Care Giver Burden, Social and Economic Disparities and Palliation in the Pediatric Tracheostomy Population (2022 AMW) Front Matter
2022 AAO-HNSF Annual Meeting & OTO Experience
Transoral laser CO2 microsurgery (TLM) is the standard surgical approach for the treatment of early glottic squamous cell carcinoma (SCC). The alternative is radiation therapy. Concept : Contrary to open surgical procedures, the TLM approach is based on the pattern of local tumor spread, resecting only the involved tissue and structures using narrow margins, thereby sparing uninvolved structures and improving functional outcomes. Early glottic tumors may be removed by applying phonosurgical concepts while a more aggressive compartmental resection potentially involving larger portions of the larynx is necessary for more advanced disease. TLM is an effective and validated treatment: (1) The large series of consecutive patients (n> 100) reported by multiple centers have shown very excellent oncological results, (2) TLM is more cost-effective than radiation therapy or transcervical surgery, (3) Greater quality of life outcomes are reported after TLM, (4) All modalities remain feasible in case of recurrence including revision-TLM, radiation therapy or transcervical surgery. (5) Treatment preference in patients: the most common reason for choosing TLM is shorter treatment duration than radiation therapy and preservation of ulterior treatment options in case of recurrence. Controversial topic debate: “Complications of Endoscopie Laser Cordectomies: Myth or Reality? Many potential complications are reported in the litterature: Airway Complications, Hemorrhage, Edema requiring tracheotomy, Postoperative emphysema, Pharyngeal bruising, Granuloma, Web, Laryngocele, Dental injury, Complications related to laser use (Endotracheal tube cuff perforation, Eye / skin burns, Airway fire). The aim of this course is to review the reported rates of complication, the risk/benefit balance of the procedure and complication prevention strategies.