Transoral Flexible Laser Surgery of the Larynx with Blue Laser.

INTRODUCTION: Laser surgery of the larynx is currently the standard of clinical practice in a multitude of procedures. Lasers with photoangiolytic properties have a wide application in endolaryngeal lesions. One of their most prominent features is the ability to coagulate blood vessels, reducing unwanted tissue damage. Our objective is to expose the uses of the blue laser (445 nm) in the larynx. MATERIAL AND METHODS: A retrospective study was carried out including 47 patients treated with blue photoangiolytic laser from October 2021 to January 2023 at a university hospital. Demographic data, type of lesion presented, date of intervention and scope of the procedure, as well as the parameters of the laser used, were recorded. The number of sessions received per patient, the result and complications were also collected. RESULTS: A total of 47 patients with laryngeal lesions were treated, including vascular angiomas, laryngeal sulcus vocali, vocal cord polyps, Reinke's edemas, laryngeal papillomatoses, subglottic stenosis, laryngeal synechiae, subglottic granulomas, glottic scars, vocal fold leukoplakias, laryngeal dysplasias and tracheostomal granulomas. The mean age was 52.5 years, and 64.3% of the patients were women. The range of power used in the resective surgeries was 2-10 Watts with a 20-millisecond window. The average number of sessions received was 2.1 (range 1-4). A satisfactory situation was obtained in 45 of the 47 patients treated (95.75%), and an evident decrease in lesions was seen in the remaining two. There was no evidence of any complications directly derived from the use of the blue laser. Twenty-seven cases (54%) were treated exclusively in-office. CONCLUSIONS: The blue laser is safe and effective in the treatment of a wide range of laryngeal pathologies. Its advantages include its portability, its photoangiolytic qualities as well as its ability to vaporize tissue in contact mode, which can treat subepithelial vessels or resect lesions.

Segundos tumores primarios y sus factores de riesgo en pacientes con tumores índice de cabeza y cuello / Second primary tumors and their risk factors in patients with primary head and neck tumors

Introducción y objetivo: El término de segundo tumor primario (STP) es utilizado para designar un nuevo cáncer primario que se presenta en una persona a la que se le ha diagnosticado un cáncer previamente. Se considera que los STP se producen de forma independiente y no como resultado de un resurgimiento o metástasis del tumor índice o primer tumor primario (PTP). El objetivo de este estudio es investigar la prevalencia, factores de riesgo, localización y tratamiento de los STP, así como el tiempo transcurrido entre la aparición de los tumores. Método: Se realiza un estudio retrospectivo descriptivo con pacientes con diagnóstico de STP entre enero del 2004 y diciembre de 2021 en el Hospital Universitario de Fuenlabrada. Se analizó la prevalencia y localización de los STP, los factores de riesgo relacionados, el tiempo entre la aparición del PTP y el STP, el tratamiento del PTP y STP y su resultado. Resultados: Del total de 360 casos del registro de tumores, 73 pacientes (20,2%) fueron incluidos en el estudio por padecer un STP. De los participantes, el 75% eran fumadores y el 46,6% bebedores. La mayor parte de estos pacientes fueron tratados quirúrgicamente. Se observó que el PTP con mayor desarrollo de STP fue el de cáncer de laringe, siendo la supraglotis la sublocalización más frecuente. El STP más frecuente fue el carcinoma epidermoide de pulmón. Conclusiones: En nuestra serie los STP aparecen en el 20% de los pacientes con tumores índice de cabeza y cuello. Son más frecuentes tras el cáncer de laringe, siendo la localización más frecuente el pulmón. Tanto el tabaco como el alcohol juegan un papel importante en su desarrollo, acortando el tiempo entre la aparición de los tumores, además de poder aparecer recidivas, persistencias y metástasis. (AU)

Introduction and objective: The term second primary tumor (SPT) is used to designate a new primary cancer that occurs in a person previously diagnosed with cancer. SPT are considered to occur independently and not as a result of a resurgence or metastasis of the index tumor or first primary tumor (FPT). The aim of this study is to investigate the prevalence, risk factors, location and treatment of STP, as well as time elapsed between tumor occurrence. Method: A retrospective descriptive study was performed including patients diagnosed with SPT between January 2004 and December 2021 at Hospital Universitario de Fuenlabrada. The prevalence and location of SPT, related risk factors, time between the onset of FPT and SPT, treatment of FPT and SPT and their outcome were analyzed. Results: From a total of 360 cases, 73 patients were included in the study because of SPT. 75% were smokers and 46.6% were drinkers. Most of these patients were treated surgically. It was observed that the FPT with the highest development of SPT was the larynx, with supraglottis being the most frequent sublocalization. The most frequent SPT was epidermoid carcinoma of the lung. Conclusions: In our series SPT appear in 20% of head and neck tumors. They are more frequent after laryngeal cancer, the most frequent location being the lung. Both tobacco and alcohol play an important role in their development, shortening the time between the appearance of tumors, in addition to the possibility of recurrence, persistence and metastasis. (AU)

Infiltración temprana en la parálisis laríngea: evolución y factores pronósticos / Early infiltration in laryngeal paralysis: course and prognostic factors

Introducción y objetivo: La parálisis de las cuerdas vocales (CCVV) es una patología prevalente e incapacitante. El objetivo principal de este estudio es comparar la recuperación de la movilidad y funcionalidad de las CCVV, así como el requerimiento de tiroplastia en dos grupos de pacientes, los que se trataron con infiltración temprana con ácido hialurónico (GIT) y los no infiltrados (GNI). Método: Estudio retrospectivo observacional. Para formar el GNI se filtró la base de datos de 715 exploraciones de parálisis laríngeas y se seleccionaron 33 pacientes que cumplieran los criterios de inclusión. Para el GIT se incluyeron a los pacientes infiltrados por parálisis laríngea en los últimos 3 años (n=22). En el GNI se analizó como medida de resultado: la recuperación de la movilidad y funcionalidad de la cuerda y la necesidad de tiroplastia. En el GIT se midió, adicionalmente, la fecha de la infiltración. Resultados: Los resultados del GIT son significativamente mejores (p=0.001) en la recuperación de la movilidad de las CCVV. Se observa una reducción no significativa (p=0.14) en la necesidad de tiroplastia en los pacientes infiltrados. Existen diferencias significativas entre los pacientes con parálisis unilateral del GNI vs GIT (p=0.009), mientras que los grupos con parálisis bilaterales no son comparables entre sí, debido al compromiso de la vía aérea que sufren los pacientes con la cuerda en posición medial. Discusión: La infiltración con ácido hialurónico proporciona el tratamiento temporal del defecto de cierre glótico con baja tasa de complicaciones, prolongando el tiempo máximo de fonación y la funcionalidad de la cuerda vocal parética, pudiendo reducir tratamientos posteriores. Se ha propuesto como un tratamiento que puede mejorar la calidad de vida del paciente. Sin embargo, es importante seleccionar adecuadamente los pacientes, ya que no todos pueden ser candidatos... (AU)

Introduction and objective: Vocal cord paralysis is a prevalent and disabling pathology. The main objective is to compare the recovery of movility and functionality of vocal cords, as well as the requirement of definitive surgery in two groups of patients: non-infiltrated group (NIG) versus early infiltration group with hyaluronic acid (EIG). Method: Retrospective observational study. To set up the NIG, we sorted the database of 715 videos labeled as “laryngeal paralysis” and selected n=33 patients who met the inclusion criteria of the study. To create the EIG, we selected patients injected with hyaluronic acid in the last 3 years (n=22). In the NIG, the following were analyzed as outcome measures: recovery of mobility and functionality of the cord and the need for thyroplasty. In the EIG, the date of infiltration was also measured. Results: The results of the EIG are significantly better (p=0,001) in terms of vocal cord mobility recovery. A non-significant reduction (p=0.14) was observed in the need for thyroplasty in injected patients. There are significant differences between patients with unilateral paralysis of the NIG vs EIG (p=0.009), while the bilateral groups are not comparable, due to the compromise of the airway suffered by patients with the cord in a medial position. Discussion: Early infiltration with hyaluronic acid provides temporary treatment of the glottic closure defect with a low rate of complications, prolonging the maximum phonation time and improving the vocal movement, which may reduce the need for subsequent treatments. It has been proposed as a treatment that can improve the patient’s quality of life. However, it is important to properly select patients, since not all may be candidates... (AU)