Laser Atraumatic Treatment of Ectasias on Vocal Cords

描述（申请人提供）：临床上，声带小血管畸形（SVMs，包括其他小血管病变）是困扰声音的常见问题。这种疾病对专业语音使用者来说尤其麻烦。它可能有声带出血和疤痕的高风险，从而永久改变声音。目前，这个问题的治疗方法是使用CO2激光或其他“冷”显微手术对病变进行内窥镜切除。然而，这些治疗方法远不能令人满意，因为所有这些手术都需要切开正常的上皮并破坏正常的赖因克氏层。这种干预往往会导致疤痕和声音恢复不良。脉冲染料激光（PDL）已成功地用于治疗微血管病变的皮肤组织，通过其高选择性破坏目标血管，同时保留正常组织。我们之前的研究表明PDL作为常规手术治疗喉乳头状瘤的替代方法的有效性和安全性。在本研究中，我们的假设是微血管靶向（MVT）治疗PDL治疗声带SVMs是安全有效的。我们将对这一假设进行验证，具体目的如下：(1)进一步优化仓鼠模型颊袋内的PDL参数；(2)比较同一模型下PDL与CO2激光手术的治疗选择性和安全性；(3)在20例声带svm患者中，PDL是否比CO2激光在有效清除病变的同时更好更快地改善声音。这是首次使用激光MVT技术治疗声带支持向量机的研究。这种新的微创治疗方法，如果在本研究中取得成功，将为目前治疗声带疾病的手术方法提供一种理想的、极好的替代方法。在门诊治疗时，不需要全身麻醉，既安全又方便。

DESCRIPTION (provided by applicant): Clinically, small vascular malformations (SVMs, including other small vascular lesions) on the vocal folds are a common problem that disturbs the voice. This disease is especially troublesome for the professional voice user. It may have a high risk of vocal fold hemorrhage and scarring, thereby permanently altering voice. Currently, this problem is treated with endoscopic removal of the lesions with the use of a CO2 laser or other "cold" microsurgeries. However, those treatments are far from being satisfactory because all of those procedures require an incision through a normal epithelium and disruption of the normal Reinker's layer. Such intervention can often result in scarring and poor voice restoration. The pulsed dye laser (PDL) has been successfully used for treatment of microvascular lesions in cutaneous tissue, through its high selectivity for destroying targeted vasculature while sparing normal tissue. Our previous studies have shown the efficacy and safety of PDL as an alternative to routine surgeries for treatment of laryngeal papilloma. In this proposed study, our hypothesis is that microvascular targeting (MVT) therapy with PDL is safe and effective for treatment of SVMs on vocal folds. We will test this hypothesis with following specific aims: (1) to further optimize PDL parameters in the cheek pouches of a hamster model; (2) to compare the treatment selectivity and safety between PDL and CO2 laser surgery in the same model; and (3) to determine whether PDL will produce better and quicker voice improvement while effectively clearing the lesions than the CO2 laser, in 20 patients with vocal fold SVMs. This is the first study to use laser MVT technique to treat vocal fold SVMs. This new and less invasive treatment, if success in this study, will provide an ideal and excellent alternative to current surgical approaches for treatment of these diseases on the vocal fold. It would be safe and convenient enough for an out-patient treatment, without requiring a general anesthesia.