The digital AcuBlade laser system to remove huge vocal fold granulations following subglottic airway stent

Abstract

We report a case of granulations that complicated subglottic stent placement and completely destroyed vocal folds with luminal stent obstruction. A microbial aetiology significantly contributed to the occurrence of granulations associated with mechanical irritation. The granulations were successfully resected using a digital AcuBlade laser system, a new generation of CO2 laser used in otorhinolaryngology, particularly in vocal cord disease. It permitted a precise control of the scan line between vocal fold and granulation for several reasons. The scan line was completely electronic and integrated in the scanner. The sweep in speed was constant and the energy distribution was uniform along the entire length of the time. The interpulse pause was of ∼1 ms, allowing the tissue cooling with reduction of thermal spread and quicker healing support. The result was the radical excision of granulations without injuring vocal folds. The respiratory function was restored and no other treatments such as arytenoidectomy or cordectomy associated with the alteration of phonatry function were required. No intraoperative or/and postoperative complications were registered and the patient was discharged 7 days after the procedure.

Keywords: Air way stent; Granulation; Laser resection; Subglottic stenosis; Vocal fold.

Figure 1:

Rigid bronchoscopy showed the presence of bilateral huge granulations that completely covered vocal folds (A). Under granulations, the stent resulted to be in site but its lumen was partially obstructed by granulation (B). The patient was intubated with a small laser-safe endo-tracheal tube which passed through the stent. To preserve the stent from thermal injury, a gauze was placed around the orotracheal tube under granulations (C).

Figure 2:

The granulations were completely resected, and after the procedure the vocal folds seemed to be normal and the luminal stent free (A). Endoscopic view showed patent glottic lumen at 3-month follow-up (B). AcuBlade™ connected with an operative microscope is reported in (C). The scanner is a device connected between the laser arm and the micromanipulator. By a computer-guided system of rotating mirrors, the scanner allows the beam to sweep a given surface with extreme rapidity. Scan patterns enable incision (linear or arc-incision) and ablation (circle) using parameters proposed by laser-controlling software. The incision line can be rotated to the right or left with joystick (D).