Planning regular treatment intervals can be difficult given when managing RRP since irregular and unpredictable clinical behavior between patients and even within the same patient. We introduced the green-light 532nm Pulsed-KTP laser as a reliable means of treating papilloma while minimizing vocal scarring, which greatly facilitates management. Selective disruption of the micro-vessels in the papilloma lesions through photoangiolysis has been shown to be a highly effective means of treating the disease while preserving vocal function..
We do not use the CO2 laser or microdebriders due to the fact that these devices are more likely to cause injury to the delicate vocal membranes. Over the past several years, our treatment paradigm for papilloma has shifted from the operating room under general anesthesia (exclusively) to a majority of the procedures being done as an office-based laryngeal surgery under local anesthesia. This critical advancement that we created has yet to be provided to most patients in the USA and overseas.
Most recently, we pioneered the use of Avastin (Bevacizumab) to prevent recurrence of laryngeal papillomatosis. Initial observations thus far suggest that a majority of patients can be injected with Avastin in the office with limited subsequent need for laser treatment. We are in the process of more formally studying the Avastin as a treatment for RRP. However, initial operative management of these patients with the pulsed-KTP laser under general anesthesia remains an integral part of our papilloma treatment paradigm to control the initial volume of disease. The precision afforded by direct larynoscopy with high-powered magnification from a surgical microscope and the ability to treat the undersurface of glottic structures has proven to be valuable.