Abstract
Objective
To evaluate the stagewise treatment of anterior commissure laryngeal web caused by recurrent laryngeal papillomatosis.
Methods
One patient with anterior commissure laryngeal web caused by recurrent laryngeal papillomatosis underwent laryngomicrosurgery three times. At the same time of using CO 2 laser to remove papilloma, we performed vocal cord mucosal flap repair and suture.
Results
After 1 year following up, laryngeal papilloma did not recur and the voice quality of the patient significantly improved with no wheezing sound.
Conclusion
This method can resolve the problem of recurrence and adhesion in laryngeal papilloma.
1
Introduction
Recurrence is one of the main problems of adult respiratory papilloma and serious complications often occurring during the course of treatment, mostly frequently anterior commissure laryngeal web , leading to severe hoarseness and dyspnea. Conventional treatment for this condition is to place laryngeal membrane or stent to prevent laryngeal web after complete cure of the laryngeal papillomatosis, which often requires larynx transection surgery or treatment of longer course. We have adopted a stagewise treatment approach to solve this problem. First of all, anterior commissure laryngeal web is cut open and the mucosa is sutured to close the wound. At the same time, CO 2 laser is applied to remove the papilloma at the side of the vocal cord with more lesions. A few months later, another surgery is performed, during which the same method is used to process the anterior commissure laryngeal web and CO 2 laser ablation is applied to remove the papilloma at the contralateral side. Thus, this multi-step procedure can significantly improve the anterior commissure laryngeal web and eliminate laryngeal papilloma.
2
Case reports
A 22-year-old female laryngeal papilloma patient underwent six surgeries in other hospitals, and she had anterior commissure laryngeal web and recurrent papilloma. The patient had severe hoarseness and shortness of breath after activities. During the first laryngomicrosurgery under suspension laryngoscope, we first used scissors to cut open the fused laryngeal web by 8 mm, and bilateral mucosal wound was closed using 8–0 absorbable suture. In addition, we applied CO 2 laser to remove papilloma to as deep as the surface of the vocal cord ligament ( Fig. 1 ). After 3 months, the patient was re-admitted into our hospital for treatment. At this time, the anterior commissure laryngeal web was shortened by 5 mm but the papilloma at the middle-posterior of left vocal cord and middle-anterior of right vocal cord had reoccurred. A secondary surgery was performed to cut open the anterior commissure laryngeal web and close the left mucosal wound with 8–0 absorbable suture. In addition, CO 2 laser was applied to remove papilloma at the middle-posterior of left vocal cord and middle-anterior of right vocal cord to as deep as the surface of the vocal cord ligament ( Fig. 2 ). After another 3 months, the patient received the third surgery. At this time the anterior commissure laryngeal web basically disappeared and right vocal cord mucosa was smooth with the exception of a small papilloma at the posterior end and more recurrent papilloma at the middle-anterior left vocal cord. We used CO 2 laser to excise these remaining papillomas ( Fig. 3 ). Follow-up examination after 2 months showed that the anterior commissure laryngeal web completely disappeared and bilateral vocal cord mucosa was smooth, with no papilloma recurrence. The surgery was successful because the stage-wise strategy resolved the problem of papilloma recurrence and anterior commissure laryngeal web. During the 1 year follow-up, laryngeal papilloma did not recur and the voice quality of the patient significantly improved with no wheezing sound ( Fig. 4 ).
