Laser Atraumatic Treatment of Ectasias on Vocal Cords

描述（由申请人提供）：临床上，声带上的小血管畸形（SVMs，包括其他小血管病变）是干扰声音的常见问题。这种疾病对于专业语音用户来说尤其麻烦。它可能有很高的风险声带出血和疤痕，从而永久改变声音。目前，这个问题是通过使用CO2激光或其他“冷”显微手术的内窥镜切除病变来治疗的。然而，这些治疗远不能令人满意，因为所有这些手术都需要通过正常上皮的切口和正常Reinker层的破坏。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）已成功地用于治疗皮肤组织中的微血管病变，通过其高选择性破坏靶血管，同时保留正常组织。我们以前的研究已经表明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。在这项拟议的研究中，我们的假设是，微血管靶向（MVT）治疗与PDL是安全和有效的治疗声带上的SVMs。我们将通过以下具体目的来检验这一假设：（1）进一步优化仓鼠模型中PDL参数;（2）在同一模型中比较PDL和CO2激光手术的治疗选择性和安全性;以及（3）确定PDL是否将产生比CO2激光更好和更快的语音改善同时有效地清除损伤，20例声带SVMs患者。这是第一个使用激光MVT技术治疗声带SVMs的研究。这种新的和微创的治疗方法，如果在这项研究中成功，将提供一个理想的和优秀的替代目前的手术方法治疗这些疾病的声带。对于门诊治疗来说，这是足够安全和方便的，不需要全身麻醉。

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.