Novel In-Office KTP Laser Treatment of Anterior Glottic Webs

Objective: Acquired anterior glottic webs are the result of trauma, iatrogenic, radiation, or inflammation to the anterior commissure, resulting in narrowing of the airway and elevated pitch. They are very challenging to treat, and contemporary management strategies typically involve repeat procedures under general anesthesia with high rates of web recurrence. We aim to describe a novel treatment for anterior glottic webs with potassium titanyl phosphate (KTP) laser treatment that are performed in-office under topical anesthesia.

Methods: This is a retrospective chart review of six patients with an anterior glottic web who were managed in an office setting with KTP laser between the years 2019 and 2023. Demographic data, patient reported outcome measures, and treatment details were collected. Preprocedure and postprocedure video laryngoscopy was collected, and representative images were evaluated by blinded laryngologists. The reviewer, blinded to treatment status, was asked to measure the length of the vocal fold from vocal process to current anterior commissure and in addition, measure vocal process to expected ideal anterior commissure. The percentage change in length of the anterior glottic web is then calculated and reported.

Results: Six patients were included in the study, all tolerated the procedure well, and no adverse events. Patient follow up was on average 7 months (5 weeks to 3.1 years), with three of six patients having approximately 3 years follow up. All patients had a reduction in the length of the anterior glottic web, with an average pretreatment web length 40.4%, falling to 15.4% postKTP; t(6) = 3.43, 95%CI [6.29-43.71], P < 0.05. There were no significant change in VHI-10 scores post treatment t(3) = 1.73, 95% CI [-2.93-9.93].

Conclusions: KTP is a novel in-office treatment that offers promising and potentially durable results in the management of anterior glottic web.

Level of evidence: Level 4 - Case series study design.