![]() ![]() Flexible transnasal endoscope under topical anesthesia - 4% lidocaine spray.Angiolytic laser surgery - complete resolution in 85% with one treatment (17 cases) and in 155 (3 cases) after two procedures.Mizuta et al (2012) compared vocal fold polyp in-office treatment with KTP in an older group selected for in-office treatment with a younger group treated under general anesthesia with 'microflap' resection showing similar favorable outcomes they conclude the transasal laser approach 'may be used as an effective, practical, and safe alternative treatment for small vocal polyps".6 week follow showed similar favorable results in both groups.Transnasal laser approach: higher subjective effectiveness at 2 weeks post-op compared to microdirect laryngoscopy with resectino.Findings from comparison of matched pairs (25 each) with hemorrhagic vocal vold polyps.All specimens sent for pathologic review.Goal to leave free margin of vocal folds straight with avoiding excess removal of mucosal cover and lamina propria.Grasping and cutting of the exopyitc vocal polyps done bimanually (microscopic control). ![]() ![]() ![]() Small-caliber endotracheal tube (5.0/5.5 for women 5.5/6.0 for men).General anesthesia for microlaryngoscopic surgery (N=25).Suggested that use of biopsy forceps to remove coagulated polyp facilitates more rapid removal of coagulated polyp.They cite previous study suggesting that final outcome comparable whether or not the coagulate polyp removed (Wang 2013).The mean duration of the procedure was 14 minutes.Blunt-ended grasping forceps used to remove cauterized vocal polyp.532-nm wavelengtyh, 6-8 watts per pulse, 20-30 ms pulse width wtih 2Hz repetition rate.5 ml of 2% lidocaine dripped into the laryngeal introitus.Oropharynx and vallecula sprayed with 2% lidocaine.Nasal cavity: cotton pledet soaked in 1:10,000 epinephrine and 2% lidocaine solution placed.In office transnasal approach with laser (N=25).They related that because only smaller polyps were addressed, the "contralateral-reactive nodules, when present, were mostly minimal" Wang et al (2015) reported use comparison of in-office transnasal laser applied to small polyps (less then 1/3 the length of the membranous vocal cord) followed by transnasal deployment of forceps to removal residual with standard microdirect laryngoscopy under general anesthesia. in recovery perios (4 weeks or more)the polyp is anticipated to regress as the 'surrounding mucosa contrasct to close the wound' (citing ).Goal: preserve by avoiding thermal damage to normal superficial lamina propira and surrounding mucosa.Shoffel-Havakuh et al (2018): reported initial use of KTP laser for hemorrhagic polyps was based on laser wavelength selectively targetting hemoglobin - but with expanded experience, has expanded to other lesions (including non-hemorrhagic polyps) 'CONTROLLED UNDERTREATMENT': as a 'prudent approach' to 'deliberately avoid lesion overtreatment, sometimes at the cost of subsequent revision procedure" They identify that uncertainty in laser fluence (energy density delivered) and lead often to the concept of 'CONTROLLED UNDERTREATMENT' Technical challenges relating to instrumentation and laryngeal movement were listed a potential factors that conceivably could result in less favorable outcomes compared to OR procedures. See also: Superior Laryngeal Nerve Blocks Instruction Video Glossopharyngeal nerve block (gag reflex, transoral vocal cord surgery)Ī nice review of in office procedures for benign laryngeal lesions (Shoffel-Havakuh 2018 epub) identified the evolving nature of information addressing in-office treatment with lack of substantial comparative data outside of retrospective case series. Return to: KTP Laser for the Larynx Recurrent Vocal Fold Polyp In-Clinic Treatment Polyps Nodules Cysts Vocal Fold Polyps (polypoid corditis) case example of surgical treatment ![]()
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