Laser safety in head and neck cancer surgery

The use of trans-oral laser techniques for the resection of head and neck carcinomas has increased exponentially over the last four decades. Inadvertent laser damage to the patient or operating theatre staff is an acknowledged risk. However, no data exist to verify the safety margin of commonly employed precautions. The aims of this study was to assess the safety margins of protective strategies commonly adopted when using CO₂ lasers to resect tumours of the head and neck. A Sigmacon Acupulse Lumenis™ CO₂ laser was evaluated. The beam was focused to 2 mm diameter at 402 mm focal length. Gauze swabs, neurosurgical patties, surgical gloves, paper drapes and conventional endotracheal (ET) tubes were tested against the following laser variables: power, beam characteristics and angle of beam incidence (90 & 45°). Laser penetration time through the material under test was recorded in seconds (s). All the materials where tested dry and some, when appropriate, were tested wet. The mean of three recordings was calculated. The results demonstrated dry gauze swabs, neurosurgical patties and paper drapes provided 0 s protection at 2 W (lowest power). However, when wet, the laser failed to penetrate the swabs and neurosurgical patties, even after 180 s of continuous application. Gloves (single or double layer), and ET cuffs were penetrated in less than 1 s at 2 W. Time to penetrate a size 6.0 ET tube at 2 W continuous setting increased from <1 s at 90° to 42 s at 45°. These data are essential for anyone using CO₂ lasers for the resection of head and neck tumours. The importance of keeping laser consumables wet throughout the procedure is highlighted. The angle at which the laser hits the ET tube may impart some protection against airway fire but the data support the need to cover the ET tube with damp swabs or neuropatties when possible.     

Ultrasound-guided procedures for the office

Ultrasonography has an ever increasing role in the management of a wide variety of diseases affecting the head and neck. While ultrasonography is most commonly used for imaging of thyroid pathology, it also can be utilized in a host of diagnostic and therapeutic procedures. This article reviews the office-based ultrasound-guided procedures in the head and neck and discusses technical considerations for performing these interventions.     

HIV protocol for the pediatric otolaryngology office

With the increasing awareness and concern over the transmission of human immunodeficiency virus (HIV) to health care providers, the development of a reasonable approach to patient care is necessary with those suspected of or documented as being HIV-positive. Children are all too frequently the innocent victims of this deadly disease and will often require the services of the otolaryngologist for evaluation, diagnosis, and treatment. In order to provide appropriate care for these children and reduce the risk of possible contamination of health care professionals or other patients a protocol was established for the Pediatric Otolaryngology Division of Children's Hospital at Washington University. This protocol is discussed in detail with explanation of rationale and alternatives.     

Computerized plastic surgery office

PURPOSE OF REVIEW: Technology in general and computer capabilities in particular are growing at an exponential rate. Keeping current with the latest technological capacities and means of incorporating this technology into the facial plastic surgeon's office poses a significant challenge. This review will document the most appropriate method of incorporation and the latest available technological tools. RECENT FINDINGS: Recent developments in wireless networking, systems integration, digital photography and video, powerful inexpensive computer systems, and the growth of personal digital assistant integration have all contributed to a surge in technological advances. Implementing any or all can significantly benefit the busy facial plastic surgery office. SUMMARY: Keeping abreast of technological advances is a daunting task. Adaptation of these advances into the office can at times be overwhelming. This review will assist the practicing physician in incorporating selective technological tools to streamline his or her systems and increase efficiency.     

Laser application in the tracheobronchial tree

The use of lasers has greatly expanded our ability to treat diseases of the tracheobronchial tree. We must be aware of the advantages and disadvantages of each particular wavelength. In addition, the specific safety precautions for each laser wavelength must be followed closely.     

Cyanoacrylate in myringoplasty - an office based procedure

Graft failure continues to be a problem for surgery of the perforated eardrum. We present our experience of six cases managed using commercially available superglue (cyanoacrylate) for myringoplasty. This method is simple, office based, less time consuming and cost effective. An insulin syringe was used to deliver the glue after a temporalis fascia graft was tucked under the edges of the perforation.     

The asepsis problem at the office of the ENT physician

Microorganisms were determined in a microbiological study in the near environment of ENT working places. We found especially saprophytic flora as Micrococcus sp., Staphylococcus epidermidis and aerobic spore-forming microorganisms on 54 examination instruments of 2 outpatient and 2 inpatient treatment areas. In 22% of the instrument examinations, microbiological controls were negative. There were no pathogenic microorganisms.