Factors responsible for the development of carbon granuloma post transoral laser cordectomy

Our study was performed with an aim to analyse the factors responsible for the formation of a carbon granuloma (CG) following transoral laser microlaryngeal cordectomy (TLMC) for early glottic carcinoma. Our study comprises of retrospective data analysis of 78 patients who underwent TLMC for early glottic carcinoma between 2012 and 2017 with the laser settings of an acublade with scanning system, size 1-2 mm, depth 1-3 (250-750 μm), power 10 watts in a repeat mode with time off 0.25 s. A total of 19 patients had undergone type 1 cordectomy, 38 patients a type 2 cordectomy, 20 patients a type 3 cordectomy and 1 type 4 cordectomy. In the follow-up period, patients were divided into two groups-group A, who healed well and group B, who developed a CG. Both groups were analysed based on surgical factors (type of cordectomy, postoperative surface of vocal fold and cautery use) and healing factors (presence of diabetes mellitus and laryngopharyngeal reflux). Of 81 cordectomies, 15 (18.5%) developed a CG at an average period of 4 weeks postoperatively. All 15 patients were managed medically and by 4-8 weeks, 13 carbon granulomas resolved. Surgical excision in 2 patients who did not improve revealed granulation tissue. Of 40 type 2 cordectomies, 9 developed a CG (22.5%); of 20 type 3 cordectomies, 5 developed a CG (25%) and the 1 patient of type 4 cordectomy developed a CG (100%). Patients with cautery use, diabetes mellitus (DM) and laryngopharyngeal reflux (LPR) had a higher rate of CG formation. To summarise, in our study, a CG developed in 18.5% of our TLMC patients at an average postoperative duration of 4 weeks. An algorithm for treating and preventing this type of lesion is recommended.