gms | German Medical Science

80. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V.

Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V.

20.05. - 24.05.2009, Rostock

Laser surgery in clinical practice

Meeting Abstract

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German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 80th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Rostock, 20.-24.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09hno104

DOI: 10.3205/09hno104, URN: urn:nbn:de:0183-09hno1049

Veröffentlicht: 22. Juli 2009

© 2009 Sedlmaier.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

CO2 lasers (10600nm), Nd:YAG lasers (1064nm) and diode lasers (940,812nm) are now widely applied in outpatient ENT surgery. Benefits to users in hospitals and private practices include bloodless incisions, athermic tissue ablation, and hemostatic tissue sealing (1).

Ear indications

1.
Secretory otitis media, acute otitis media, barotrauma
CO2 laser myringotomy (e.g., Otoscan®, power: 15 W, scanner diameter: 2.2 mm, pulse time: 180 ms) with a diameter of 2 mm results in a 2–3 week period of transtympanic ventilation. It is thus possible to avoid ventilation tube insertion with its undesirable side effects, including atrophic scar formation, persistent perforations, recurrent otorrhea, cholesteatoma formation, and swimming and bathing restrictions (2). In acute otitis media with vestibulocochlear complications, CO2 laser myringotomy is a suitable method for achieving medium-term drainage of the middle ear (3). Acute complaints of barotrauma after landing in an airplane can be promptly treated under surface anesthesia and can enable transtympanic ventilation for a possible return flight.
2.
Persistent mesotympanic perforation of the eardrum
Long-lasting mesotympanic perforations of the tympanic membrane can be of inflammatory, traumatic or postoperative origin. When a perforation is freshened by juxtapositioned single shots with the CO2 laser (1 W, 50 ms, focussed beam) under surface anesthesia, three treatments can achieve a cumulative closure rate of at least 61% (4). Laser-assisted freshening of a perforation offers a promising option in cases requiring an uncomplicated alternative to conventional surgical procedures. This fast procedure is particularly useful for avoiding reoperation in patients with a residual defect after tympanoplasty.
3.
Secretory radical cavity
Secretory radical cavities are frequently caused by an incomplete epithelial lining and the formation of inflammatory granulation tissue. The tissue is ablated with the CO2 laser under local anesthesia (e.g., power 6W, scanner diameter: 1 mm, pulse time: 100 ms). The surfaces are then treated until they are covered by squamous epithelium.
4.
Eustachian tube opening failure
Failure of tube opening reduces ventilation of the tympanic cavity, which can lead to the development of secretory otitis media, otitis media mesotympanalis and epitympanalis and adhesive processes. Fixed-dose endoscopic transnasal ablation of the epipharyngeal tubal ostium (diode laser 812 nm, 5W, continuous wave, preconditioned bare fiber) can achieve a tubal function improvement detectable by the usual clinical examination methods in 70% of the patients (5). This was confirmed by a pressure chamber examination that has not yet been published.

The procedure is suitable for treating patients with recurrent perforation after tympanoplasty, an adhesive process or secretory media and also for those suffering from earache due to impaired pressure compensation after landing in an airplane or diving.

Nasal indications

1.
Turbinate hyperplasia and septal ridges
Chronic turbinate hyperplasia as well as septal spurs and ridges can be effectively treated with the fiber-coupled diode laser or Nd:YAG laser (5W, continuous wave, preconditioned bare fiber) under endoscopic guidance. Hard and soft tissue can be ablated with adequate hemostasis by applying the pulsed diode laser (940 nm, chopped mode, power 50W, pulse time: 0.03s, pause time 0.5s).
2.
Chronic sinusitis
Chronic sinusitis results from impaired ventilation and drainage of the paranasal sinuses. Laser techniques enable bloodless removal or opening of structures that impede access to the middle nasal meatus, e.g. hyperplastic mucosa of the middle turbinates, a concha bullosa, a bulla ethmoidalis, and recurrent polyps. Conventional surgery can thus often be avoided.

Oral and pharyngeal indications

Tonsil hyperplasia – laser tonsillotomy

Laser tonsillotomy is now regarded as the treatment of choice for symptomatic tonsil hyperplasia. The postoperative pain and the risk of secondary bleeding are significantly lower than after tonsillectomy (6). The intervention can be performed with the CO2 laser (12W, continuous wave, handpiece) and the diode laser (812nm, 5W, continuous wave, preconditioned fiber) (6).

Skin indications

1.
Rhinophyma
Conventional rhinophyma surgery with cutting instruments is usually only performed under general anesthesia because of the strong bleeding tendency. Use of the CO2 laser with a suitable scanner system enables bloodless layer-by-layer ablation of the hyperplastic tissue under local anesthesia (15W, paintbrush, scanner diameter: 5mm) (7).
2.
Teleangiectases
Facial teleangiectases can be cosmetically displeasing. Selective sclerotherapy is performed using the Nd:YAG or diode laser with a focus handpiece (30W, continuous wave). Bubble-free ice cubes are used to cool the surface and compress the vessels. The penetration depth and the strong absorption of hemoglobin at these wavelengths enable selective vessel closure while sparing the skin (1).

Conclusion: Use of the CO2 laser as a cutting and ablating tool and the diode or Nd:YAG laser as a quartz-fiber-compatible laser system has substantially broadened the spectrum of outpatient ENT surgery. Users and patients profit from the low-stress minimally invasive procedure.

Please contact the author for a reference list: benedikt.sedlmaier@charite.de