The role of the laser in laryngotracheal reconstruction

The laser lends itself to several potential applications in management of laryngotracheal stenosis. These may be divided into two applications: primary, when the laser is used to address the obstruction directly, and secondary, when the laser is applied after the laryngotracheal reconstruction procedure to manage complications. A variety of lasers has been explored for use in the treatment of laryngotracheal stenosis. The three lasers most commonly used for the airway are the CO₂, neodymium:yttrium-aluminum-garnet (Nd:YAG), and the potassium-titanyl-phosphate (KTP) systems. The CO₂ laser has been the mainstay in the management of most airway lesions because of surgeon familiarity and its precise cutting properties. The Nd:YAG system has the advantage of transmission through flexible fibers and delivery by either contact or noncontact mode. Because of its preferential absorption by hemoglobin, the KTP laser may have even greater advantages when used to address granulation tissue, which is often friable and tends to bleed. Techniques for primary application of the laser are detailed for partial stenoses or webs, laryngomalacia, and bilateral true vocal cord paralysis or fixation. In addition, techniques are discussed for the use of the laser in a secondary role for the management of postoperative granulomas and cicatrix. With advances in laser technology and endoscopy, the laser will continue to be of central importance in laryngotracheal reconstruction.