Krivopalov A.A., Shamkina P.A., Panchenko P.I. Clinical aspects of laser surgery for chronic laryngeal diseases. Head and neck. Russian Journal. 2022;10(4):30–40
Introduction. The problem of phonosurgery remains relevant today since the prevalence of benign and tumor-like laryngeal lesions is up to 55–70% among the productive pathology of the upper respiratory tract. A new 445 nm surgical laser having a high hemostatic and resection effects was certified for the medical market in 2018. To date, there are very few works in foreign and Russian literature devoted to the use of that laser device in ENT practice, particularly in laryngology.
Purpose of the study. Conducting of a comparative analysis of intraoperative and postoperative results in patients treated with semiconductor lasers.
Material and methods. The clinical study involved 80 adult patients aged 22 to 73 years (46,44±12,13 years) with chronic laryngeal diseases: group 1 – 50 patients treated with a semiconductor laser with a wavelength of 445 nm; group 2 – 30 patients treated with a semiconductor laser with a wavelength of 980 nm. The duration of surgical intervention, the occurrence of intraoperative bleeding and the need for laser hemostasis were evaluated. All patients underwent videolaryngostroboscopy, fibrolaryngoscopy and acoustic voice analysis before and after the surgery. Also patients completed the VHI-30 questionnaire.
Results. Among intraoperative parameters, a statistically significant difference was obtained by comparing the duration of surgery (group 1 – 14.9±5.5 minutes, group 2 – 17.9±6.3 minutes). According to the laryngeal fibroscopy results, faster rate of the endoscopic picture normalization was noted in the 445 laser group (on the 10th day; p=0,002). Also according to the laryngeal stroboscopy results significantly more positive dynamics was noted in group 1 (day 14; p=0,020). Two weeks after surgery, the VHI-30 index was significantly lower in the 445 nm laser group compared to the 980 nm laser group (p=0,042). Among the acoustic voice analysis parameters, the results of the maximum phonation time, Jitter, Shimmer significantly differed by groups two weeks after surgical treatment with more pronounced positive dynamics in group 1. The fundamental tone frequency and HNR index did not depend on the type of surgical laser used.
Conclusion. Work with a laser 445 nm was characterized by shorter duration of surgical intervention compared to a laser 980 nm (p=0,026). In the group of patients treated with a 445 nm laser, were determined faster periods of regression of the inflammatory process from the vocal folds, restoration of vibratory function, normalization of acoustic parameters of the voice and the index of voice impairment and quality of life VHI-30 (p<0,05).
Key words: chronic laryngeal diseases, phonosurgery, laser 445 nm, Trublue laser, intraoperative indicators, postoperative indicators
Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. There was no funding for this study