Office-Based Laser Surgery - Laryngeal Papilloma

Office-based Laser Surgery - Is it Right For Me? Los Angeles, Orange County, San Diego Laryngeal Surgeon

Today I saw a patient who self-referred for office-based laser surgery using the pulsed KTP laser.  He has had 3 prior surgeries greater than 10 years ago, and he was told that he was an extremely difficult surgical exposure.  When I examined his larynx, he had a tremendous amount of papilloma filling the entire airway and involving both vocal folds and the area in between (the anterior commisure). 

This patient obviously has a challenging surgical problem; an extensive quantity of papilloma, and challenging anatomy making endoscopy difficult.  This is a good case to highlight some key points: 

1) The ideal candidate for pulsed KTP laser or pulsed dye laser treatment in the office has a mild to moderate quantity of papillomatous disease.  If disease is too extensive, treatment in the office can still be performed, but it can be slow and tedious, and may require more than one session to remove all of the disease.

2) A large quantity of disease in the anterior commisure is problematic in the office.  In the operating room, a special instrument (vocal cord spreader) can be used to separate the vocal folds and direct treatment toward only one vocal fold.  This prevents "webbing", or scarring of the vocal cords together.  In the office we have no such device, and treatment of bulky disease in the anterior commisure should be approached with caution.

3) The ideal candidate should have a mild to moderate gag reflex.  A severe gag reflex can preclude treatment in the office.

And how did I approach this case?  Despite his difficult surgical exposure in the past, I was confident that I could adequately expose his larynx.  Therefore, I recommended his first treatment in the operating room, and subsequent treatments in the office to handle recurrent disease.  He will be asked to follow-up regularly in order to treat him before his disease becomes out of control in the future.

Laryngeal Papilloma and Other Disorders

Above are photos of a patient with asthma and laryngeal papillomatosis.  Over the past 5 months she has had 2 episodes where her voice became hoarse, and she suspected worsening of her underlying papilloma.  Examination, however, revealed white debris on the vocal cords, and in the lower throat.  She was treated with antifungal medication and her voice returned.  As you can she, there is papilloma present on the right posterior vocal cord and on the left anterior vocal cord.  But this is not the underlying cause of her recent change in voice. 

This case illustrates that patients with papilloma are susceptible to other causes of laryngitis.  In her case, inhaled corticosteroids for asthma led to the fungal infection. 

Office-Based Laser Surgery

For those with recurrent respiratory papilloma, repeat visits to the operating room become quite burdonsome. Dependence on others for transporation to and from surgery, missed work or school, and extended recovery time from general anesthesia are all disadvantages of treatment in the operating room setting.  Because of these disadvantages, the treatment of laryngeal and respiratory papillomatosis has been a target for innovations the eliminate the need for general anesthesia.  These innovations include special lasers targeting the blood supply of the respiratory warts, and adjuvant medical therapies designed to slow or eliminate recurrence.   In regards to laser treatment of papillomatosis, small laser fibers are passed through a channel on the side of an endoscope and used to remove the disease while sparing uninvolved tissue. 

The procedure is performed by first numbing the throat, and then passing the laryngoscope through the nostril into the lower throat.  The laser is pointed at the involved disease and suction attached to the laryngoscope is used to remove throat debris.  The procedure generally takes 10-15 minutes to perform, although it may take longer if there is extensive disease.  The procedure is very well tolerated by patients.  Papillomatosis can be challenging to treat in the office-setting if it becomes too large or bulky, and at that point patients are best serves in the sedated, operating room setting.

In addiion to the laser, injectable medications can be administered in the office-setting through the mouth or neck and into the involved area of the airway.  At the present time Cidofovir is widely used, and active investigations focus on newer agents such as Avastin, an antiangiolytic drug.

Newport Voice and Swallowing is proud to offer patients in the Orange County, Los Angeles, San Diego, Inland Empire, Coachella Valley, and Southern California regions minimally invasive office-based surgery for recurrent respiratory papillomatosis.  We are one of only 2 or 3 practices in Southern California offering this treatment, and our patients travel from afar to undergo treatments.  If you are interested in this cutting-edge treatment please contact our office at 949-764-1850.

Recurrent Respiratory Papillomatosis Blog - Welcome!

Before and After Photos of Laryngeal Papillomatosis - Treated with Pulsed KTP Laser

Welcome to the Laryngeal Papillomatosis/Recurrent Respiratory Papillomatosis blog! The goal will be to provide a forum for discussion regarding vocal cord papillomatosis and an educational site for patients and primary care physicians who may be unfamiliar with this disease. Please follow our blog and provide feedback.

To those of you unfamiliar with Newport Voice and Swallowing, we provide comprehensive care for patients with voice, swallowing, airway, and disorders and diseases of the ear, nose, throat, head, and neck. Our practice is located in Orange County, California. Newport Beach is near Irvine, Huntington Beach, Long Beach, Santa Ana, Anaheim, Los Angeles, Riverside, San Bernadino, and San Diego.