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Background: Presently, there is a lot of confusion in the identification and classification and no consensus regarding the management of hyperplastic laryngeal lesions (HLL). Conventional transoral microsurgery has some drawbacks and is not always possible. The purpose of the study was to identify criteria for preoperative detection of HLL with high malignant potential and to assess the effectiveness of flexible endoscopic surgery (FES) in the management of HLL. Methods: A review of relevant English literature and a retrospective review of medical records of 37 patients with HLL, treated by FES, was performed. Results: Endoscopic and histologic features of HLL are discussed. An endoscopic classification of HLL is proposed: chronic hyperplastic laryngitis (CHL), chronic hyperplastic laryngitis with keratosis (CHLK), leukoplakia, pachydermia, and verrucous neoplasia. The role of FES using different tools in the diagnosis and management of HLL is presented. We applied flexible endoscopic laryngeal surgery (FELS) for 37 patients (ages, from 20 to 77 years, men 34, women 3) with the following types of HLL: CHLK 5, leukoplakia 18, pachydermia 12, verrucous neoplasia 2. Tracheostomy was offered in 1 case of obstructive verrucous neoplasia with subsequent decanulation after successful endoscopic management. According to the data from the literature and our own observations, the following criteria seem to point to a HLL with high malignant potential: verrucous neoplasia, pachydermia, a lesion affecting more than a half of the vocal fold, mucosal hyperemia, high-grade dysplasia in biopsy samples. The expected result (total eradication of the visible lesion) was obtained in all of our cases (mean follow-up period 76 months). Invasive carcinoma developed subsequently in 2 patients that continued to smoke after surgery. All the patients that could be followed-up stated an improvement of their voice after surgery. Conclusion: The following criteria can be used for preoperative detection of HLL with high malignant potential: verrucous neoplasia, pachydermia, a lesion affecting more than a half of the vocal fold, mucosal hyperemia, high-grade dysplasia in biopsy samples. Flexible endoscopic surgery, preceded by large flexible forceps biopsy, is a good alternative for HLL management. Diathermy snare is a useful tool for the diagnosis and first-line treatment in selected patients. [ABSTRACT FROM AUTHOR]

This is a difficult task, due to the thick keratin layer on the tumour surface and hard tumour consistency, and requires a special effort from the clinician, which usually is not necessary in case of biopsy of papilloma or typical SCC. Diagnosis is difficult because the tumour appears macroscopically "malignant" and microscopically "benign".5 The presence of the thick layer of keratin on the tumour surface creates major obstacles for obtaining an adequate biopsy material, which frequently results in inadequate traditional biopsy and inconclusive histologic response. In order to obtain an adequate biopsy specimen for histologic confirmation of the nature of tumour, flexible endoscopic snare diathermy excision under local anaesthesia with lidocaine 2% was used. [Extracted from the article]

The use of lasers has revolutionized the minimally invasive surgery of the larynx. The physical principles of the laser functioning and the interaction between laser and the biological tissue are discussed in this article. We mention the most frequently used types of lasers in laryngology, the difference among them and the comparative characteristics. The precaution and safety measures in using lasers are described. We also discuss the advantages of laser surgery in different clinical applications. The accumulation of a more significant clinical material is required in order to determine the indications and the role of a certain type of laser for the treatment of a certain pathology of the larynx. However, it is important to mention that the efficiency of all types of lasers is highly dependent upon operative technique and the skills of the surgeon. [ABSTRACT FROM AUTHOR]

Larynx cancer in young pregnant women is very uncommon. The treatment modalities traditionally used for larynx cancer management may present high risk either for the mother or the fetus. A rational therapeutic approach (flexible endoscopic laser surgery), that allows avoiding the risk of radiation therapy and general anesthesia, is presented. [ABSTRACT FROM AUTHOR]