Pulsed-dye laser in the treatment of recurrent respiratory papillomatosis of the larynx.

The transnasal flexible esophagoscope can be used as a panendoscope. Its distal chip camera provides outstanding visualization and high resolution.

The treatment of recurrent respiratory papillomatosis of the airway has primarily been surgical--that is, operative debulking with a carbon dioxide (C[O.sub.2]) laser or cold instrumentation. The problem with using the C[O.sub.2] laser or cold instruments is that scar tissue formation, often significant in nature, is inevitable.

Recently, the pulsed-dye laser (PDL) has been used successfully in the upper aerodigestive tract to treat papillomas. The PDL penetrates epithelium without damaging it, and the laser energy is selectively absorbed by the underlying microvasculature. The result is the selective destruction of the subepithelial microvasculature and ischemia of the diseased epithelium.

With the transnasal flexible esophagoscope, a laser fiber can be directed via the working channel toward the lesion. The laser is directed to within 2 mm of the tissue surface, and the lesion can be treated until it is blanched (figure). Treatment can be administered in the outpatient clinic with only topical nasal and laryngopharyngeal anesthesia.

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From the Center for Voice Disorder, Department of Otolaryngology, Wake Forest University Medical Center, Winston-Salem, N.C.; www.thevoicecenter.org