The CO2 laser in the laryngeal microsurgery.

636 patients suffering from several laryngeal pathologies were treated with the CO2 laser. The results obtained confirm that this instrument is a valid alternative surgical tool, in comparison with the traditional surgery, because it allows to carry out the removal of the lesion with greater precision and more advantageously, when clinical indications are exact and surgical technique correctly performed. The results are as follows: Vocal nodules: no real advantages are offered by the CO2 laser in the treatment of these pathologies, whereas, in a small percentage of cases, the occurrence of reactive nodules or scars was noted; Cordal polyps are better removed with the traditional procedures, whereas the CO2 laser allows a more accurate excision of voluminous polyps or edemas of Reinke because of the bloodless operative field; Dyskeratoses: better functional results can be obtained using the laser. In these cases, however, an accurate preoperative evaluation is of fundamental importance to exclude any carcinomatous degeneration; Laryngeal amyloidosis is easily removed with minimal trauma and functional impairments using the laser; Laryngeal papillomatosis: the laser makes it possible to achieve complete recovery if radical excision, avoidance of accidental laryngeal damage and frequent postoperative controls are done; Laryngeal cancers: when clinical indications are correct, the main laser advantages in the treatment of T1 and T2 glottic cancers are the endoscopic removal of the lesion, avoidance of tracheotomy, shorter hospital stay and better quality of voice. Radical excision of the lesion is obtained by dissecting the tumor along the traditional cleavage plane, i.e. the inner perichondrium of the thyroid cartilage; Bilateral vocal cord paralysis: partial or total arytenoidectomy can be performed with the laser, with excellent functional results and minimal trauma and inconveniences; Laryngeal stenoses: chronic aditus edemas, vocal cord synechiae and webs are easily removed, taking care to avoid damage to the posterior commissure or to the elastic tracheal wall and performing frequent endoscopic removal of the fibrin clots in the postoperative period. Concentric stenoses and circumferential webs are firstly vaporized, then a silastic Montgomery T-tube is placed in the neocavity and left in place until re-epithelialization is completed. The insertion of a metallic tracheotomic cannula in the horizontal and descendant branches of the T-tube has been shown to be a useful precaution in order to achieve better results.