Flash pump dye laser treatment of laryngeal papillomas

To evaluate the feasibility and safety of the flash pump dye (FPD) laser for the treatment of laryngeal papillomas, we performed a prospective nonrandomized trial comparing FPD and carbon dioxide (CO2) laser treatment of laryngeal papillomas in a tertiary care children's hospital. Nine patients from 2 to 20 years of age with severe recurrent laryngeal papillomas were enrolled in the study. All patients underwent CO2 laser debulking of papillomas on the left hemilarynx, with 8 W continuous or pulsed energy. The right hemilarynx was treated with the FPD laser with 12 to 77 pulses at 8 to 12 J, through a custom-designed 90 degrees firing fiber. An end point of blanching and purpura of the papillomas was used. The main outcome measures were the safety and ease of operation with the FPD laser, and decreased papilloma size based on visual inspection at 2 weeks postoperative and at the next laser procedure. Seven patients were irradiated I time with an FPD laser, and 2 patients 2 times. No intraoperative complications were noted. One patient developed early postoperative stridor. No patients described more discomfort, and 5 patients described their voice as being the same as or better than it was after prior CO2 laser procedures. Five patients had a 90% or more decrease in size of papillomas on the FPD-irradiated side 2 weeks postoperatively. Three patients had approximately a 50% reduction. A treatment effect was noted in all patients, and was similar to the results noted on the CO2 laser-treated side. Early results with FPD laser treatment of laryngeal papillomas suggest the protocol is relatively safe and feasible. Long-term results are pending. Because the FPD laser coagulates rather than vaporizing tissue, potential advantages may include decreased scarring relative to CO2 laser treatment, and improved patient and operator safety.