Medium Power Density Blue Laser Photocoagulation for Vocal Fold Vascular Lesions

OBJECTIVE: The purpose of this retrospective study was to evaluate the safety and efficacy of blue laser (445 nm) at medium-power-density for treatment of vocal fold (VF) vascular lesions, and to compare outcomes to those of blue laser at lower power density and potassium-titanyl-phosphate (KTP) laser. METHODS: A retrospective chart review was conducted on patients who had undergone medium-power-density blue laser (MPDBL) treatment for vascular lesions of the vocal fold between July 2022 to April 2024 at our voice center. The following variables were obtained: patient characteristics, strobovideolaryngoscopy (SVL) examination, operative notes, and postoperative visit data (post-op day, VF hemorrhage, VF vascular patterns, VF stiffness, and lesion recurrence). SVL examinations underwent blind review by three raters to assess vascular lesion improvement. Postoperative outcomes were compared to those reported previously by our center for low-power-density blue laser (LPDBL) and KTP laser. RESULTS: There were 31 subjects (9 male, 22 female) included in the MPDBL cohort. The average age was 39.9 ± 18.0 (range = 19-80). Twenty-three subjects underwent bilateral VF laser ablation of vascular lesions, and eight underwent unilateral ablation for a total of 54 VFs operated on. Historical controls from previously published data were included. The control groups comprised 75 VFs treated with LPDBL, and 100 VFs treated with KTP laser. The surgical objective score was significantly lower in the MPDBL group compared to the LPDBL group and KTP group for all postoperative visits (P < 0.001). MPDBL was consistently associated with the lowest proportions of no edema at all postoperative time points, highest proportion of vocal fold stiffness at all time points, and the highest average VF hemorrhage scores. Cumulatively, 46.7% of patients in the LPDBL group had a recurrent lesion compared to 11.1% in the MPDBL group and 10.0% in the KTP laser group (P < 0.001). CONCLUSION: MPDBL improves lesion control to levels comparable to KTP, and it is better than LPDBL; but it loses the tissue‑sparing benefit and is associated with greater and more persistent adjacent-tissue injury. Laser selection should be guided by the clinical goals of the patient and surgeon.