Congenital laryngeal cyst: a case report.

Congenital laryngeal cysts are a rare cause of stridor in the neonate. Nevertheless, delayed diagnosis and treatment can cause life-threatening airway obstruction. Even though the diagnosis is easily made by careful inspection, treatment results often in recurrence. These facts are illustrated by a case of a baby with a saccular cyst. Immediately after diagnosis and 5 days later the cyst was de-roofed using a CO2 laser via an endolaryngeal approach. Because of a second recurrence an excision of the cyst was performed via a lateral cervical approach.

Treatment of the obstructive nose by CO2-laser reduction of the inferior turbinates: technique and results.

In our department we treat chronically enlarged inferior turbinates (not responding to adequate medical therapy) with the CO2-laser or by partial inferior turbinoplasty. In this work the technique is described and short- and long-term results are evaluated. We divided our study group into two populations: one group with a follow-up of 18 months for which we could obtain objective measurements of the nasal patency by means of a preoperative and postoperative active anterior rhinomanometry, and another group with a follow-up of more than 15 years, for which (because of the absence of a pre-operative rhinomanometry) we could only obtain a subjective evaluation of the results by means of a questionnaire. Relief of nasal obstruction was reported by 88.5% of the patients until 5 years after laser surgery on the inferior turbinates. There seems to be no functional impairment on the nasal mucosa after this kind of surgery. The advantages and drawbacks of this technique are discussed.

Long-term efficacy of our surgical approach to turbinate hypertrophy.

In our department, chronically enlarged inferior turbinates (not responding to adequate medical therapy) are treated with the CO2-laser or by partial inferior turbinoplasty. In this work, the latter technique is described and the short- and long-term results (up to 9 years of follow-up) are evaluated. Relief of nasal obstruction was reported by 93.5% of the patients. There was a good correlation between this success rate and the objective measurements of the nasal resistance by active anterior rhinomanometry. Rhinorrhea or postnasal drip was still present in 32.5%. Atrophic changes of the nasal mucosa were not observed in any of the patients. Early postoperative epistaxis was found in 6.5% of the patients. Late postoperative epistaxis did not occur.

Tonsillectomy and adenotomy as a one day procedure?

With special reference to the postoperative hemorrhage rate and its subsequent course, we retrospectively evaluated the outcome of 2,363 tonsillectomies and 3,295 adenotomies performed over the last 11 years at our department. The postadenotomy major bleeding frequency was 0.2%. After tonsillectomy the immediate postoperative major bleeding frequency was 2.6% and 3.0%, respectively in children and adults. Secondary bleeding after tonsillectomy occurred in 0.3% of the children and 0.5% of the adults. In contrast to adenotomy, which can be considered as a safe one day procedure, based on our results we propose to perform tonsillectomy as a more prolonged, one night stay procedure.

Posterior epistaxis: our experience with transantral ligation and embolisation.

Transantral ligation of the arteria maxillares internae (AMI) (with or without ligation of the arteria ethmoidalis) and percutaneous embolisation of AMI in cases of intractable epistaxis (i.e. epistaxis not responding to classical posterior packing) are compared. Except when ethmoidal bleeding is suspected, we recommend embolisation for epistaxis not responding to classical measures as it leads to fewer complications and recurrences, to shorter hospital stay and to improved postoperative comfort.

Premalignant lesions of the vocal cords. A retrospective study of 62 cases treated with CO2 laser.

A series of 62 patients treated by (repeated) CO2 laser excision and/or vaporization for premalignant lesions of the vocal cords was analysed retrospectively. Of the 54 patients available for follow-up (ranging from 1 to 15 years), five patients (9%) developed an invasive glottic carcinoma and needed radiotherapy. Only two patients (4%) needed extensive surgery (total laryngectomy). One patient (2%) died of a recurrent carcinoma despite radiotherapy and laryngectomy, and six patients (11%) died of a metachronic lung carcinoma. The therapeutic results of (repeated) laser therapy were comparable to those in other reports regarding radiotherapy or stripping. The subjective functional results were satisfactory and tended to improve along with refinement of laser surgery techniques. Follow-up of patients who once had a premalignant laryngeal lesion is mandatory ad vitam, regardless of the grade of the lesion. For the screening of lung cancer, there is still no consensus on a standard-of-care. The classical chest X-ray remains the most accessible and comfortable screening procedure.

[The use of the CO2 laser in otorhinolaryngology]. / Het gebruik van de CO2-laser in de Oto-Rhino-Laryngologie.

Discussion of the three types of laser used in medicine (YAG, Argon, CO2). More specifically our experience with the CO2 laser in ENT is explained.