RESUMO
OBJECTIVE: The fiber-guided carbon dioxide (CO2) laser is a useful device for laryngopharyngeal surgery. The flexible CO2 wave-guide laser has been developed and commercially available for several years. However, the transnasal use of CO2 flexible wave-guided laser surgery through the instrument channel of a flexible endoscope (CO2 TNFLS) is not permitted in Japan. This feasibility study aimed to assess the value and the safety of an in-office CO2 TNFLS procedure. METHODS: Patients with small laryngopharyngeal diseases were enrolled from June 2015. Eligible patients had indications with lesions generally localized superficial lesions such as the benign tumor, leukoplakia, and premalignant lesion-like carcinoma in situ (CIS). Patients were locally well anesthetized using xylocaine. After removing as much of the lesion(s) as possible with flexible forceps, the remainder of the lesions were evaporated using CO2 TNFLS through the instrument channel of a flexible endoscope under local anesthesia. RESULTS: Eighteen surgeries involving 13 patients, including 9 papilloma (7 recurrent respiratory papilloma [RRP]), 2 carcinoma in situ, 1 leukoplakia, and 1 large epiglottic cyst), were performed. Four patients with RRP required multiple surgeries. Except for 3 patients with RRP, all patients achieved disease control without additional intervention. All procedures were completed with no severe adverse events. CONCLUSION: Office-based CO2 TNFLS is safe and feasible for patients with laryngopharyngeal pathologies. It is especially valuable for RRP patients with small lesions to avoid surgery under general anesthesia.
Assuntos
Carcinoma in Situ/cirurgia , Neoplasias Laríngeas/cirurgia , Terapia a Laser/métodos , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Infecções por Papillomavirus/cirurgia , Neoplasias Faríngeas/cirurgia , Infecções Respiratórias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios , Anestesia Local , Cistos/cirurgia , Epiglote/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Doenças da Laringe/cirurgia , Lasers de Gás/uso terapêutico , Leucoplasia/cirurgia , Masculino , Pessoa de Meia-Idade , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural , Doenças Faríngeas/cirurgia , Resultado do TratamentoRESUMO
Inflammatory myofibroblastic tumor (IMT) is a benign neoplasm of intermediate biologic potential. It rarely occurs in the larynx, and it has not been previously reported in the epiglottis. We treated a 66-year-old woman who presented with progressive dysphonia and a mass on her suprahyoid epiglottis. The tumor was completely excised with a CO2 laser; no adjuvant therapy was administered. Histopathology revealed that the mass was an IMT. No evidence of recurrence was noted after 6 months of follow-up. We present what we believe is the first case of an epiglottic IMT to be reported in the literature, and we propose CO2 laser excision without adjuvant therapy as an acceptable treatment.
Assuntos
Epiglote , Granuloma de Células Plasmáticas , Lasers de Gás/uso terapêutico , Idoso , Disfonia/etiologia , Epiglote/patologia , Epiglote/cirurgia , Feminino , Granuloma de Células Plasmáticas/diagnóstico , Granuloma de Células Plasmáticas/fisiopatologia , Granuloma de Células Plasmáticas/cirurgia , Humanos , Doenças da Laringe/diagnóstico , Doenças da Laringe/cirurgia , Miofibroblastos/patologia , Resultado do TratamentoRESUMO
Therapeutic drainage of lymphedema can alleviate facial and cervical edema after surgery or irradiation. It is fully justified even in a malignant tumour with a hopeless prognosis, although there is a risk of increasing the tendency to metastasis.