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Microdissection or Microspot CO 2 Laser for Limited Vocal Fold Benign Lesions: A Prospective Randomized Trial
Author(s) -
Benninger Michael S.
Publication year - 2000
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/00005537-200002001-00001
Subject(s) - microdissection , medicine , laser capture microdissection , larynx , cordectomy , vocal folds , laryngoscopy , laser , surgery , laryngeal neoplasm , biology , intubation , biochemistry , gene expression , physics , gene , optics
CO 2 lasers have become an important technological advance and an integral tool for the laryngeal surgeon since the 1960s. Surgeons have used lasers for a variety of benign and malignant lesions in the larynx with good success. With better understanding of the microarchitecture of the vocal folds and the recognition of heat distribution into surrounding tissues that occurs with the use of standard CO 2 lasers, questions and concerns have been raised regarding the use of the CO 2 laser for benign lesions of the vocal folds. With the advent of the microspot CO 2 laser with a spot size of less than 250 μm, the potential heat distribution to the deeper layers of the lamina propria has been reduced. The microspot CO 2 laser has been suggested to be an appropriate tool for the excision of superficial benign lesions of the vocal fold and may be considered as an appropriate treatment alternative to microdissection. Only a limited number of studies have compared the efficacy of microdissection versus microspot CO 2 laser surgery in the larynx, and no prospective, randomized trials have been performed. Objective This study was designed to compare microspot CO 2 laser excision and microdissection for superficial benign lesions confined to the free margin of the vocal fold. Study Design: A randomized, prospective trial comparing microspot CO 2 laser excision and microdissection in the removal of nodules, polyps, and mucous retention cysts of the vocal fold. Methods Acoustic and aerodynamic measures and videostroboscopic and perceptual audio recordings evaluated by a panel of blinded viewers and listeners were studied preoperatively and 2 to 3 weeks and 5 to 12 weeks postoperatively. Surgical and recovery times were compared between the two groups. Results Thirty‐seven patients met selection criteria and were enrolled, 21 in the microdissection group and 16 in the laser excision group. Significant improvements in videostroboscopic parameters were found over time in both groups. Significant improvements were noted for perceptual analysis over time for the laser excision group with nonsignificant improvements over time for the microdissection group. There was no difference in any measure between laser excision and microdissection at the two postoperative visits. There was no difference in surgical or recovery time between laser excision and microdissection. Acoustic and aerodynamic parameters were noncontributory in evaluating outcomes of treatment, since most values were normal before surgery. Conclusion No differences in clinical outcomes are identified when comparing microdissection with laser excision of nodules, polyps, and mucous retention cysts of the vocal folds.