532 nm pulsed potassium-titanyl-phosphate laser treatment of laryngeal papillomatosis under general anesthesia.
OBJECTIVE
Angiolytic lasers have been shown to be an effective treatment strategy for laryngeal papillomatosis. These lasers precisely target hemoglobin within the microcirculation of papillary lesions. We have previously demonstrated the advantages of the fiber-based pulsed 532-nm potassium-titanyl-phosphate (KTP) laser in an office setting (with local anesthesia). This investigation provides the first report of the pulsed-KTP laser during microlaryngoscopy under general anesthesia.


METHODS
A prospective pilot study was performed in 55 adult patients with laryngeal papillomatosis to determine disease response.


METHODS
During suspension microlaryngoscopy, a solid-state 532 nm pulsed-KTP laser was used (15 ms pulse width, 5.25-7.5 J/pulse maximum output, 2 Hz repetition rate, 0.4 mm fiber, approximately 20-80 J/cm2 fluence) to treat laryngeal papillomatosis. All patients underwent postoperative videolaryngoscopy to assess disease regression based on a previously used rating scale.


RESULTS
Thirty-seven patients underwent 55 procedures during the 18-month study period. Near-term follow-up with an early postoperative evaluation was available in 23 patients (35 procedures). Fourteen patients (20 procedures) were geographically distant and only returned after developing symptoms with significant disease recurrence. Of the 35 procedures in which near-term follow-up was available, 90% or greater disease regression was achieved in 28 of 35 (80%), 75% to 89% disease regression was achieved in 4 of 35 (11%), and 50% to 74% disease regression in 3 of 35 (9%). Anterior-commissure disease was present in 51 of 55 (93%) cases, and no new webbing/synechia occurred. All patients reported that their vocal function improved after treatment.


CONCLUSIONS
The 532 nm pulsed-KTP laser was effective for treating recurrent respiratory papillomatosis, which was similar to our experience as an office-based procedure.
Burns
James A
JA
Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. Burns.james@mgh.harvard.edu
Zeitels
Steven M
SM
Akst
Lee M
LM
Broadhurst
Matthew S
MS
Hillman
Robert E
RE
Anderson
Rox
R
D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D007828:Laryngoscopy; D053685:Laser Therapy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D010212:Papilloma / Q000473:pathology / Q000601:surgery*; D010865:Pilot Projects; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014741:Video Recording