Surgical treatment using a laser with a wavelength of 445 nm in patients with chronic paralytic laryngeal stenosis

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.

Keywords

larynx / recurrent nodular goiter / laser chordaritenoidotomy / 445 nm wavelength laser / chronic paralytic laryngeal stenosis / tissue carbonation / healing by primary tension / risk of recurrent laryngeal stenosis

References

[1] 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.).

[2] Степанова Ю.Е., Готовяхина Т.В., Мохотаева М.В., Махоткина Н.Н. Комплексная реабилитация пациентов с односторонним парезом гортани после хирургического вмешательства на щитовидной железе (медико-педагогические рекомендации) // Российская оториноларингология. 2014. № 4. С. 131–137.

[3] 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.).

[4] Подкопаева Ю.Ю., Кривопалов А.А. Современные представления о диагностике и лечении хронических двусторонних паралитических стенозов гортани // Российская оториноларингология. 2013. № 6. С. 146–155.

[5] 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

[6] Кирасирова Е.А., Лафуткина Н.В., Мамедов Р.Ф., и др. Современные аспекты лечения больных двусторонним параличом гортани // Наука и инновации в медицине. 2020. Т. 5, № 1. С. 4–8. DOI: 10.35693/2500-1388-2020-5-1-4-8

[7] Remacle M, Eckel HE, editors. Surgery of larynx and trachea. Berlin: Springer-Verlag. 2010. 307 р. DOI: 10.1007/978-3-540-79136-2

[8] Surgery of larynx and trachea / ed. by M. Remacle, H.E. Eckel. Berlin: Springer-Verlag. 2010. 307 р. DOI: 10.1007/978-3-540-79136-2

[9] 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

[10] Francis D.O., Pearce E.C., 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. Vol. 150, No. 4. P. 548–557. DOI: 10.1177/0194599814521381

[11] 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

[12] Захарова М.Л., Павлов П.В. Причины и диагностика параличей гортани в детском возрасте // Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. 2019. Т. 25, № 2. С. 44–49. DOI: 10.33848/foliorl23103825-2019-25-2-44-49.

[13] 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

[14] Карпищенко С.А., Рябова М.А., Болознева Е.В., Фаизова А.Р. Результаты консервативной терапии при ранних послеоперационных парезах голосовых складок // Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. 2021. Т. 27, № 3. С. 36–42. DOI: 10.33848/foliorl23103825-2021-27-3-36-42

[15] Klensasser O. Microlaryngoscopie und endolaryngeale Microchirurgie: technik und typische befunde. Stuttgart: F.K. Schattauer, 1968. 128 р.

[16] Klensasser O. Microlaryngoscopie und endolaryngeale Microchirurgie: technik und typische befunde. Stuttgart: F. K. Schattauer, 1968. 128 р.

[17] 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

[18] Ossoff R.H., Sisson G.A., Duncavage J.A. Endoscopic laser arytenoidectomy for the treatment of bilateral vocal cord paralysis // Laryngoscope. 1984. Vol. 94, No. 10. P. 1293–1297. DOI: 10.1288/00005537-198410000-00006

[19] Pluzhnikov MS, Ryabova MA, Karpischenko SA. Khronicheskie stenozy gortani. Saint Petersburg: Ehskulap; 2004. 206 p. (In Russ.).

[20] Плужников М.С., Рябова М.А., Карпищенко С.А. Хронические стенозы гортани. Санкт-Петербург: Эскулап, 2004. 206 с.

[21] Sargsyan SA. Surgical treatment of bilateral neurogenic laryngeal stenosis of paralytic etiology by extralaryngeal laterofixation. Russian Otorhinolaryngology. 2012;(1):148–152. (In Russ.).

[22] Саркисян С.А. Хирургическое лечение двустороннего нейрогенного стеноза гортани паралитической этиологии экстраларингеальным способом // Российская оторинларингология. 2012. № 1. С. 148–152.

[23] Pluzhnikov MS, Aleksandrov AN, Ryabova MA, et al. Laser medicine in otorhinolaryngology. Bulletin of Otorhinolaryngology. 2000;(6):40–41. (In Russ.).

[24] Плужников М.С., Александров А.Н., Рябова М.А., и др. Лазерная медицина в оторинолариногологии // Вестник оториноларингологии. 2000. № 6. С. 40–41.

[25] 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

[26] Кривопалов А.А., Подкопаева Ю.Ю. Лазерная эндоскопическая ларингопластика в лечении хронических паралитических стенозов гортани // Медицинский Совет. 2015. № 8. С. 32–35. DOI: 10.21518/2079-701X-2015-8-32-35

[27] 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

[28] Дайхес Н.А., Виноградов В.В., Решульский С.С., и др. Анализ поздних осложнений эндоларингеальной хирургии с использованием СО2-лазера // Оториноларингология. Восточная Европа. 2022. Т. 12, № 2. С. 138–146. DOI: 10.34883/PI.2022.12.2.014

[29] 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.).

[30] Кирасирова Е.А., Пиминиди О.К., Лафуткина Н.В. Влияние сопутствующей соматической патологии на результат ларингопластики у пациентов с двусторонним параличом гортани // Голова и шея. 2017. № 2. С. 30–33.

[31] 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.).

[32] Чалык Ю.В., Рубцов В.С. Доклиническая оценка воздействия высокоэнергетического лазерного излучения 0,97 мкм на пластинчатые препараты печени // Фундаментальные исследования. 2011. № 3. С. 166–171.

[33] 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

[34] Кривопалов А.А., Шамкина П.А., Ильина В.А., и др. Применение лазера с длиной волны 445 нм в хирургии гортани: экспериментальное исследование // Российская оториноларингология. 2022. Т. 21, № 5. С. 47–54. DOI: 10.18692/1810-4800-2022-5-47-54

[35] 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

[36] Кривопалов А.А., Шамкина П.А., Панченко П.И. Клинические аспекты лазерной хирургии хронических заболеваний гортани // Голова и шея. 2022. Т. 10, № 4. С. 30–40. DOI: 10.25792/HN.2022.10.4.30-40

[37] 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

[38] Lin R.J., 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. Vol. 131, No. 4. P. 853–858. DOI: 10.1002/lary.28892

[39] 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

[40] Braun A., Kettner M., Berthold M., et al. Efficiency of soft tissue incision with a novel 445-nm semiconductor laser // Lasers Med Sci. 2018. Vol. 33, No. 1. P. 27–33. DOI: 10.1007/s10103-017-2320-9

[41] 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

[42] Hess M.M., Fleischer S., Ernstberger M. New 445 nm blue laser for laryngeal surgery combines photoangiolytic and cutting properties // Eur Arch Otorhinolaryngol. 2018. Vol. 275, No. 6. P. 1557–1567. DOI: 10.1007/s00405-018-4974-8

[43] 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

[44] Hamdan A.L., Ghanem A. Un-sedated office-based application of blue laser in vocal fold lesions // J Voice. 2021. Vol. 21, No. 21. P. 1–5. DOI: 10.1016/j.jvoice.2021.03.031

[45] 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

[46] Кривопалов A.A., Шамкина П.А., Степанова Ю.Е., и др. Хирургия доброкачественных и опухолеподобных образований гортани с использованием полупроводникового лазера с длиной волны 445 нм // Российская оториноларингология. 2021. Т. 20, № 6. С. 102–108. DOI: 10.18692/1810-4800-2021-6-102-108

[47] 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

[48] Кривопалов А.А., Шамкина П.А., Степанова Ю.Е., и др. Хирургия доброкачественных и опухолеподобных образований гортани с использованием полупроводникового лазера 445 нм: послеоперационное ведение // Медицинский Совет. 2021. № 18. С. 178–183. DOI: 10.21518/2079-701X-2021-18-178-183

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