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  • Title: Severe laryngeal dysplasia in a 20-year-old nonsmoker treated with CO2 laser excision: a case report and review of the literature.
    Author: Fraser L, Kelly G, MacLennan K, Makura ZG.
    Journal: Photomed Laser Surg; 2010 Oct; 28 Suppl 2():S115-9. PubMed ID: 20860544.
    Abstract:
    OBJECTIVE: We present the unusual case of a 20-year-old female nonsmoker with severe laryngeal dysplasia managed with endoscopic CO(2) laser resection with frozen-section analysis. We use her case as a platform for discussion of the current evidence surrounding laryngeal dysplasia, particularly etiology and the use of lasers in management. BACKGROUND DATA: Laryngeal dysplasia represents a series of progressive epithelial changes that can eventually lead to invasive laryngeal carcinoma. Typically, most patients are male, in their 50s or 60s, and are smokers; to our knowledge our patient represents the youngest reported case of this condition in a woman with no established risk factors. We discuss the implications of this on her subsequent management with the CO(2) laser. METHODS: With the help of intraoperative photographs, we describe our excisional technique with the CO(2) laser, model 315M Superpulse class 4 (Irradia AB, Stockholm, Sweden) at a 6-W continuous power setting. RESULTS: At 6 months after surgery, our patient remains disease free with good voice quality. CONCLUSIONS: Our patient appears to defy all the usual etiologic stereotypes that usually govern the development of laryngeal dysplasia. CO(2) laser excision plus intraoperative frozen-section analysis remains a safe and reliable method for the treatment of laryngeal dysplasia; the reassurance of histologically clear margins minimizes the extent of radical laser excision necessary and provides good functional results. We provide a comprehensive overview of the current literature on laryngeal dysplasia etiology and treatment, particularly the use of lasers in management.
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