C02 Laser-assisted Phonosurgery for Benign Glottic Lesions

Objective (1) To determine glottic function following carbon dioxide (CO2) laser-assisted phonosurgery of benign laryngeal disease. (2) To evaluate post-operative glottic morphology and disease recurrence rate. Methods Comparative retrospective case series of patients with benign glottic pathology treated by laser-assisted phonosurgery over 10 years. 235 consecutive patients had pre- and postoperative data collected from objective laryngeal examination, videostroboscopy recording of vocal fold mucosal wave movement, electroacoustic voice analysis of fundamental frequency, jitter, shimmer, and harmonics to noise ratio, as well as perceptual voice evaluation. This data was also compared to that of 20 healthy volunteers. (Statistical analysis: Wilcoxon test and Mann-Whitney test respectively). Definitive voice and morphologic evaluation was completed after 6 months. Results Evaluation of the pre- and postoperative functional results demonstrated a statistically significant improvement in all spectrographically analysed objective voice parameters (p<0.001), with a restored voice quality as good as the control group (p<0.001). Postoperative morphological analysis using videostroboscopic examination confirmed 3 recurrences of granuloma and 1 of Reinke's oedema. Recurrence was estimated objectively if the lesion was analogous to the original pathology. Glottic closure was complete in 96.5% of cases. False vocal fold adduction was normal in 88.5% of cases, with forced hyper-adduction being present in 11.5%. Phonatory vibration was cord-cord type in 100% of cases. Conclusions Our study demonstrates a statistically significant improvement in all acoustic parameters recorded. Postoperative vocal fold function and mucosal wave morphology were largely restored. CO2 laser-assisted voice restoration for benign glottic disease is effective.