Laryngeal Leukoplakia: State of the Art Review

Abstract

Objective This state-of-the-art article reviews the epidemiology, diagnosis, and management of vocal fold leukoplakia, with focus on recent advances. It focuses on the clinical challenges that otolaryngologists face balancing both oncological efficacy and functional outcomes in leukoplakia and presents the current philosophies and techniques to consider when managing such patients. Data Sources PubMed/MEDLINE. Review Methods We conducted a detailed review of publications related to vocal cord and laryngeal leukoplakia, dysplasia, hyperkeratosis, leukoplakia endoscopy, and leukoplakia management focusing specifically on oncologic outcomes, voice preservation, current and emerging diagnosis, and management techniques. Conclusions There has been a paradigm shift away from performing “vocal cord stripping” procedures that can cause irreversible hoarseness toward voice preservation surgery while achieving comparable oncologic control. Surgical technical and instrumental developments have been designed to maximally treat superficial disease while preserving underling vibratory mucosa. Recent improvements in histopathological grading systems and advances in biomarker classification may allow for improved oncologic risk stratification. Furthermore, improvements in endoscopic imaging capabilities and contact endoscopy are currently being studied for their potential diagnostic significance. Implications for Practice To optimally manage vocal fold leukoplakia, the otolaryngologist should become familiar with the oncologic implications of the disease and the importance of obtaining pathologic diagnosis to rule out malignancy. In addition, the surgeon should maintain surgical techniques and knowledge of available instruments and lasers that can assist in surgical management while prioritizing the preservation of vibratory tissue and voice quality. Finally, the surgeon and the patient should understand the clinical importance of routine endoscopic surveillance.

Readability of Online Materials Related to Vocal Cord Leukoplakia

“…10 Regarding vocal cord leukoplakia, there remain active discussions within the medical community on malignant potential and desired degree of surgical care (biopsy vs complete microflap removal), as well as the role of nonoperative management, use of angiolytic lasers, and potential for office-based treatment. [11][12][13][14] Correlations between pathologic classification and biologic behavior have been historically poor such that the World Health Organization recently simplified recommended pathologic categorization for vocal fold dysplasia. 15 Given the variations in care that patients may receive depending on the management approach that is recommended by the otolaryngologist, it is important for patients to have access to readable and understandable online materials to learn about available treatment options and participate in informed decision making.…”

Vocal Folds Leukoplakia: The Efficacy of Vitamin A in the Initial Treatment

“…Among the proposed treatments, there is surgical excision by various techniques (scalpel, cryotherapy, photodynamic therapy, laser or vaporization), drug treatment, topical or systemic (antiinflammatory drugs, antifungal, retinoic, carotenoid, folic acid), abandonment of aggravating addictions (cigarette and alcohol), and monitoring. 4,8,16,18,27 In our study, we evaluated the non-surgical treatment of vocal fold leukoplakia with vitamin A, and we noted that 62% of the lesions disappeared completely (34%) or showed partial improvement (28%) after treatment, with statistical difference in the pre and posttreatment moments in favor of using the medication (►Table 1). However, in eight vocal folds, there was an increase in the size of the leukoplakia (38%).…”

“…For other authors, these rates are higher, around 67% in smokers. 8 Leukoplakic lesions of the larynx can be found in one or both vocal folds. Other injuries associated with smoking may also be present, such as Reinke's edema and polyps.…”

Laryngeal Leukoplakia: A Focus on Histology

“…Early detection is the strongest prognostic factor affecting the patients' survival. However, the biopsy technique has some limitations, as mucosal sampling could underestimate the severity of the lesion first because of the poor depth of biopsy, then because of the histological heterogeneity of broader lesions [2,3].…”