Background and Objectives

This investigation determined incision characteristics and soft-tissue damage resulting from standardized incisions using a wide range of laser modes and parameters of a diode laser at 810 nm.



Study Design/Materials and Methods

Histologic examinations were performed to verify vertical and horizontal tissue damage as well as incision depth and width.



Results

Incision depth and width correlated strongly with average powers, but not with laser parameters or the used tips. No laser damage was visible to the naked eye in the bone underlying the incisions in the range between 0.5–4.5 W.



Conclusion

The remarkable cutting ability and the tolerable damage zone clearly show that the diode laser is a very effective and, because of its excellent coagulation ability, useful alternative in soft-tissue surgery of the oral cavity. Lasers Surg. Med. 25:401–406, 1999. © 1999 Wiley-Liss, Inc.

Effects on oral soft tissue produced by a diode laser in vitro.

Surgery of the tonsils is still one of the most frequent procedures during childhood. Due to a series of fatal outcomes after hemorrhage in children in Austria in 2006, the standards and indications for tonsillectomy have slowly changed in Germany. However, no national guidelines exist and the frequency of tonsil surgery varies across the country. In some districts eight times more children were tonsillectomized than in others. A tonsillectomy in children under six years should only be done if the child suffers from recurrent acute bacterially tonsillitis. In all other cases (i.e. hyperplasia of the tonsils) the low risk partial tonsillectomy should be the first line therapy. Postoperative pain and the risk of hemorrhage are much lower in partial tonsillectomy (=tonsillotomy). No matter whether the tonsillotomy is done by laser, radiofrequency, shaver, coblation, bipolar scissor or Colorado needle, as long as the crypts are kept open and some tonsil tissue is left behind. Total extracapsular tonsillectomy is still indicated in severely affected children with recurrent infections of the tonsils, allergy to antibiotics, PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) and peritonsillar abscess. With regard to the frequency and seriousness of the recurrent tonsillitis the indication for tonsillectomy in children is justified if 7 or more well-documented, clinically important, adequately treated episodes of throat infection occur in the preceding year, or 5 or more of such episodes occur in each of the 2 preceding years (according to the paradise criteria). Diagnosis of acute tonsillitis is clinical, but sometimes it is hard to distinguish viral from bacterial infections. Rapid antigen testing has a very low sensitivity in the diagnosis of bacterial tonsillitis and swabs are highly sensitive but take a long time. In all microbiological tests the treating physician has to keep in mind, that most of the bacterials, viruses and fungi belong to the healthy flora and do no harm. Ten percent of healthy children even bear strepptococcus pyogenes all the time in the tonsils with no clinical signs. In these children decolonization is not necessary. Therefore, microbiological screening tests in children without symptoms are senseless and do not justify an antibiotic treatment (which is sometimes postulated by the kindergartens). The acute tonsillitis should be treated with steroids (e.g. dexamethasone), NSAIDs (e.g. ibuprofene) and betalactam antibiotics (e.g. penicillin or cefuroxime). With respect to the symptom reduction and primary healing the short-term late-generation antibiotic therapy (azithromycin, clarithromycin or cephalosporine for three to five days) is comparable to the long-term penicilline therapy. There is no difference in the course of healing, recurrence or microbiological resistance between the short-term penicilline therapy and the standard ten days therapy. On the other hand, only the ten days antibiotic therapy has proven to be effective in the prevention of rheumatic fever and glomerulonephritic diseases. The incidence of rheumatic heart disease is currently 0.5 per 100,000 children of school age. The main morbidity after tonsillectomy is pain and the late haemorrhage. Posttonsillectomy bleeding can occur till the whole wound is completely healed, which is normally after three weeks. Life-threatening haemorrhages occur often after smaller bleedings, which can spontaneously cease. That is why every haemorrhage, even the smallest, has to be treated properly and in ward. Patients and parents have to be informed about the correct behaviour in case of haemorrhage with a written consent before the surgery. The handout should contain important addresses, phone numbers and contact persons. Almost all cases of fatal outcome after tonsillectomy were due to false management of haemorrhage. Haemorrhage in small children can be especially life-threatening because of the lower blood volume and the danger of aspiration with asphyxia. A massive haemorrhage is an extreme challenge for every paramedic or emergency doctor because of the difficult airway management. Intubation is only possible with appropriate inflexible suction tubes. All different surgical techniques have the risk of haemorrhage and even the best surgeon will experience a postoperative haemorrhage. The lowest risk of haemorrhage is after cold dissection with ligature or suturing. All "hot" techniques with laser, radiofrequency, coblation, mono- or bipolar forceps have a higher risk of late haemorrhage. Children with a hereditary coagulopathy have a higher risk of haemorrhage. It is possible, that these children were not identified before surgery. Therefore it is recommended by the Society of paediatrics, anaesthesia and ENT, that a standardised questionnaire should be answered by the parents before tonsillectomy and adenoidectomy. This 17-point-checklist questionnaire is more sensitive and easier to perform than a screening with blood tests (e.g. INR and PTT). Unfortunately, a lot of surgeons still screen the children preoperatively by coagulative blood tests, although these tests are inappropriate and incapable of detecting the von Willebrand disease, which is the most frequent coagulopathy in Europe. The preoperative information about the surgery should be done with the child and the parents in a calm and objective atmosphere with a written consent. A copy of the consent with the signature of the surgeon and both custodial parents has to be handed out to the parents.

Tonsillitis and sore throat in children.

Objectives It was the aim of this study to determine thermal and histologic events resulting from soft tissue incision with three CO 2 lasers: one emitting light energy via a hollow waveguide at 9.3 μm; the others emitting light energy at 10.6 μm, one via a hollow waveguide, the other through an articulated arm delivery system. Study design Thirty standardized incisions were made in the oral mucosa of pig's mandibles with three different lasers at actual power levels of 1,4 and 12 W. Thermal events were recorded with thermocouples, and a histologic examination was performed to determine vertical and horizontal tissue damage as well as incision depth and width. Results Thermal and histologic results were related to parameters and beam characteristics rather than wavelength. Conclusion In addition to wavelength, many variables can contribute to the surgical characteristics of a laser.

/pdf/incision-properties-and-thermal-effects-of-three-co2-lasers-2ypuijet3q.pdf

Incision properties and thermal effects of three CO2 lasers in soft tissue.

Laser-tonsillotomy for treatment of obstructive tonsillar hyperplasia in early childhood: a retrospective review.

Die Teilresektion der hyperplastischen Tonsille, die Tonsillotomie, wird in Deutschland zur Behandlung der fruhkindlichen Obstruktion des Isthmus faucium allgemein abgelehnt. Das muss uberdacht werden. Die Ergebnisse aus dem Universitatsklinikum Benjamin Franklin (n=637), einer HNO-Belegabteilung und einer operativ ausgerichteten HNO-Praxis (n=189) zeigen, dass die in der Literatur zu findenden Angaben uber schwere Spatkomplikationen mit Vernarbungen der Tonsillenkrypten und Haufungen von Peritonsillarabszessen als Folge einer Tonsillotomie nicht weiter aufrechterhalten werden konnen. Im Nachbeobachtungszeitraum trat keine dieser Komplikationen auf. Die Tonsillotomie ist eine adaquate Behandlung der Tonsillenhyperplasie im fruhen Kindesalter und fuhrt zu sehr guter Besserung der praoperativen Beschwerden (Schnarchen, Atmungsbehinderung, Schluckbeschwerden, Gedeihstorungen). Voraussetzung fur einen langfristigen Erfolg ist dabei die konsequente Beschrankung dieses Eingriffs auf die Diagnose der Tonsillenhyperplasie.

/pdf/die-lasertonsillotomie-bei-der-tonsillenhyperplasie-des-30dsnzcnlb.pdf

Die Lasertonsillotomie bei der Tonsillenhyperplasie des Kleinkindes

The amount of different clinically available lasers is increasing. The ENT surgeon can therefore use the best laser for the planned operation. As the resources of the hospital do not increase with the laser technology, a decision has to be made whether in addition to the universal CO2-laser other types must be acquired and which type is best. This paper presents the characteristics and typical tissue interactions of several lasers for the area of the soft palate. Typical operative examples are shown, e.g. partial resection of the soft palate in patients with bronchopathy and sleep apnoea syndrome, tonsillectomy, tonsillotomy and adenotomy in adults.

Derzeitiger Stand der Laserchirurgie im Bereich des weichen Gaumens und der angrenzenden Regionen

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Derzeitiger Stand der Laserchirurgie im Bereich des weichen Gaumens und der angrenzenden Regionen