Laser vocal cord surgery is an endoscopic procedure used to remove and treat a number of conditions that affect the vocal cords, including vocal cord dysplasia, benign nodules, polyps, laryngeal papillomas and some laryngeal malignancies. Laser surgery destroys the blood supply to the lesions while leaving surrounding healthy tissue intact. This is accomplished by targeting the hemoglobin in the blood, a characteristic known as angioselectivity.
Other advantages of laser vocal cord surgery are that the procedure takes only a short time, there is no cutting involved and, most often, no general anesthesia is necessary. There is less pain for the patient and a shorter recovery time. Because the laser procedure usually takes place in the doctor’s office, there is little risk of excessive bleeding, infection or other complications. There is also only minimal risk of scarring with laser surgery which is important when the larynx is involved since scar tissue is thicker than normal tissue and does not vibrate as easily.
There are two primary types of laser vocal cord surgery: pulsed dye laser (PDL) and potassium-titanyl-phosphate (KTP). A less commonly performed procedure makes use of carbon dioxide.
During laser vocal cord surgery, the patient is typically awake, throat numbed by a local anesthetic. A flexible endoscope is passed through the nose and positioned in the larynx above the vocal cords. Then a small fiber containing the laser is threaded through the scope and directed at the targeted lesions, quickly vaporizing them. Not all vocal cord masses can be treated with PDL or KTP laser, since these procedures are only appropriate in regions containing a high concentration of blood vessels. The most common masses treated with these laser procedures are hemorrhagic polyps, granulomas, or papillomas.
Following laser vocal cord surgery, the patient must remain on strict voice rest for 1 to 2 weeks, avoid coughing, and take acid reflux medication to prevent any acid damage to the surgery site. Voice therapy with a speech language pathologist is usually prescribed to strengthen the vocal cords and, hopefully, to prevent the need for further surgery.
There are a few limitations to laser vocal cord surgery. For one thing, the specialized equipment necessary for these procedures is very expensive and therefore not available at all facilities. For another, laser vocal cord surgery cannot be used for diagnostic purposes since lasers destroy, rather than excise, tissue so the lesions removed are not available for biopsy.