Surgical treatment using a laser with a wavelength of 445 nm in patients with chronic paralytic laryngeal stenosis
- Authors: Panchenko P.I.1, Shamkina P.A.1, Krivopalov A.A.1, Mazeina E.S.1
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Affiliations:
- Saint Petersburg Research Institute of Ear, Throat, Nose and Speech
- Issue: Vol 25, No 3 (2023)
- Pages: 463-470
- Section: Case report
- Submitted: 03.03.2023
- Accepted: 18.06.2023
- Published: 05.10.2023
- URL: https://journals.eco-vector.com/1682-7392/article/view/123094
- DOI: https://doi.org/10.17816/brmma123094
- ID: 123094
Cite item
Abstract
The treatment of chronic paralytic laryngeal stenosis remains a relevant issue. It ranks second and accounts for 29.9% of chronic diseases of the laryngeal plexus. The number of affected patients has increased 10-fold over the past 10 years (2010–2020). Surgical treatment of chronic paralytic laryngeal stenosis is aimed at respiratory function restoration and the possibility of decanulation of the patient while maintaining vocal function. In the literature, the effectiveness of surgical treatment of patients with laryngeal stenosis varies greatly, ranging from 22% to 94%. We have proposed a technique for performing laryngoplasty in a patient with chronic paralytic laryngeal stenosis using a laser with a wavelength of 445 nm with a supply of inert gas (helium) in the operating field. When helium was injected into the operating field, the oxygen content at the laser exposure site decreased; thus, the effect of tissue carbonation was minimized, and thermal damage to surrounding tissues was reduced. Owing to the presence of gas, the smoke generated during the operation was quickly removed from the operating field, which provided good visualization. The properties of the aforementioned laser ensure a “bloodless” operating field, increasing the accuracy of surgical intervention. When using this laser, thermal damage to the surrounding tissues is no more than 0.6 cm in depth. This minimizes inflammatory reactions in the larynx in the postoperative period and promotes faster patient rehabilitation. The proposed volume of resection of the anatomical structures of the larynx was as follows: the posterior two-thirds of the vocal muscle and the anterior two-thirds of the body of the arytenoid cartilage, with the preservation of the mucous membrane to close the surgical wound, which ensures healing by primary tension and creates the necessary lumen of the glottis for sufficient breathing and allows for the maintenance acceptable voice function for patient communication. A laser with a 445-nm wavelength and a flap for closing the surgical wound used during the operation can speed up the recovery process and reduce the risk of relapse. This technique can be a method of choice for the treatment of patients with paralytic laryngeal stenosis.
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About the authors
Pavel I. Panchenko
Saint Petersburg Research Institute of Ear, Throat, Nose and Speech
Author for correspondence.
Email: p.panchenko@niilor.ru
ORCID iD: 0000-0002-3380-7228
SPIN-code: 8136-7768
junior research assistant
Russian Federation, Saint PetersburgPolina A. Shamkina
Saint Petersburg Research Institute of Ear, Throat, Nose and Speech
Email: p.s.ent@bk.ru
ORCID iD: 0000-0003-4595-365X
SPIN-code: 4694-4855
junior research assistant
Russian Federation, Saint PetersburgAleksandr A. Krivopalov
Saint Petersburg Research Institute of Ear, Throat, Nose and Speech
Email: krivopalov@list.ru
ORCID iD: 0000-0002-6047-4924
SPIN-code: 8135-9408
MD, Dr. Sci. (Med.)
Russian Federation, Saint PetersburgEkaterina S. Mazeina
Saint Petersburg Research Institute of Ear, Throat, Nose and Speech
Email: katyamzn@mail.ru
ORCID iD: 0000-0003-3326-7636
SPIN-code: 9346-7831
resident
Russian Federation, Saint PetersburgReferences
- Stepanova JE, Gotovyahina TV, Mokhotaeva MV, Mahotkina NN. Complex rehabilitation of patients with unilateral vocal fold paresis after thyroid surgery (medical and pedagogical recommendations). Russian Otorhinolaryngology. 2014;(4):131–137. (In Russ.).
- Podkopaeva JJ, Krivopalov AA. Сurrent understanding of the diagnosis and treatment of chronic bilateral laryngeal paralytic stenosis. Russian Otorhinolaryngology. 2013;(6):146–155. (In Russ.).
- Kirasirova EA, Lafutkina NV, Mamedov RF, et al. Current aspects of treatment of patients with bilateral laryngeal paralysis. Science and Innovations in Medicine. 2020;5(1):4–8. (In Russ.). doi: 10.35693/2500-1388-2020-5-1-4-8
- Remacle M, Eckel HE, editors. Surgery of larynx and trachea. Berlin: Springer-Verlag. 2010. 307 р. doi: 10.1007/978-3-540-79136-2
- Francis DO, Pearce EC, Ni S, et al. Epidemiology of vocal fold paralyses after total thyroidectomy for well-differentiated thyroid cancer in a Medicare population. Otolaryngol Head Neck Surg. 2014;150(4):548–557. doi: 10.1177/0194599814521381
- Zakharova ML, Pavlov PV. Causes and diagnosis of laryngeal paralysis in childhood. Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. 2019;25(2):44–49. (In Russ.). doi: 10.33848/foliorl23103825-2019-25-2-44-49
- Karpischenko SA, Ryabova MA, Bolozneva EV, Faizova AR. Results of conservative therapy for early postoperative vocal fold paresis. Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. 2021;27(3): 36–42. (In Russ.). doi: 10.33848/foliorl23103825-2021-27-3-36-42
- Klensasser O. Microlaryngoscopie und endolaryngeale Microchirurgie: technik und typische befunde. Stuttgart: F.K. Schattauer, 1968. 128 р.
- Ossoff RH, Sisson GA, Duncavage JA. Endoscopic laser arytenoidectomy for the treatment of bilateral vocal cord paralysis. Laryngoscope. 1984;94(10):1293–1297. doi: 10.1288/00005537-198410000-00006
- Pluzhnikov MS, Ryabova MA, Karpischenko SA. Khronicheskie stenozy gortani. Saint Petersburg: Ehskulap; 2004. 206 p. (In Russ.).
- Sargsyan SA. Surgical treatment of bilateral neurogenic laryngeal stenosis of paralytic etiology by extralaryngeal laterofixation. Russian Otorhinolaryngology. 2012;(1):148–152. (In Russ.).
- Pluzhnikov MS, Aleksandrov AN, Ryabova MA, et al. Laser medicine in otorhinolaryngology. Bulletin of Otorhinolaryngology. 2000;(6):40–41. (In Russ.).
- Krivopalov AA, Podkopaeva YY. Endoscopic laser laryngoplasty in the treatment of chronic paralytic laryngeal stenosis. Medical Council. 2015;(8):32–35. (In Russ.). doi: 10.21518/2079-701X-2015-8-32-35
- Daikhes NA, Vinogradov VV, Reshulskiy SS, et al. Analysis of late complications following CO2 -laser endolaryngeal microsurgery. Otorhinolaryngology. Eastern Europ. 2022;12(2):138–146. (In Russ.). doi: 10.34883/PI.2022.12.2.014
- Kirasirova EA, Piminidi OK, Lafutkina NV, et al. Influence of accompanying somatic pathology on the result of laryngoplastics in patients with bilateral paralysis of thelarynx. Head and Neck. 2017;(2):30–33. (In Russ.).
- Chalyk YuV, Rubtsov VS. Doklinicheskaya otsenka vozdeistviya vysokoehnergeticheskogo lazernogo izlucheniya 0,97 mkm na plastinchatye preparaty pecheni. Fundamental'nye issledovaniya. 2011;(3):166–171. (In Russ.).
- Krivopalov AA, Shamkina PA, Il’ina VA, et al. Use of 445 nm laser in laryngeal surgery: experimental study. Russian Otorhinolaryngology. 2022;21(5):47–54. (In Russ.). doi: 10.18692/1810-4800-2022-5-47-54
- Krivopalov AA, Shamkina PA, Panchenko PI. Clinical aspects of laser surgery for chronic laryngeal diseases. Head and Neck. 2022;10(4):30–40. (In Russ.). doi: 10.25792/HN.2022.10.4.30-40
- Lin RJ, Iakovlev V, Streutker C, et al. Blue light laser results in less vocal fold scarring compared to KTP laser in normal rat vocal folds. Laryngoscope. 2021;131(4):853–858. doi: 10.1002/lary.28892
- Braun A, Kettner M, Berthold M, et al. Efficiency of soft tissue incision with a novel 445-nm semiconductor laser. Lasers Med Sci. 2018;33(1):27–33. doi: 10.1007/s10103-017-2320-9
- Hess MM, Fleischer S, Ernstberger M. New 445 nm blue laser for laryngeal surgery combines photoangiolytic and cutting properties. Eur Arch Otorhinolaryngol. 2018;275(6):1557–1567. doi: 10.1007/s00405-018-4974-8
- Hamdan AL, Ghanem A. Un-sedated office-based application of blue laser in vocal fold lesions. J Voice. 2021;21(21):1–5. doi: 10.1016/j.jvoice.2021.03.031
- Krivopalov AA, Shamkina PA, Stepanova YuE, et al. Surgery of benign and tumor-like laryngeal formations using 445 nm semiconductor laser. Russian Otorhinolaryngology. 2021;20(6): 102–108. (In Russ.). doi: 10.18692/1810-4800-2021-6-102-108
- Krivopalov AA, Shamkina PA, Stepanova JE, et al. Endolaryngeal surgery of benign vocal fold lesions with a 445 nm semiconductor laser: postoperative management. Medical Council. 2021;(18): 178–183. (In Russ.). doi: 10.21518/2079-701X-2021-18-178-183