Vocal cord leukoplakia: Management in the or and office

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Lee Akst

Johns Hopkins Medicine, USA

: J Otol Rhinol

Abstract

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This presentation will comprehensively review evaluation and management of laryngeal leukoplakia. Though white vocal fold lesions are common, management remains challenging – doing too little may allow precancerous lesions to progress, while doing too much may create unnecessary dysphonia through scar. I will present a framework for management of leukoplakia which balances oncologic with functional outcomes, with the goal of achieving disease control without creating scar. Stateof-the-art advances in care of leukoplakia will be emphasized, and surgical techniques discussed will include role of infusion, use of the KTP laser, and micro-flap resection of diseased epithelium. Advanced use of the KTP laser for office treatment of laryngeal dysplasia, an important part of my own practice and something which is only available in a limited number of centers worldwide, will be discussed as well, to include appropriate anesthesia techniques for office-based procedures. Epidemiology of leukoplakia, rates of progression to malignancy, and role of office-based biopsy will be reviewed. Though focus will be on KTP laser strategies as these represent cutting edge approached to management of this disease, I will also discuss cold instrument and CO2 laser techniques so that the audience, regardless of the tools available to them in their own practices will be able to transition techniques learned in this presentation to care of their own patients. Approaches to anterior commissure involvement, bilateral disease, and multiply recurrent dysplasia will be discussed through case presentations which should increase audience interest. After the completion of this presentation, participants should be able to: understand the need to balance oncologic efficacy with functional outcomes in leukoplakia care; discuss treatment alternatives for laryngeal leukoplakia, emphasizing surgical techniques of KTP, CO2, and cold-instrument phonosurgery in the operating room and pulsed KTP laser treatment in an office setting.

Biography

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Lee Akst is Head of the Johns Hopkins Voice Center and Director of the Division of Laryngology at Johns Hopkins University Department of Otolaryngology-Head and Neck Surgery. The focus of his clinical practice is on management of voice disorders with focus on office-based treatments and operative management of epithelial diseases such as vocal cord leukoplakia, papilloma, and early glottis cancer. He has lectured extensively on phono-surgical techniques, treatment of laryngeal leukoplakia, laryngopharyngeal reflux, and globus pharyngeus. He has been working with engineers at Johns Hopkins on novel robotic platforms to bring robotic surgery into the endolarynx to aid microlaryngeal operative precision. He received his undergraduate and medical degrees from Yale University, did his Otolaryngology Residency at Cleveland Clinic, and laryngology fellowship at Massachusetts General Hospital.