Lesion-based selection of photoangiolytic and carbon dioxide lasers for laryngeal and tracheal lesions

초록

Laser management of laryngeal and tracheal disease increasingly relies on matching laser-tissue interactions to lesion-specific goals rather than selecting devices in isolation. This review synthesizes comparative evidence on photoangiolytic platforms, including the potassium titanyl phosphate laser and the 445 nm blue laser, and contrasts these approaches with carbon dioxide (CO2) laser techniques. It then translates the findings into practical lesion-level decision algorithms. Across indications, the key differentiators are chromophore selectivity and the depth of the thermal effect, which shape voice preservation, healing, and recurrence control. Photoangiolytic strategies are most consistently supported for vascular-dominant pathologies, such as recurrent respiratory papillomatosis and benign superficial vascular lesions, with broad feasibility for repeat treatment and office-based workflows. CO2 laser methods remain central when precise epithelial cutting, specimen acquisition, and defined depth resection are required, particularly for the management of higher-risk dysplasia. Organizing recommendations by lesion-specific decision points reduces redundancy and produces clearer clinical pathways, while highlighting gaps in head-to-head trials, standardized reporting of laser parameters, and evidence for distal tracheal disease.

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