CO2 laser treatment of laryngeal stenoses after supracricoid laryngectomies

Abstract

We have read a very interesting paper “CO2 laser treatment of laryngeal stenoses after reconstructive laryngectomies with cricohyoidopexy, cricohyoidoepiglottopexy or tracheohyoidoepiglottopexy”. Our experience with reconstructive laryngectomies dates back to 1990. We have performed 82 reconstructive laryngectomies with CHP and CHEP. We have not had any experience with THEP [1]. In our series post-operative stenosis occurred in ten patients (12%). In majority of stenoses the neo-laryngeal mucosal Xap was recognized in six cases, semi-circumferential stenosis in three cases and one patient had synechia between epiglottis and arytenoid. They were treated with 23 laser CO2 procedures (mean 2,3 procedures, range 1–4 procedures). All operations were performed under general anesthesia with typical Kleinsasser set, together with a surgical microscope Zeiss S 21 with a focal lens of 400 mm connected to a micromanipulator. The continuous mode of 5–12 W was used. All patients received dexamethasone sodium phosphate (Dexaven) 4 mg every 8 h over a period of 48 h. Oral antibiotic 1 g cefuroxime sodium was continued for 10 days. Also methyl prednisolone was administered locally [2]. Unfortunately we have not had experience with mitomycin C yet. The main problem in the case of reconstructive laryngectomy is the lack of the rigid structures and the possibility to collapse, especially during sleep. It causes more problems which are technically diYcult in external approach procedure. It is more diYcult in comparison to widening neolaryngeal lumen after vertical laryngectomies. That is why we would like to recommend CO2 procedure with silastic separator or Montgomery tube insertion postoperatively. Patient B.C., 45-year-old female, after RL with CHP was treated with CO2 laser due to neo-laryngeal mucosal Xap. As a result of the operation the progression of stenosis was observed. Trying to avoid the external approach procedure the CO2 laser technique was repeated with subsequent selfmade silastic separator insertion. It was inserted endoscopically and Wxed with vicryl 2.0 sutures with Lichtenberger endolaryngeal needle carrier and tied bilaterally at the neck [3] (Fig. 1).