Article

Laser surgery of the larynx: the case for caution.

Ear, nose, & throat journal (Impact Factor: 0.88). 12/1992; 71(11):593-5.
Source: PubMed

ABSTRACT Laser surgery has been advocated for treatment of many laryngeal lesions. Although the CO2 laser has many advantages, its safe use requires special education of the surgeon and operating room team, and considerable surgical skill. Several dangers inherent in laser use for laryngeal surgery must be considered. These include vocal fold scarring secondary to thermal injury, loss of histopathologically important tissue through vaporization, airway fire and others. Laser-related complications must be considered whenever use of this instrument is contemplated.

0 Followers
 · 
94 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Successful treatment of vocal nodules is primarily accomplished through the direction of voice-language pathologists and teachers of music and speech. Rarely is surgical treatment necessary, although recent reports have suggested a correlation between vocal nodules and failed voice training with anterior commissure microwebs. One hundred fifteen consecutive patients with vocal nodules were evaluated. Eight anterior commissure microwebs were identified (7%), four of these in performers. Of the 96 patients with sufficient follow-up, 65 (68%) had complete resolution of their nodules and 17 (18%) had sufficient improvement to return to normal vocalization without surgical treatment. Nine patients required surgery, two of these with anterior commissure microwebs. All eight patients with microwebs had resolution of their nodules with either nonsurgical or surgical therapy. In total, 94% of patients were able to return to normal voice function, while the 6% of failures either did not receive or were noncompliant with voice therapy. Microwebs were found to be uncommon in patients with vocal nodules. Microwebs and other laryngeal pathologies in patients with nodules may be associated with a higher incidence of patients failing conservative voice therapy treatment.
    Journal of Voice 10/1995; 9(3):326-31. DOI:10.1016/S0892-1997(05)80241-3 · 0.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: FragestellungIm Zusammenhang mit Laseranwendungen bei Atemwegseingriffen kommt es immer wieder zu Brandzwischenfllen, die durch die Entwicklung verschiedener Instrumente und Vorgehensweisen vermieden werden sollen. Unsere Untersuchung gilt der Feststellung der Widerstandsfhigkeit des jngst entwickelten LaserJet-Katheters aus Polytetrafluorthylen (PTFE) gegenber Bestrahlung mit einem CO2-Laser.MethodikZur Simulation der Gasanreicherung im Hypopharynx wurde in Anlehnung an die europische Norm ISO-11990 eine zylinderfrmige, einseitig verschlossene Stahlkammer konstruiert. Zwlf fabrikneue Katheter wurden mit dem proximalen Ende an eine Sauerstoffsonde (6l/min) angeschlossen. Das distale Ende wurde 10cm tief in die Stahlkammer gelegt und mit einem Laserstrahl unterschiedlicher Intensitt und Zeitdauer im sog. Superpulsmodus (Impulsrate 250Hz) und mit einem Auftreffwinkel von 75 bestrahlt. Die Laserleistung wurde von 2–15W variiert und die Widerstandsfhigkeit des Katheters mit und ohne Sauerstofffluss bestimmt. Die Expositionsdauer betrug jeweils abwechselnd 1s und 10s. Art und Ausprgung der Vernderungen wurden dokumentiert.ErgebnisseDie Bestrahlung fhrte zu Beschdigungen des Katheters, wie einfache und doppelte Perforation, Rauch, Farbvernderung, Verformung und Bruch. Diese traten spter und weniger ausgeprgt auf, wenn der Katheter von Sauerstoff durchstrmt war. Ohne Sauerstofffluss kam es zum Bruch des Katheters bei 2-W-Laserleistung nach 40s, mit Sauerstofffluss waren mindestens 4W ber 20s erforderlich. Bei Laserleistungen ber 8W brach der Katheter bei Direktbestrahlung unter 10s.SchlussfolgerungWir konnten nachweisen, dass der LaserJet-Katheter selbst nicht entflammbar ist und auch keinen Brand unterhlt. Allerdings ist er nicht gegen Funktionseinbusse oder Zerstrung bei Direktexposition unter einem anhaltenden Laserstrahl bei klinisch blicher Intensitt geschtzt. Polytetrafluorthylen verformt sich und schmilzt bei Temperaturen um 327C. Diese Temperatur kann bei Direktbestrahlung des Katheters mit dem CO2-Laser berschritten werden. Bei sachgemem Gebrauch ist von einer sehr hohen Sicherheit gegen Brandzwischenflle auszugehen.BackgroundLaser surgery within the airway is often performed with the patient under general anaesthesia and with infraglottic jet ventilation via a specially designed catheter which should not be inflammable. We investigated the laser-resistance of a recently introduced jet ventilation catheter (LaserJet) made of polytetrafluoroethylene.MethodsFor the simulation of gas accumulation in the hypopharynx a cylindric steel chamber with an open and a closed end was used to simulate the operative setting according to the European standard ISO-11990. In a series of 12 tests the disposable laser jet catheter was attached to the proximal end of the oxygen supply tubing, and the distal end was introduced 10cm into the steel chamber. The catheter was repeatedly exposed to the beam of a CO2-laser device with energies varying from 2–15W and with an impact angle of 75. The changes in the catheter were assessed with and without an oxygen flow of 6l/min. Time of exposure varied from 1 to 10s. Size and nature of the changes in the catheter were documented.ResultsWe found damage to the catheter that occurred in the following order: simple (front wall) and double perforation (front and back wall), smoke emission as evidence for pyrolysis, discolouration, deformation and rupture. The extent of damage to the catheter shaft under direct laser beam exposition was dependent on the laser intensity. When there was no oxygen flow, a beam of 2W needed 40s to perforate the catheter shaft, while with an oxygen flow of 6l/min, a laser intensity of 4W needed 20s to cause perforation. Rupture of the catheter occurred in less than 10s with a laser intensity of 8W or more.ConclusionsWe could demonstrate that the LaserJet catheter is not inflammable and also does not sustain fire. However, it is not laser-resistant as to maintaining its texture and shape while under direct exposure to a continuous laser beam, as applied under clinical conditions. Polytetrafluoroethylene deforms and melts at temperatures above 327C which is usually exceeded by the CO2-laser.
    Der Anaesthesist 08/2004; 53(9):820-825. DOI:10.1007/s00101-004-0717-x · 0.74 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Dentre os vários tipos de laser usados em Medicina, o laser de CO2 é o mais usado na Otorrinolaringologia e Cirurgia de Cabeça e Pescoço. As vantagens de seu uso são a diminuição do sangramento, a diminuição do edema no pós-operatório e a facilidade de acesso ao campo operatório, entre outras. Desde os trabalhos de Jako e Strong em 19721,2, quando o laser de CO2 passou a ser usado no tratamento de papilomatose laríngea e de lesões malignas glóticas iniciais, suas indicações têm aumetado, principalmente em lesões benignas, a partir da alta tecnologia desenvolvida dos últimos anos como, por exemplo, a diminuição do microspot e o uso do superpulso, reduzindo conseqüentemente seu efeito térmico sobre os tecidos. MÉTODOS: Neste trabalho foram realizadas incisões com instrumental a frio e com laser de CO2 1 watt de modo contínuo e superpulso, em pregas vocais caninas e observado, através de cortes histológicos corados pelo método de Sirius Red, a quantidade de colágeno depositada sobre as mesmas. RESULTADOS: A quantidade de colágeno das pregas vocais foi maior do que no grupo controle, e estatisticamente maior no grupo de animais submetidos a procedimentos com instrumental a frio do que com laser de CO2. Não houve diferença estatística entre o grupo controle e o grupo submetido a incisões com instrumentos a frio. CONCLUSÃO: A microcirurgia de laringe com o laser de CO2, quando este é usado em baixa potência, com pequeno "microspot" e com superpulso, é um método seguro em relação à deposição de colágeno, quando comparado com instrumentos com lâmina a frio, obedecendo os princípios da fonomicrocirurgia.
    Revista Brasileira de Otorrinolaringologia 12/2003; 69(6):753-759.