Features of CO₂-laser application in surgical treatment of chronic cicatrical stenoses of the larynx

The aim of the review is to identify current possibilities of carbon dioxide laser application in microsurgical treatment of chronic laryngeal cicatricial stenoses. Currently, laser endolaryngeal surgeries are one of the main standards in surgical treatment of patients with this laryngeal pathology, including when providing high-tech assistance. Various types of lasers and methods of surgical treatment of the larynx are used. The choice of these methods is primarily determined by the opinion of the operating surgeon. The review highlights the principles of laser surgery in general, and when using carbon dioxide laser in particular. The use of micromanipulators makes it possible to combine the work of carbon dioxide laser with the operating microscope, affecting target tissues noninvasively with maximum precision. This technology makes it possible to expand the range of surgical manipulations in endolaryngeal surgeries. The main operating modes of the carbon dioxide laser, applicable for different clinical situations, such as power, impulse, laser power density (PD) are considered. In addition, the combination of a micromanipulator with an operating microscope allows the use of additional techniques aimed at preventing restenosis, such as the use of microflaps, submucosal laryngeal cicatricial tissue vaporization. The possibilities of the recurrence of cicatricial stenosis by different variants of stenting are presented. The risk of complications of this technique is not higher than in other types of larynx laser surgeries, and with proper preventive measures can be minimized. In the review, possible complications, both early and late, measures of their prophylaxis, as well as ways to eliminate their consequences are analyzed in detail.