Severe Laryngeal Dysplasia in a 20-Year-Old Nonsmoker Treated with CO 2 Laser Excision: A Case Report and Review of the Literature

Abstract

Objective: We present the unusual case of a 20-year-old female nonsmoker with severe laryngeal dysplasia managed with endoscopic CO₂ laser resection with frozen-section analysis. We use her case as a platform for discussion of the current evidence surrounding laryngeal dysplasia, particularly etiology and the use of lasers in management. Background data: Laryngeal dysplasia represents a series of progressive epithelial changes that can eventually lead to invasive laryngeal carcinoma. Typically, most patients are male, in their 50s or 60s, and are smokers; to our knowledge our patient represents the youngest reported case of this condition in a woman with no established risk factors. We discuss the implications of this on her subsequent management with the CO₂ laser. Methods: With the help of intraoperative photographs, we describe our excisional technique with the CO₂ laser, model 315M Superpulse class 4 (Irradia AB, Stockholm, Sweden) at a 6-W continuous power setting. Results: At 6 months after surgery, our patient remains disease free with good voice quality. Conclusions: Our patient appears to defy all the usual etiologic stereotypes that usually govern the development of laryngeal dysplasia. CO₂ laser excision plus intraoperative frozen-section analysis remains a safe and reliable method for the treatment of laryngeal dysplasia; the reassurance of histologically clear margins minimizes the extent of radical laser excision necessary and provides good functional results. We provide a comprehensive overview of the current literature on laryngeal dysplasia etiology and treatment, particularly the use of lasers in management.