Severe laryngeal dysplasia in a 20-year-old nonsmoker treated with CO2 laser excision: a case report and review of the literature.
OBJECTIVE
We present the unusual case of a 20-year-old female nonsmoker with severe laryngeal dysplasia managed with endoscopic CO(2) laser resection with frozen-section analysis. We use her case as a platform for discussion of the current evidence surrounding laryngeal dysplasia, particularly etiology and the use of lasers in management.


BACKGROUND
Laryngeal dysplasia represents a series of progressive epithelial changes that can eventually lead to invasive laryngeal carcinoma. Typically, most patients are male, in their 50s or 60s, and are smokers; to our knowledge our patient represents the youngest reported case of this condition in a woman with no established risk factors. We discuss the implications of this on her subsequent management with the CO(2) laser.


METHODS
With the help of intraoperative photographs, we describe our excisional technique with the CO(2) laser, model 315M Superpulse class 4 (Irradia AB, Stockholm, Sweden) at a 6-W continuous power setting.


RESULTS
At 6 months after surgery, our patient remains disease free with good voice quality.


CONCLUSIONS
Our patient appears to defy all the usual etiologic stereotypes that usually govern the development of laryngeal dysplasia. CO(2) laser excision plus intraoperative frozen-section analysis remains a safe and reliable method for the treatment of laryngeal dysplasia; the reassurance of histologically clear margins minimizes the extent of radical laser excision necessary and provides good functional results. We provide a comprehensive overview of the current literature on laryngeal dysplasia etiology and treatment, particularly the use of lasers in management.
Fraser
Lyndsay
L
Department of Otolaryngology, Pinderfields General Hospital, Aberford Road, Wakefield, England. LyndsayFraser@doctors.org.uk
Kelly
Gerard
G
MacLennan
Kenneth
K
Makura
Zvoru G G
ZG
D002245:Carbon Dioxide; D005260:Female; D005629:Frozen Sections; D006801:Humans; D007822:Laryngeal Neoplasms / Q000145:classification / Q000473:pathology / Q000601:surgery*; D053685:Laser Therapy / Q000379:methods; D011184:Postoperative Period; D011230:Precancerous Conditions / Q000145:classification / Q000473:pathology / Q000601:surgery*; D014833:Voice Quality; D055815:Young Adult
D002245:Carbon Dioxide