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Complications of laser surgery for recurrent respiratory papillomatosis
D M Crockett1, B F McCabe, C J Shive
1Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City.
Abstract:
During an 8-year period, 66 patients with recurrent respiratory papillomatosis underwent 890 laser microlaryngoscopy procedures. A retrospective analysis of immediate and delayed complications occurring with laser microlaryngoscopy in the treatment of these patients revealed that complications secondary to anesthetic technique and laser methodology were remarkably low (0.3%). Delayed complications of tissue injury (36% of pediatric patients and 17% of adult patients) were more frequent and included anterior glottic webbing, interarytenoid scarring and arytenoid fixation, vocal fold fibrosis, and generalized endolaryngeal glottic stenosis. All patients were evaluated by direct visualization and recording at the time of the operative procedure, as well as by review of intraoperative photographs. A smaller group of patients underwent analysis of voice recordings and laryngeal stroboscopy. The frequency and severity of tissue injury was higher in the patients with more severe disease who underwent multiple operative procedures.
Insights
Laser microlaryngoscopy for recurrent respiratory papillomatosis has low immediate risks but significant delayed tissue injury complications, especially in children and those with severe disease.
Area of Science:
- Otolaryngology
- Laser Surgery
- Respiratory Medicine
Background:
- Recurrent respiratory papillomatosis (RRP) is a rare disease requiring repeated surgical intervention.
- Laser microlaryngoscopy is a common treatment modality for RRP.
Purpose of the Study:
- To analyze the immediate and delayed complications of laser microlaryngoscopy in RRP patients.
- To identify risk factors for complications in RRP treatment.
Main Methods:
- Retrospective analysis of 890 laser microlaryngoscopy procedures in 66 RRP patients over 8 years.
- Evaluation through direct visualization, intraoperative photographs, voice recordings, and laryngeal stroboscopy.
Main Results:
- Immediate complications related to anesthesia and laser were low (0.3%).
- Delayed complications, primarily tissue injury, were more frequent: 36% in pediatric and 17% in adult patients.
- Tissue injury included glottic webbing, scarring, fixation, fibrosis, and stenosis, with higher incidence in severe, multi-procedure cases.
Conclusions:
- Laser microlaryngoscopy is relatively safe regarding immediate complications for RRP.
- Delayed tissue injury is a significant concern, particularly in pediatric patients and those with extensive disease requiring multiple surgeries.
- Long-term management strategies should aim to mitigate these delayed sequelae.