gms | German Medical Science

During the last few decades there has been an increased interest in the diagnosis and management of premalignant and early malignant laryngeal lesions. Improved clinical diagnosis and a more strict, but still subjective histopathological classification in combination with multiple objective parameters have without doubt increased our knowledge both concerning clinical diagnosis and management of these lesions.

Most of these lesions are diagnosed on the vocal cords where they give symptoms, as discomfort and hoarseness. The supra- and subglottic regions are silent areas.

Patients with voice disorders should be examined by stroboscopy and preferably videolaryngostroboscopy. This enables an assessment of adhesions and invasive processes with disappearance of the mucosal wave. Patients with chronic laryngitis, keratosis and erytroplasias should be carefully followed. The microlaryngoscopy should be combined with the use of optical instruments. Laryngeal smear cytology may be used but can by no means supersede the histological examination. The same is true for contact endoscopy and autofluoroscence endoscopy. Compact endoscopy is a term combining autofluoroscence and contact endoscopy.

Our various subjective histopathologcal classifications necessitate a close collaboration between clinician and examining pathologist to give the patient a correct treatment.

Today most laryngologists agree that endoscopic treatment by excision or stripping with or without the use of laser should be the initial treatment for premalignant and early malignant lesions of the larynx. The classification of the endoscopic procedures introduced by the ELS has nowadays been widely accepted.