The treatment with carbonic laser or CO₂ has two main applications in our Department: The removal or vaporisation of benign, pre-malignant lesions and the treatment of laryngeal lesions. At the Instituto Oncológico we have applied the CO₂ laser technique since the beginning of the 80s.

The treatment of laryngeal tumours is still an issue: it can be treated surgically, with partial or total surgery, with external surgery or by endoscopy and radiotherapy, alone or complementary. In general the treatment is functional surgery or radiotherapy for early stages and total laryngectomy for advanced stages. The election of a specific therapeutic depends not only on the localisation and tumoral extension but on other several factors such as the general state of the patient, the experience, the medical team’s philosophy and the patient’s decision.

At the end of the 70s the CO₂ laser started to be used in the resection of larynx tumours. The indications for the use of the CO₂ laser for the resection of these tumours are increasing. Laser surgery presents clear advantages if compared to conventional surgery, such as scarce morbility; tracheotomy is not necessary, short in-patient stay, low cost, etc. Once accepted the possibility of resection by microsurgery, we must demand the same possibility of carrying out the complete tumoral resection and the peripheric healthy tissue.

Another important application of laser surgery is the permeabilisation of the aerial light with resection of part of the excrescent tumours that block it, as an alternative to tracheotomies and emergency laryngectomies. The preserving of the voice and the elimination of the tracheostoma are the justification of a conservative laryngectomy. The reactive edema, specfically in the mucous that covers the aritenoids is constant in all cases. Its decrease and therefore, the laryngeal recanalization are carried out spontaneously and quickly in some cases but slowly and irregularly in other cases. Nearly all the patients can be decannulated within the first month. However, the presence of high laryngostenosis or larynx immovability makes decannulation impossible. Nowadays, with CO₂ laser this problem can disappear although sometimes several sessions are needed to achieve the repermeability and even the realisation of wider resection when there s a fixation of the vocal cords. Bad prognostic factors are: the delay of the beginning of the treatment (more than a year), immovability of the cricoaritenoid articulation, the administration of radiotherapy and post-operational infectionalthough sometime.