In-Office KTP Treatment of Recurrent Respiratory Papillomatosis

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Author: R. Jun Lin
Published:
Specialties: Otolaryngology
Schools: University of Pittsburgh Voice Center
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Basic Info

Contributors: Clark A. Rosen

Laryngeal recurrent respiratory papillomatosis can be treated in the office using a 532-nm pulsed KTP laser under local anesthesia while the patient is awake without sedation.

DOI: http://dx.doi.org/10.17797/5ar3jihu3g

Editor Recruited By: Michael Johns III, MD

Advanced

Procedure

KTP laser treatment of recurrent respiratory papillomatosis in the office

Indications

Small RRP lesions
Patient tolerance and/or preference

Contraindications

Bulky RRP lesions
Patient anxiety
Significant gag reflex
Medical comorbidities that contraindicate an in-office procedure

Instrumentation

Setup

Patient sits in an upright position in a chair. Physician driving the laryngoscope stands on the patient¢s right side while the assistant, who passes the lidocaine drip catheter and laser fiber, stands on the patient¢s left.

Preoperative Workup

Blood pressure and heart rate measurements before the procedure.

Anatomy and Landmarks

Good knowledge of the laryngeal anatomy
Knowledge of KTP laser treatment classifications:
KTP V ¢ Noncontact, angiolysis
KTP 1 ¢ Noncontact, epithelium intact
KTP 2 ¢ Noncontact, epithelium disruption
KTP 3 ¢ Select contact or noncontact, epithelial ablation without tissue removal
KTP 4 ¢ Contact, epithelial ablation with tissue removal

Advantages/Disadvantages

Advantages: Avoids general anesthesia; allows ¢touch-up¢ removal of small RRP lesions
Disadvantages: Not ideal in bulky RRP lesions; not as precise as treatment under general anesthesia

Complications/Risks

Vasovagal reaction, epistaxis, incomplete removal of RRP lesions, may require multiple procedures, anterior glottic web formation.

Disclosure of Conflicts

Vasovagal reaction, epistaxis, incomplete removal of RRP lesions, may require multiple procedures, anterior glottic web formation.

Acknowledgements

References

Zeitels SM, Akst LM, Burns JA, Hillman RE, Broadhurst MS, Anderson RR. Office-based 532-nm pulsed KTP laser treatment of glottal papillomatosis and dysplasia. Ann Otol Rhinol Laryngol. 2006; 115(9):679-85.
Zeitels SM, Burns JA. Office-based laryngeal laser surgery with the 532-nm pulsed-potassium-titanyl-phosphate laser. Curr Opin Otolaryngol Head Neck Surg. 2007;15(6):394-400.
Mallur PS, Johns III MM, Amin MR, Rosen CA. Proposed classification system for reporting 532-nm pulsed potassium titanyl phosphate laser treatment effects on vocal fold lesions. Laryngoscope 2014; 124: 1170-1175.
Dippoid S, Becker C, Nusseck M, Richter B, Echternach M. Narrow band imaging: a tool for endoscopic examination of patients with laryngeal papillomatosis. Ann Otol Rhinol Laryngol 2015; 124(11): 886-92.

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