広範な喉頭パピローマの治療

Abstract

Four cases of laryngeal papillomatosis were reported to illustrate the clinical features associated with this condition. A 42 year old male operated on by laryngofissure method had received the same surgery about 20 years before. Laryngeal stent was used for the fixation of a free skin flap which was implanted in a raw surgical surface for 3 months for preventing web formation. However, this resulted in a poor voice due to severe adhesion occurring between both cords. The second case, a 38 year old female, had laryngeal surgery 4 times because of recurrent laryngeal papillomatosis and had been treated with a 4,500 rad irradiation. We performed a single vocal cordectomy. No recurrence was observed but an inadequate voice ensued. A 9 year old boy suffering from dyspnea was referred to our clinic for a close examination of his upper respiratory tract. A large papillomatous mass was excised with carbon dioxide laser. Subsequent laser vaporization was performed for more precise removal of the residual disease. A 52 year old male was also operated on using YAG laser for laryngeal papilloma. The latter two patients showed good phonation after surgery. We surmise that laser surgery is recommended for preserving the structure and function of the vocal cords. As an assessment for wide spread laryngeal papillomatosis, laser surgery or a combination of laser treatment and removal utilizing forceps were acceptable according to several references for preventing frequent recurrences, thick web formation and poor voice after operation.