Surgical and Voice Outcomes of Office-Based Vocal Fold Dysplasia and Leukoplakia Surgery: A Systematic Review

Objective: To investigate the surgical and voice quality outcomes of office-based laryngeal surgery for patients with laryngeal dysplasia and leukoplakia. Data Sources: PubMed, Google scholar, and Cochrane databases. Review Methods: Three independent investigator search databases for studies reporting surgical or voice quality outcomes of patients treated with office-based surgery for vocal fold dysplasia or leukoplakia. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were considered. Primary outcomes included patient tolerance, lesion regression, complications, number of interventions, and subjective and objective voice quality assessments. The bias analysis was carried out with the Methodological Index for Non-Randomized Studies (MINORS). Results: Fourteen studies were included, accounting for 186 patients with vocal fold leukoplakia and 72 patients with dysplasia. Potassium-Titanyl-Phosphate (KTP), Pulsed Dye Laser (PDL), and Blue Laser were the most used lasers. Office-based leukoplakia and dysplasia surgery was associated with a cumulative complication rate of 2.3% and 1%, respectively and a high patient tolerance level. Repeat treatment was needed in 12%-58.7% of patients for persistent disease noted at the first follow-up; overall, 39% of patients required more than one procedure. Subjective voice quality and some acoustic measurements demonstrated significant pretreatment to post treatment improvements but only one study considered multidimensional voice quality evaluation. There was substantial heterogeneity across studies for inclusion criteria, surgical, and voice quality outcomes. Conclusion: Office-based laser surgery is a safe and effective treatment for vocal fold dysplasia and leukoplakia leading to complete or partial disease regression in most cases. Future investigations should consider multidimensional voice quality assessment protocols to evaluate longitudinal voice quality outcomes. Heterogeneity among included studies and limited reporting of procedural approach represent the primary limitations of this review.