At their early stages, the pre-cancerous lesions (early, mild, and severe dysplasia) and malignant laryngeal neoplasia mainly occur on the vocal cords and thus produce changes in voice quality. If a diagnosis is achieved early enough, conservative treatments can be performed which allow for a good prognosis in terms both of local control and vocal outcome. Being common to conditions that differ greatly from one another in terms of prognosis and therapeutic implications, dysphonia should never be underestimated. In such cases as well a suitable differential diagnosis should rely mainly on a thorough rigid and / or flexible endoscope-based examination and on a videolaryngoscopic examination, which in selected cases should be corroborated by the use of diagnostic imaging techniques such as CT and / or MRI. In early-stage laryngeal cancer an excisional biopsy is performed, meaning that the histological examination follows the removal of the entire lesion together with surgical margins of healthy tissue, which at once allows for both an accurate diagnosis and definitive treatment. In this field, CO2 laser endoscopy-based treatment has been the approach of choice throughout the last decade. In fact, this minimally invasive surgical approach allows for oncological control of the disease in over 85% of cases compared to traditional therapeutic options (radiotherapy and / or open surgery), while at the same time boasting several advantages such as a short hospitalization time (day surgery), almost immediate resumption of work, low complication and morbidity rates, the absence of a tracheotomy, the preservation of the laryngeal cartilaginous framework and no aftereffects precluding further treatment options. From a functional point of view, the CO2 laser allows for preservation of the patient’s voice quality by enabling the surgeon to only resect the vocal cord’s surface. In addition to dysphonia, the symptoms typical of intermediate-to-advanced stage laryngeal cancer may include impaired swallowing (dysphagia), foreign body feeling in the throat, reflex auricular pain and difficulty breathing in (inspiratory dyspnea), especially so when under stress. In addition, clinical signs such as laterocervical increased-volume lymphadenopathy may occur. In any case, the diagnosis relies on the integration of both endoscopic and radiological techniques (CT, MRI, echography). In such cases, and in the light of the oncological outcomes it produces, the CO2 laser endoscopy-based treatment should be considered a valid alternative to open surgery, radiotherapy, as well as non-surgical protocols (chemo and radiation therapy). In addition, its functional outcomes in terms of speech, swallowing, and life quality are significantly better than those of the treatments mentioned above.
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Montgomery future
