[Treatment with CO2 laser of premalignant glottic epithelial lesions]

Pre-malignant lesions of the larynx can degenerative into invasive carcinoma. There is not an universally accepted classification and treatment. We present our experience in the treatment with endoscopic CO2 laser for the pre-malignant glottic epithelial lesions. At the same time we carry out a review of the literature published. During a period of ten years we have treated 69 patients with one of these techniques: resection of the epithelial lesion or vaporization. The election of the technique depends on the size of the lesion, the macroscopic aspect, anterior commissures involvement and the surgeons experience. The histological findings were: 53.6% keratosis and 23.2% mid dysplasia both of them treated with vaporization and resection; 14.5% moderate dysplasia and 8.7% severe treated with resection of the lesion. There were no important complications during the operation. Recurrence occurred in 7 patients (10%) but after treatment all of them were free of disease during the follow-up period, they didn't progress to carcinomatosis. 9 patients (13%) had a malignant evolution: 3 keratosis, 1 mild dysplasia, 3 moderate dysplasia and 2 severe dysplasia. Only one case (1.5%) underwent total laryngectomy. The early diagnosis and an appropriate treatment reduced the possibilities of malignant transformation. The therapy with CO2 laser is the treatment of choice in this kind of lesions.