Laryngeal Dysplasia and Early Glottic Cancer Management

PROGRAM DESCRIPTION: Laryngeal dysplasia creates a challenge for treating Otolaryngologists. Overly aggressive treatment may result in poor functional outcomes while under-treatment may allow for disease progression. Likewise, resection of early glottic carcinoma must be performed in an oncologically sound manner, but with as little impact to the voice as possible.

The availability of channeled laryngoscopes has led to increased in-office biopsy and laser ablation procedures for laryngeal lesions. We will review indications and techniques for office-based procedures. We will also review how laryngeal stroboscopy and narrow band imaging can contribute to Trans-oral laser microsurgery (TLM) is a surgical technique for removing tumors from the upper aerodigestive tract. In TLM, appropriate laser usage allows for division of a tumor into multiple segments to assess its depth through the resection. If performed appropriately, this allows for minimal removal of tissue to maximize functional outcomes while still being able to assess margins for oncologically sound resections.

This presentation will review optimal care practices of patients with laryngeal dysplasia and early glottic cancer, starting with office workup including the utility of laryngoscopy, stroboscopy, and narrow-band imaging. We will review when pre-operative imaging may be indicated and concerning features to evaluate. We will review treatment options for various lesions including office-based biopsy and laser ablation and trans-oral laser resection. We will indications for imaging and finally we will review surgical technique for minimizing risk of recurrence or progression while maximizing functional outcomes.

OUTCOME OBJECTIVE 1: Attendees will be able to interpret office laryngoscopy for dysplastic laryngeal lesions including when to utilize narrow band imaging or stroboscopy and when imaging is indicated.

OUTCOME OBJECTIVE 2: Attendees will be able to explain when office-based biopsy or ablation is indicated for vocal fold lesions and describe the technique for performing office-based biopsy and laser ablation.

OUTCOME OBJECTIVE 3: Attendees will be able to explain when TLM is indicated for early stage glottic cancer and describe the technique for performing TLM with a carbon dioxide laser. They will also learn of and be able to describe potential complicating factors.

BACKGROUND STATEMENT: The management of laryngeal dysplasia and early glottic cancer remains controversial. Newer techniques, most notably narrow band imaging can be implemented to help guide treatment. This course will seek to provide the audience with up to do information on diagnosis and treatment.

Comprehensive Otolaryngology Track Statement :