The role of the CO2 laser in the management of laryngotracheal stenosis: a survey of 100 cases.
Over the last decade, improvement of CO2 lasers with the microspot and ultrapulse technologies has broadened the indications for endoscopic CO2-laser resection of benign laryngotracheal stenosis (LTS). This article reviews 100 patients treated solely by endoscopic means for a LTS. There were 47 grade III, 41 grade II and 12 grade I stenoses according to the Myer-Cotton classification. The postoperative results show that the improvement to a nearly normal (>80% luminal size) airway declines from 92% (11/12 patients) for grade I to 46% (19/41 patients) for grade II and 13% (6/47 patients) for grade III stenoses. When compared to open surgery for more severe grades of stenosis (31 grade IV, 66 grade III and 3 grade II stenoses), the results of the endoscopy group is much less favorable: 36% of patients in the endoscopy group versus 76% of patients in the open surgery group were rehabilitated to a normal respiration without exertional dyspnea and 38% versus 5% patients remained tracheotomy dependent. However, if strict selection and therapeutic criteria are respected, a significant number of grade I and II stenoses, and to a lesser degree of grade III stenoses, can be improved to a nearly normal airway by endoscopic means only. The endoscopic treatment is potentially less invasive and risky and only needs a short hospital stay. To try this as a first treatment modality in a selected group of patients is worthwhile, provided that this endoscopic treatment is not repeated a second time, if the stenosis recurs to its initial grade after a primary CO2-laser treatment. Some guidelines for safe endoscopic treatment modalities with of the CO2 laser, dilatation and/or stenting are proposed.
Monnier
Philippe
P
Department of Otolaryngology and Head and Neck Surgery, Hôpital Cantonal Universitaire Vaudois, 1011 Lausanne, Switzerland. Philippe.Monnier@chuv.hospvd.ch
George
Mercy
M
Monod
Marie-Laure
ML
Lang
Florian
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004417:Dyspnea / Q000209:etiology / Q000517:prevention & control; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007829:Laryngostenosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D014135:Tracheal Stenosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D014140:Tracheotomy; D016896:Treatment Outcome