Carbon dioxide laser in removal of polytef paste.

Teflon injection is the most popular surgical technique for improvement of voice in patients with a unilaterally paralyzed larynx. The results with this method usually are good, but cases of overinjection with resultant poor voice, airway compromise, or both, do occur. The carbon dioxide laser has become a standard instrument for laryngeal surgery, and it might reasonably be used in attempts to correct the overinjected vocal cord. Realizing that Teflon could share flammable characteristics with other polymers, such as rubber and polyvinylchloride, we investigated the effect of the carbon dioxide laser on fresh polytef paste (Mentor O & O Inc, Hingham, Mass) before using it in a patient with an overinjected hemilarynx. Fresh paste was found to ignite after exposure to standard laser power at normal time settings, both in room air and in an oxygen-enriched atmosphere. To determine the effect of the laser on Teflon in situ, the paste was injected subcutaneously and intramuscularly into a rat. After a suitable interval of time, the Teflon was found to glow but not ignite when exposed to the laser under standard operating conditions. Only under high power in an oxygen-enriched environment did ignition occur. In our patient, the laser was used to incise the mucosa over the polytef granuloma, and standard microsurgical (nonlaser) techniques were used to complete the removal with good results. Laryngologists should be aware of the dangers of using the carbon dioxide laser on or near Teflon, especially in freshly injected vocal cords.