Laryngomicrosurgery with carbon dioxide laser for laryngeal papillomatosis: application of a two-stage operation.
Among the many treatments reported, CO2 laser surgery has recently been applied in the field of laryngomicrosurgery to treat laryngeal papilloma. It is exceedingly difficult to cure this disease, however, because of its rapid recurrence following surgery. Incomplete removal of papilloma is believed to be caused by the difficulty of precisely identifying residual papillomas during surgery. In an effort to resolve this problem, we have developed a new surgical method which we call the "two-stage operation," in which a series of two operations are performed about 10 days apart. By the time of the second operation, the bleeding, coagulated blood, and carbonized tissue from the first operation have resolved, and the laryngeal image is much clearer. If additional lesions are found, they are removed at the second operation. We applied this method to several patients with recurrent laryngeal papillomatosis and obtained good results. This new method is clearly useful in the treatment of laryngeal papillomatosis, and it promises to decrease the recurrence rate. In this paper we present the case of a 26-year-old male with laryngeal papilloma who underwent surgery 1 month previously at another hospital. Laryngeal endoscopy revealed multiple papillomas especially of the glottis. The first operation with the CO2 laser was performed on April 16, 1990. Visible lesions appeared to have been completely removed. The second operation was carried out 10 days after the first operation, and the small residual lesions were removed with the CO2 laser. The patient has been disease-free for 18 months.
Sakoh
T
T
Department of Otolaryngology, School of Medicine, Keio University, Tokyo, Japan.
Fukuda
H
H
Sasaki
S
S
Sakaguchi
R
R
Shiotani
A
A
Kawaida
M
M
Kanzaki
J
J
D000328:Adult; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D007830:Larynx / Q000473:pathology / Q000601:surgery; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008866:Microsurgery; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control / Q000601:surgery*; D010212:Papilloma / Q000473:pathology / Q000601:surgery*