Lasers in ENT :-

Common Laryngeal indications for laser

Juvenile laryngeal papillomatosis: The major advantage of laser in these conditions is a very low recurrence rate and an acceptable voice after surgery. If the papillomas are beyond the larynx, then a bronchoscopic coupler is used to deflect the laser beam.

Laryngeal polyps and granulomas: Polyps or granulomas of the vocal cords can be excised by laser or can even be vaporized. The precise incision and good post-operative voice are the main reasons why laser is mostly used in these conditions.

Congenital subglottic haemangioma: Formerly, excision of the subglottic haemangioma had a high operative mortality and likelihood of recurrence. Laser surgery has brought a totally new perspective to treatment of this condition. It provides a simple endoscopic one stage removal, minimal bleeding and may avert a tracheostomy. The absence of post-surgical laryngeal edema facilitates early extubation.

Carcinoma in situ of the vocal cords: Laser is a satisfactory method of local control of carcinoma with a good post-operative voice and provides a quick treatment to the patient.

Invasive carcinoma of the vocal cords: The technique of CO2 laser helps in excision of the lesion for frozen section. The results of this method are comparable to radiation therapy. However, a proper case selection is required.11

Bilateral Abductor cord palsy: The surgery of cordectomy achieved a big milestone after the introduction of laser. One can do a simple cordectomy (partial or total) or an arytenoidectomy depending on the airway available between the two vocal cords. The procedure is extremely precise and with relatively minimal blood loss

Other laryngeal indications of laser are:

Reinke’s Oedema.
Congenital subglottic stenosis.
Laryngeal stenosis.

Bronchoscopic applications of CO2 laser

Lesions further down the trachea require the use of a bronchoscope. Special bronchoscopic couplers have been designed for projecting the laser beam. The coupler contains mirrors for altering the angle of the beam from the laser arm. Ventilation is maintained via the sidearm of the bronchoscope and trachea viewed through the eyepiece coupler. The newer neodymium - YAG laser is excellent especially for bronchial granulomas, papilomas, web-stenosis, and for palliative purposes in endotracheal neoplasm.

Lasers in ear surgery

Laser in ear surgery was tried in 1979. Laser surgery especially for otosclerosis provides pinpoint accuracy and instantaneous cauterisation minimising tissue trauma.

Uses of laser in Ear surgery are
• Perilymphatic gusher.
• Revision stapedectomy

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