2013 to October 2014 were retrospectively reviewed. Preoperative and postoperative clinical outcomes and surgical findings were evaluated. Results . A total of 39 patients were treated with PDL-assisted enucleation LMS. The average age was 43.7 years (range 20–73), and there were 20 males and 19 females (17 professional voice users). In all cases, the hemorrhagic polyp was successfully enucleated after application of PDL, thereby preserving the overlying epithelium. Postoperative voice outcomes were favorable with clear preservation of the vocal fold mucosal wave. Conclusion . PDL-assisted enucleation LMS for the treatment of hemorrhagic vocal polyps can be a safe and effective surgical technique. It can be considered a promising treatment option for hemorrhagic vocal polyps.
    Full-text · Article · Nov 2015
    • "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.
    Full-text · Article · Aug 2011
  • [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.
    Article · Jan 2008
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