Surgical treatment using a laser with a wavelength of 445 nm in patients with chronic paralytic laryngeal stenosis

Abstract

The treatment of chronic paralytic laryngeal stenosis remains a relevant issue. It ranks second and accounts for 29.9% of chronic diseases of the laryngeal plexus. The number of affected patients has increased 10-fold over the past 10 years (20102020). Surgical treatment of chronic paralytic laryngeal stenosis is aimed at respiratory function restoration and the possibility of decanulation of the patient while maintaining vocal function. In the literature, the effectiveness of surgical treatment of patients with laryngeal stenosis varies greatly, ranging from 22% to 94%. We have proposed a technique for performing laryngoplasty in a patient with chronic paralytic laryngeal stenosis using a laser with a wavelength of 445 nm with a supply of inert gas (helium) in the operating field. When helium was injected into the operating field, the oxygen content at the laser exposure site decreased; thus, the effect of tissue carbonation was minimized, and thermal damage to surrounding tissues was reduced. Owing to the presence of gas, the smoke generated during the operation was quickly removed from the operating field, which provided good visualization. The properties of the aforementioned laser ensure a bloodless operating field, increasing the accuracy of surgical intervention. When using this laser, thermal damage to the surrounding tissues is no more than 0.6 cm in depth. This minimizes inflammatory reactions in the larynx in the postoperative period and promotes faster patient rehabilitation. The proposed volume of resection of the anatomical structures of the larynx was as follows: the posterior two-thirds of the vocal muscle and the anterior two-thirds of the body of the arytenoid cartilage, with the preservation of the mucous membrane to close the surgical wound, which ensures healing by primary tension and creates the necessary lumen of the glottis for sufficient breathing and allows for the maintenance acceptable voice function for patient communication. A laser with a 445-nm wavelength and a flap for closing the surgical wound used during the operation can speed up the recovery process and reduce the risk of relapse. This technique can be a method of choice for the treatment of patients with paralytic laryngeal stenosis.