Laryngeal papillomatosis surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Surgery
There is no cure for laryngeal papillomatosis. Traditional surgery and carbon dioxide laser surgery, a "no touch" removal of affected tissue, are forms of treatment for laryngeal papillomatosis. Carbon dioxide laser removal is the most common removal method. These lasers pass electricity through a tube containing carbon dioxide and other gases to generate light. The carbon dioxide laser must be used precisely to prevent scarring, fibrosis, and laryngeal web malformation. In children, carbon dioxide laser is effective for removing papillomas on the larynx. In the past 10 years, surgeons have begun using a device called a microdebrider, which uses suction to hold the tumor while a small internal rotary blade removes the growth.
Photodynamic therapy controls tumors by using targeted dyes and bright light to illuminate tumors. In this procedure, a doctor injects a light sensitive dye that is only absorbed by the tumors. Then the doctor activates the dye using a bright light, and the tumors are eliminated. This procedure has also been able to decrease the number of tumors that reoccur.
Once the tumors have been removed, they have a tendency to return unpredictably. It is common for patients to require repeat surgery. With some patients, surgery may be required every few weeks in order to keep the breathing passage open, while others may require surgery only once a year. In the most extreme cases where tumor growth is aggressive, a tracheotomy may be performed. Tracheotomy reroutes air around the affected area. An incision is made in the front of the patient's neck, and a breathing tube is inserted through a hole (stoma) into the windpipe. The patient is then able to breathe through the tube. Although this is usually temporary, some patients must use the tube indefinitely. This method should be avoided if at all possible, since insertion of a breathing tube may cause the tumors to form as far down as the lungs. The tracheal tube re-routes all or some of the exhaled air away from the vocal folds, the patient may find it difficult to speak. With the help of a voice specialist or speech-language pathologist who specializes in voice, the patient can learn how to use his or her voice.