Photoangiolytic lasers such as the 532-nm potassium-titanyl-phosphate (KTP) and the
novel 445-nm blue laser (introduced into the United States in 2020) are absorbed selectively
by hemoglobin, permitting targeted ablation of vascular structures such as vascular
malformations of the vocal fold (VF). Previously, we reported the high rate of success
of KTP laser photocoagulation for VF vascular lesions. Compared with other photoangiolytic
lasers, blue laser has the highest absorption in hemoglobin, and therefore it can
be operated at lower power densities to minimize thermal injury to adjacent tissue.
The purpose of this study was to determine the efficacy and safety of blue laser for
treatment of VF vascular lesions using low power densities, and to compare outcomes
of blue laser with those of KTP laser.
Adult voice patients who underwent blue laser treatment of VF vascular lesions in
the operating room at the lowest power densities that appeared clinically to cause
the effect desired were included in this retrospective study. Baseline lesion characteristics
and postoperative outcomes were assessed with a model that we had described previously.
Postoperative outcomes were compared to those of previously reported KTP laser.
Thirty-one subjects (54 VFs treated) underwent blue laser vaporization of VF vascular
lesions (average age was 40.63 ± 17.51). Data were compared to those of 66 subjects
(100 VFs) who had undergone KTP laser vaporization of VF vascular lesions. There were
no significant differences in subject demographics, past medical or surgical history,
or preoperative location or severity of vascular lesions. Surgical success for blue
laser at the low power densities used was 3.74 ± 0.50, 3.55 ± 0.94, 3.90 ± 0.94, and
3.70 ± 1.11 (out of 5) at postoperative visits 1-4, respectively. Surgical objective
score was significantly greater following KTP laser at every postoperative visit.
Treatment with KTP laser resulted in significantly greater generalized postoperative
edema, and blue laser resulted in significantly greater localized edema at postoperative
visits one and two. At visit three and four, there are no significant differences.
VF stiffness following blue laser was 2.41 ± 0.67, 1.91 ± 0.69, 1.33 ± 0.47, and 1.10
± 0.18 (out of 4) at postoperative visits 1-4, respectively. Postoperative VF stiffness
did not differ significantly from KTP laser. Postoperative hemorrhage severity after
blue laser was 1.79 ± 0.54, 1.59 ± 0.48, 1.15 ± 0.25, and 1.14 ± 0.26 (out of 4) at
postoperative visits 1-4, respectively. Blue laser resulted in significantly less
VF hemorrhage than KTP laser at the first (1.79 ± 0.54 versus 2.26 ± 0.83) and second
(1.59 ± 0.48 versus 1.98 ± 0.72) postoperative visits. Vascular lesions treated with
low-power-density blue laser were significantly more likely to recur than those treated
with KTP laser (40.74% versus 10.00%). New vascular malformations were significantly
more likely to form after blue laser than KTP (24.07% versus 6.00%). Subjects treated
with low-power-density blue laser were significantly more likely to undergo repeat
surgery than those treated with KTP (31.48% versus 14.00%). Significant predictors
for the need for repeat blue laser included lesion recurrence, a lower surgical objective
score at the third or fourth postoperative visit and a higher baseline lesion severity
Blue laser is an effective tool for the surgical management of VF vascular lesions.
Although overall surgical success ratings were inferior to KTP laser at the power
densities used, the severity of postoperative edema and VF hemorrhage were significantly
less with blue laser. Re-evaluation of blue laser using higher power densities is