Laser Surgery or Laser Voice Surgery or Voice Laser Surgery
Vocal cord surgery is a very precise and delicate surgery and there have been many advances in this field over the last few years. The most notable amongst these is the adaptation of surgical lasers for microlaryngeal surgery.
The Laser surgery is performed under general anaesthesia and a rigid endoscope is used to access the area of the vocal cords. The surgeon uses a operating microscope to view the area of surgery and the operation is carried out using special micro instruments and lasers.
The Laser has several advantages over traditional “cold” surgical techniques.
• The ability to operate without mechanical movement, thus minimizing the risk of damaging the delicate vocal fold structures.
• Microscopic precision with almost no thermal damage to surrounding tissue.
• Improved control of bleeding, which gives a clear and dry operating field.
• All surgery is contact less, which in turn has its advantages.
• Less trauma to the tissues – this reduces swelling and pain after surgery and thus leads to faster healing.
• Surgery is highly sterile and there is no post-operative infection.
• A markedly improved success rate of recovering voice with fewer recurrences of benign lesions.
• Reduced surgical and hospitalization time
What is the scope of Laser Phonosurgery?
Laser phonosurgery is performed with good effect for various laryngeal pathologies which include
Pathological lesions like:
• Protruding lesions like vocal nodules, polyps, vocal cord cysts, papillomas
• Angiomatous lesions and Reinke’s oedema.
• Recessed lesions like sulcus vocalis
• Leucoplakia and intramucosal cysts
• Malignancy – Over the years, endoscopic laser microsurgery has shown itself to be an effective treatment for early stages of laryngeal cancer. It can also be used in late stages as part of palliative surgery (debulking)
The Laser is also used for alteration of the pitch of the voice.
Endoscopic Laser Surgery for Early Glottic Cancer
Early glottic cancers can be cured with transoral laser resection.
When early glottic cancers involve anterior commissure, a decrease in local control is evident leading to still controversy concerning the best treatment modality.
The CO2 Laser is commonly used in the larynx as laser beam is a very precise haemostatic scalpel which seals off blood and lymph vessels making it very useful while operating on cancers or vascular lesions of the larynx.
Endoscopic laser surgery provides the same results as external major surgery in selected laryngeal cancers.
Endoscopic Laser Surgery for Glottic Web & Reinke’s Oedema
Benign glottic lesions like Anterior Glottic Web, Reinke’s Oedema or Smokers polyps are better treated with lasers or radiofrequency.
Reinke’s oedema or Smokers polyps can also be treated in the office using laser. An endoscope is placed to visualize a patient larynx and then Laser energy is applied to vocal folds resulting in changes of vocal folds with time, minimizing the size of the vocal folds.
Challenge in treating Congenital Webs is to prevent re-webbing. Endoscopic silastic keel placement helps to prevent rewebbing.