Laryngeal dysplasia

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Author:
esmond
ID:
164938
Filename:
Laryngeal dysplasia
Updated:
2015-06-30 07:18:45
Tags:
Head neck
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Description:
ENT UK Laryngeal dysplasia position paper
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  1. Leukoplakia initial management 
    • Single/multiple foci - completely excised if possible.
    • Widespread/confluent - mapped & multiple biopsies & staged resection if feasable. low threshold rebiopsy.

    All biopsies mounted
  2. Treatment modality
    • Either
    • Cold steel
    • Laser - CO2, ablation discouraged
    • Radiotherapy - rarely, poor access in high grade
  3. Risk factor reduction
    • Smoking
    • Alcohol
    • Reflux
  4. Grading
    • WHO - squamous hyperplasia,mild,mod,severe dysplasia, ca insitu
    • Ljubliana - squamous cell (simple) hyperplasia, basal/parabasal cell hyperplasia,atypical hyperplasia, carcinoma in-situ
    • severe dysplasia . atypical hyperplasia and carcinoma in situ - discuss MDT
  5. Decision to treat
    • 10-20% risk of malignant tranformation
    • =atypical hyperplasia, severe dysplasia orcarcinoma in situ
    • dysplasia at surgical margins is notconsidered to be an indication for further excision orbiopsy
    • Lesions that subsequently recur or change inappearance warrant further investigation.
  6. Risk classification
    • High risk
    • 1. severe dysplasia or carcinoma insitu or
    • 2. mild/moderate dysplasia with i Continued smoking.ii. persistent hoarseness.or iii lesion visible on endoscopy.

    • Low risk
    •  all else

  7. Follow up
    • Low risk general ENT surgeons, minimum 6 month
    • High risk - Head & Neck clinic, as for T1
  8. Persistent/recurrent lesions
    • Focal mild/moderate - excisied if possible
    • Widespread mild/moderate - excsion or observation
    • Focal severe - treat as T1, excise, radiotherapy if access problems, continued smoking, preference,2+ recurrences
    • Widespread severe - radiotherapy esp if cont smoking

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