The role of the CO2 laser in the management of laryngotracheal stenosis: a survey of 100 cases.

Over the last decade, improvement of CO2 lasers with the microspot and ultrapulse technologies has broadened the indications for endoscopic CO2-laser resection of benign laryngotracheal stenosis (LTS). This article reviews 100 patients treated solely by endoscopic means for a LTS. There were 47 grade III, 41 grade II and 12 grade I stenoses according to the Myer-Cotton classification. The postoperative results show that the improvement to a nearly normal (>80% luminal size) airway declines from 92% (11/12 patients) for grade I to 46% (19/41 patients) for grade II and 13% (6/47 patients) for grade III stenoses. When compared to open surgery for more severe grades of stenosis (31 grade IV, 66 grade III and 3 grade II stenoses), the results of the endoscopy group is much less favorable: 36% of patients in the endoscopy group versus 76% of patients in the open surgery group were rehabilitated to a normal respiration without exertional dyspnea and 38% versus 5% patients remained tracheotomy dependent. However, if strict selection and therapeutic criteria are respected, a significant number of grade I and II stenoses, and to a lesser degree of grade III stenoses, can be improved to a nearly normal airway by endoscopic means only. The endoscopic treatment is potentially less invasive and risky and only needs a short hospital stay. To try this as a first treatment modality in a selected group of patients is worthwhile, provided that this endoscopic treatment is not repeated a second time, if the stenosis recurs to its initial grade after a primary CO2-laser treatment. Some guidelines for safe endoscopic treatment modalities with of the CO2 laser, dilatation and/or stenting are proposed.