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Ultrastructural evaluation of 585-nm pulsed-dye laser-treated glottal dysplasia
Carlos Ayala1, Martin Selig, William Faquin
1Department of Otology and Laryngology, Harvard Medical School, Division of Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts 02114, USA.
Objective/Hypothesis:
To describe the ultrastructural changes occurring within pulsed-dye laser (PDL)-treated glottal tissues.
Study Design:
Prospective.
Methods:
Nine patients presenting with glottal dysplasia requiring biopsy to rule out microinvasive carcinoma were enrolled in this prospective study. At least two samples were obtained in each case: one from a PDL-treated area and another from a non-PDL-treated area (obtained from a nonphonatory region as an internal control). In some cases, a third sample was obtained from the junction between PDL- and non-PDL-treated areas. All samples were examined with light microscopy (H and E stain) and transmission electron microscopy. Observations were made of morphological changes within the epithelium, epithelial/ superficial lamina propria (SLP) junction, and the lamina propria of tissues treated with the PDL. Eight of nine patients were followed for a period of 9-25 months (mean, 18 months) with two recurrences that were retreated with awake-PDL and followed for an additional 8.3 and 9.5 months without recurrence. Vocal fold appearance returned to normal within 3-4 weeks posttreatment.
Results:
Intraepithelial desmosome junctions were preferentially destroyed, and regional blood vessels were coagulated. The PDL consistently caused a separation of epithelial cells away from the basement membrane.
Conclusions:
The PDL allowed for both a surgical and a nonsurgical multimodality method for treatment of precancerous lesions with minimal effects on the SLP.
