The KTP laser is increasingly being used in an outpatient setting – particularly in North America – to treat various laryngeal pathologies including papillomas, leukoplakia, dysplasia and vascular lesions. This article reports the use of the KTP laser in the ENT clinic at McGill University Health Center in Montreal to remove a large vocal process granuloma in a 43-year-old female. The patient had previously presented with hoarseness and a choking sensation following multiple surgeries for ulcerative colitis. A small granuloma of the left vocal process was noted on initial flexible laryngoscopy. These symptoms progressed to shortness of breath on exertion in spite of anti-reflux medication. In keeping with the progressive nature of her laryngeal symptoms, the clinical photos included in the article from the time of her follow-up clinic visit show a fairly substantial granuloma arising from the left vocal process obscuring most of the laryngeal inlet. As the patient was apparently adamant that she did not want a further surgery requiring general anaesthesia, the treating laryngologist agreed to perform in-office KTP laser excision. Following topical anaesthesia and nasal decongestion, a fibreoptic laryngoscope was passed and the KTP laser was used to cauterise the base of the granuloma. A flexible bicep forceps was subsequently introduced transnasally to grasp and remove the granuloma en masse. Eighteen months after treatment, the patient remained symptom free with no evidence of recurrence. As acknowledged by the authors, further work is required to validate the use of this technique for treating vocal process granulomas in general. Nevertheless, the accessibility and low-morbidity of the technique is certainly appealing given the high recurrence rate associated with granulomas.
In-office KTP laser excision of a vocal process granuloma
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