Authors:  Manuel Oliva Dominguez*,  Jorge Roquette Gaona**
* Otolaryngologist, ** Professor of Otolaryngology

Institution:  Hospital Universitario de Puerto Real (Cadiz) Spain

Abstract:   A patient is presented with a T1 epidermoid carcinoma of the right true vocal cord caused by smoking.  Video demonstration of C0₂  laser resection of the lesion is presented. 

Report:  The treatment of a 53 year old patient with a 1.5 to 2 pack per day smoking habit.  The patient presented with hoarseness and a T1 epidermoid carcinoma on the left true vocal cord was found.

The procedure begins by placing a piece of wet cotton in the subglottis to protect the lower respiratory tract from laser damage.

The laser mode is set to repeated superpulse. This means that in every shot, the laser delivers high energy for a very short period of time. The tissues around the incision line do not sustain significant thermal damage.

With the help of a suction probe or Bouchayer microforceps, the excision will encircle the suspicious lesion including a margin of a few milimeters and.

Notice that the laser incision is completely bloodless. Lasers can seal small vessels. By defocusing the laser, bleeding from larger vessels can also be controlled.

The pathology study of the removed tumor was an epidermoid carcinoma with the margins free of tumor. The patient was discharged from the hospital the next day and he did not require radiation or chemotherapy. Five years later, the patient’s voice was good and the larynx was completely normal on laryngoscopic exam.

The CO2-laser surgery has shown to be very useful in treating laryngeal malignancies. It avoids a tracheotomy in most cases. The patient usually stays only 1-2 days in hospital. In our hospital, we have used the laser surgery for the treatment of glottic and supraglottic tumors. Even advanced tumors can be treated with similar results to traditional open surgery. Complications, mainly postoperative hemorrhages, may occur in large supraglottic tumors (T4) involving the tongue base.

References:   

M. Oliva, J. Bartual, J. Roquette, J. Bartual. Resultados del tratamiento del cancer laringeo supraglotico mediante cirugía endoscopica con laser CO2. Acta Otorhinolaryngol Esp.  2003; 54:569-574.