Microdissection or microspot CO2 laser for limited vocal fold benign lesions: A prospective randomized trial

CO2 lasers have become an important technological advance and an integral t ool for the laryngeal surgeon since the 1960s, Surgeons have used lasers fo r a variety of benign and malignant lesions in the larynx with good success . With better understanding of the microarchitecture of the vocal folds and the recognition of heat distribution into surrounding tissues that occurs with the use of standard CO2 lasers, questions and concerns have been raise d regarding the use of the CO2 laser for benign lesions of the vocal folds. With the advent of the microspot CO2 laser with a spot size of less than 2 50 mu m, the potential heat distribution to the deeper layers of the lamina propria has been reduced. The microspot CO2 laser has been suggested to be an appropriate tool for the excision of superficial benign lesions of the vocal fold and may be considered as an appropriate treatment alternative to microdissection. Only a limited number of studies have compared the effica cy of microdissection versus microspot CO2 laser surgery in the larynx, and no prospective, randomized trials have been performed. Objective: This stu dy was designed to compare microspot CO2 laser excision and microdissection for superficial benign lesions confined to the free margin of the vocal fo ld. Study Design: A randomized, prospective trial comparing microspot CO2 l aser excision and microdissection in the removal of nodules, polyps, and mu cous retention cysts of the vocal fold. Methods: Acoustic and aerodynamic m easures and videostroboscopic and perceptual audio recordings evaluated by a panel of blinded viewers and listeners were studied preoperatively and 2 to 3 weeks and 5 to 12 weeks postoperatively, Surgical and recovery times w ere compared between the two groups. Re suits: Thirty-seven patients met se lection criteria and were enrolled, 21 in the microdissection group and 16 in the laser excision group. Significant improvements in videostroboscopic parameters were found over time in both groups. Significant improvements we re noted for perceptual analysis over time for the laser excision group wit h nonsignificant improvements over time for the microdissection group, Ther e was no difference in any measure between laser excision and microdissecti on at the two postoperative visits. There was no difference in surgical or recovery time between laser excision and microdissection, Acoustic and aero dynamic parameters were noncontributory in evaluating outcomes of treatment , since most values were normal before surgery. Conclusion: No differences in clinical outcomes are identified when comparing microdissection with las er excision of nodules, polyps, and mucous retention cysts of the vocal fol ds.