return to: KTP Laser for the Larynx; Vocal Cord Polyp Removal In Clinic (Transnasal Laryngoscopy for Vocal Fold Polyp); Hemorrhagic Vocal Cord Polyp (Hemorrhagic Vocal Fold Polyp); Polyps Nodules Cysts
Modified Operative Note
Procedure: Transnasal KTP laser treatment to left vocal fold hemorrhagic polyp (KTP V,1 modes); total 32 Joules; setting of 30 W 15 ms pulses 2 pulses per second
Preop Diagnosis: Dysphonia, left vocal fold hemorrhagic polyp with feeding blood vessels
Postop Diagnosis: Same with additional evidence for recent left vocal fold hemorrhage
Anesthesia: Nasal decongestion with Afrin followed by 4% lidocaine with 1% phenylephrine spray x2 (2 cc total); then the left nostril as packed with three neurosurgical cottonoids (soaked in 4% lidocaine with 1% phenylephrine); during flexible laryngoscopy 2 cc instilled topically to the larynx (see below)
Description of Procedure: Following identification the patient informed consent and a brief timeout with her positioned in the leaning forward sitting position in the surgery center the left nostril was examined with the VT scope cannulated with a 25-gauge sclerotherapy needle primed with 4% lidocaine dripped on the supraglottic and glottic larynx a total of 2 cc were instilled.
Careful inspection identified extension of the disease process now along the left membranous vocal fold to identify a recent vocal fold hemorrhage consistent with her recent decrement in vocal quality with feeding blood vessels identified
The flexible channeled scope (VT scope) was then removed from the nostril and cannulated with the KTP laser fiber employing the outer sheath of the 25-gauge sclerotherapy needle assembly to protect the inner channel during placement.
With continuous suction applied to the VT scope, KTP laser was administered in a non-contact manner 30 W 15 ms pulses 2 pulses per second
To the left mid dorsal vocal fold (sparing the contact surface of the vocal fold) with initial 10 J administered in a KTP V mode diffusely along the left vocal fold polyp lateral border
Followed by:
22 J administered in KTP 1 mode to obliterate the feeding vessels lateral to the polyp avoiding the contact surface of the vocal fold without epithelial disruption but with blanching seen
She tolerated procedure well.
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Treatment Classification KTP (Potassium titanyl phosphate) |
Assessment of Immediate Tissue Effect (Mallur et all 2014) |
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KTP V |
Noncontact with angiolysis |
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KTP 1 |
Noncontact mucosal blanching |
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KTP 2 |
Noncontact epithelium disruption |
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KTP 3 |
Contact with epithelial ablation without tissue removal |
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KTP 4 |
Contact with epithelial ablation with subsequent tissue removal |
References
Renee L. Eigsti MD Semirra L. Bayan MD Robert A. Robinson MD, PhD Henry T. Hoffman MD, MS: Histologic effect of the potassium‐titanyl phosphorous laser on laryngeal papilloma Laryngoscope Investigative Otolaryngology Volume4, Issue3 June 2019 Pages 323-327
Wang C-T, Huang T-W, Liao L-J, Lo W-C, Lai M-S and Chng P-W: Office-Based Potassium Titanyl Phosphate Laser-Assisted Endoscopic Vocal Polypectomy. Jama Otolarygnol Head Neck Surg/ Vol 139 (No.6), June 2013
Young VN, Mallur PS, Wong AW, Mandal R, Staltari GV, Gartner-Schmidt J, and Rosen CA: Analysis of Potassium Titanyl Phosphate Laser Settings and Voice outcomes int he Treatment of Reinke's Edema Annals of Otology Rhinology and Larygnolgoy 2015. Vol 124(3) 216-220
Mallur PS, Johns MM, Amin MR, Rosen C Proposed classification system for reporting 532-nm pulsed potassium titanyl phosphate laser treatment effects on vocal fold lesions. Laryngoscop 2014;124(5):11701175