Laser-Assisted Uvulopalatoplasty With Nd:YAG Laser for Sleep Disorders

We evaluated the apnea index (AI), the oxygen saturation above 95% (SA95), the lowest oxygen saturation (LSAT), and snoring before and after laser-assisted uvulopalatoplasty (LAUP) in 106 patients with obstructive sleep apnea syndrome (n=59) or snoring (n=47). Type 1 LAUP was performed in 42 patients and type 2 LAUP in 64 patients. A 50% or greater reduction in AI was observed in 15 patients (35.7%) who underwent type 1 LAUP and 37 patients(57.8%) who underwent type 2 LAUP. Snoring was diminished in 18 (51.4%) of 35 patients who underwent type 1 LAUP and 30 (55.6%) of 54 patients who underwent type 2 LAUP. SA95 and LSAT showed no difference. No serious complications such as significant bleeding, postoperative episodes of asphyxia, nasopharyngeal stenosis, or nasal regurgitation were observed. LAUP was an effective outpatient treatment.     

Management of a Laryngeal Venous Malformation With Nd:YAG Laser and Bleomycin Sclerotherapy

Literature describing neodymium:yttrium-aluminum-garnet (Nd:YAG) photocoagulation and sclerotherapy for laryngeal venous malformations (VMs) is sparse. Here we present a case in which an extensive laryngeal VM in a 28-year-old female was managed through a combination of four serial Nd:YAG laser photocoagulation sessions and four bleomycin injections over the course of 2 years. The treatment plan resulted in resulted in noticeable lesion ablation, mucosalization, and significant improvement in symptoms. To our knowledge, this case is the first instance of bleomycin injection specifically into a laryngeal VM reported in the English medical literature. Laryngoscope, 130:2199–2201, 2020     

The Versatile Contact Nd:YAG Laser in Head and Neck Surgery: An in Vivo and Clinical Analysis

Objective Lasers have been used in otolaryngology as a surgical instrument for more than 25 years, and the CO₂ laser has emerged as the most widely employed surgical laser in use today. However, recent technological advances have made the Nd:YAG laser a challenger as an effective photothermal surgical tool. Study Design and Methods This is a two‐part study. Tissue injury and healing profiles after application of both the CO₂ and Nd:YAG lasers are compared using an in vivo rat tongue model. A prospective clinical review based on the experience of 327 operative cases spanning a 7‐year interval using the Nd:YAG laser, highlighting its various applications and associated complications, is detailed. Results Comparable tissue and healing effects were noted with both lasers in the in vivo rat tongue model with no statistical differences. The clinical application of the laser showed wide versatility in the head and neck with a complication rate of 3%. Conclusion The Nd:YAG laser has proved equivalent in tissue damage and healing to the CO₂ laser. The Nd:YAG laser has proved itself to be an excellent and perhaps superior laser for use in head and neck surgery.     

Interstitial Nd:YAG laser therapy. Color-Doppler imaging (CDI)-guided laser therapy of hemangiomas and vascular malformations

BACKGROUND AND OBJECTIVE: Ultrasound-(US-) guided Nd:YAG laser therapy has been reported to be promising among different other options for treatment of hemangiomas and vascular malformations.The concept of CDI-guided interstitial laser therapy is therefore a further development based on the above mentioned therapeutic regime. PATIENTS AND METHODS: We examined 55 patients suffering from vascular lesions of different localization and extent pre-, intra-, and post-operatively using color-Doppler imaging (CDI). All vascular lesions were classified due to their vascularization pattern.As accurate diagnosis was imperative we decided on possible laser treatment depending on the CDI-classification. RESULTS: Intra-operative use of CDI rendered possible fiber-guidance by sonographic navigation and therefore precise treatment of aberrant vessels and well-perfused tumor areas. In 34 cases (62%) we observed complete, in 21 cases (38%) partial regression of vascular lesions. CDI allowed post-operative proof of diminution of tumor vascularization in all cases. CONCLUSIONS: CDI-guided interstitial Nd:YAG laser therapy is a minimally-invasive technique which allows replacement of conventional surgical procedures while achieving good cosmetic and functional results.CDI broadens the therapeutic possibilities in contrast to the former therapeutic concept of US-guided laser therapy due to pre-, intra and post-operative utilization of this imaging technique while significantly diminishing the intra-operative risk for the patient.     

鼻内窥镜下Nd:YAG激光治疗慢性肥厚性鼻炎

目的：探讨鼻内窥镜下Ｎｄ：ＹＡＧ激光治疗慢性肥厚性鼻炎的疗效。方法：在鼻内窥镜直视下引导Ｎｄ：ＹＡＧ激光光纤,对５７例患者行粘膜下凝固法或局部照射法治疗。结果：治愈１０例（１７．５％）,显效１６例（２８．１％）,改善２８例（４９．１％）,无效３例（５．３％）,总有效率为９４．７％,无并发症发生。结论：与中、下鼻甲部分切除术及额镜直视Ｎｄ：ＹＡＧ激光治疗相比,本治疗手术创面小,出血少,视野清晰,治疗     

Treatment of hemangioma with the neodymium:yttrium-aluminum-garnet laser (Nd:YAG laser)]

Laser therapy and in particular Nd:YAG laser therapy has become of increasing importance amongst the various methods of treating haemangiomas. Nd:YAG laser radiation penetrates deep into the tissue. To avoid undesirable results of treatment, certain treatment guidelines must be observed: to protect the tissue from serious heat damage, the Nd:YAG laser radiation should be applied exclusively with simultaneous tissue cooling. Depending on the location of the haemangioma, this is carried out with ice cubes (if possible, not containing air bubbles) or with an ice-cold Ringer solution. The depth of penetration of the laser radiation can be increased by tissue compression with a piece of ice or with a special glass disc. In very voluminous haemangiomas, the laser light is additionally applied via a bare fibre directly on to the vascular tissue. The laser power densities we use are between 500 and 3,000 watts/cm2. The power chosen depends on the tissue effect of the laser radiation. Blanching of the vascular tissue without carbonisation is aimed at. With consistent observance of the treatment guidelines specified, haemangiomas should be treated as early as possible with the Nd:YAG laser. The treatment principle of "wait and see" is often advocated, but we consider to be obsolete, since cosmetically and functionally unsatisfactory residual scars may remain even after complete haemangioma regression. Moreover, the progressive haemangiomas which often lead to complications cannot be distinguished from regressive haemangiomas. Last but not least, the child and the parents should be spared the (in some cases appreciable) psychological strain of a haemangioma.     

Anthrapyrazoles and Interstitial Laser Phototherapy for Experimental Treatment of Squamous Cell Carcinoma

Interstitial laser therapy (ILT) is an effective palliative treatment for advanced head and neck cancer, but recurrence often is seen at the margin. The objective of the current study was to test combined drug and laser therapy as an experimental approach for improved treatment of human squamous cell carcinoma (SCCA). Human SCCA tumor transplants were grown in nude mice and injected with the photosensitive anthrapyrazole CI-941 before ILT. Intralesional drug injections alone at levels ranging from 60 to 1200 μg/gm of tumor induced a growth delay at the higher doses, but recurrence was seen in all 35 tumors tested. SCCA tumor transplants injected with 240 μg/gm CI-941 followed after 4 hours by ILT with the KTP532 laser led to a complete response rate of 72% (21/29) compared with 45% (13/29) for ILT alone. Laser chemotherapy was a significant improvement compared with ILT when partial and complete responses were combined (P < 0.03). The results provide preclinical evidence that laser chemotherapy may become a useful minimally invasive treatment for advanced squamous cell carcinoma of the head and neck.     

鼻内镜下Nd:YAG激光翼管神经凝固术治疗变应性鼻炎的临床研究

目的:探讨提高治疗变应性鼻炎有效方法。方法:对145例变应性鼻炎的病人,随机分为治疗组与对照组进行疗效观察,对治疗组85例采用在鼻内镜下Nd:YAG激光翼管神经凝固术治疗;对照组6O例采用微波治疗。结果:季节性变应性鼻炎治疗组有效率98.0％,与对照组(66.7％)比较P<0.01。常年性变应性鼻炎治疗组有效率94.3％,与对照组(70.0％)比较P<0.05。治疗组总有效率96.5％(82/85)。结论:鼻内镜下Nd:YAG激光翼管神经凝固术治疗变应性鼻炎,具有疗效显著,操作简单,治疗部位基本准确,创伤小,安全等优点,无鼻出血、眼干、上腭麻木、鼻孔撕裂及牙疼头疼等并发症,有较好的临床应用价值。     

Use of the Nd:YAG laser in otorhinolaryngology]

The Nd:YAG laser is suitable for the treatment of various otorhinolaryngological clinical disorders. These include the palliative reduction of tumor size in sites with difficult access, treatment of hemangiomas and reduction of hyperplastic turbinates. Within certain limits, other indications are treatment of recurrent epistaxis and recurrent polyposis. Palliative reduction of malignancies in the nasopharynx, esophagus, and bronchial system (laser power density: 1500-8000 W/cm2) must sometimes be carried out in several sessions in order to avoid complications due to the laser (i.e., perforation of the bronchial or esophageal wall, lesions of adjacent vessels or nerves). Nd:YAG laser treatment of hemangiomas (500-3000 W/cm2) can lead to excellent results. To avoid excessive thermal lesions, vascular tissue is cooled with ice cubes or with an ice-cold Ringer's solution. The laser process is continued until the onset of tissue blanching. Carbonizations of the tissue are to be avoided. In Nd:YAG laser therapy of hyperplastic lower nasal conchae (approx. 1000 W/cm2), results are based on submucous scarring in which the covering epithelium is maintained. The objective of Nd:YAG laser treatment of recurrent epistaxis in patients with Osler's disease (500 W/cm2) is to reduce the incidence of hemorrhage. Use of the laser in recurrent polyposis is best confined to patients who refuse conventional surgical revision operations. Laser light (500-3500 W/cm2) should only be applied for a short period of time (0.5 s) to avoid creating a rarefying osteitis.     

Combined intratumor cisplatinum injection and Nd:YAG laser therapy

OBJECTIVES/HYPOTHESIS: Interstitial laser therapy (ILT) has become useful for tumor palliation in patients with advanced head and neck cancer. Cisplatinum chemotherapy also is a frequent adjuvant treatment for recurrent tumors, but systemic toxicity limits application. Intratumor cisplatinum injection combined with ILT may improve therapy of these recurrent tumors with reduced toxicity. STUDY DESIGN: Prospective. Tumor transplants were injected with cisplatinum in a gel implant before ILT to evaluate treatment response and toxicity in a preclinical study. METHODS: UCLA-P3 human squamous cell carcinoma tumors were grown as subcutaneous transplants in nude mice and treated by intratumor injection of 2 mg/mL cisplatinum in a slow-release, collagen-based gel carrier 4 hours before interstitial implantation of Nd:YAG laser fiberoptics to induce local tumor hyperthermia. Treatment efficacy and toxicity were followed for 12 weeks after combined drug and laser therapy compared with ILT alone. RESULTS: Combined cisplatinum gel and ILT was a significant improvement (P < .01 by chi-square test) and induced 57% complete responses without regrowth in 21 transplanted tumors compared with only 24% in 21 tumors after ILT alone during 12-week follow-up. Recurrences in both cases appeared to result from nonuniform laser energy delivery within tumors via the implanted fiberoptic tip. CONCLUSIONS: The results of this experimental combined cisplatinum and ILT study suggest it may be possible to improve treatment of advanced head and neck cancer by intratumor injection of gel implants containing the drug followed by interstitial Nd:YAG laser hyperthermia.     

鼻内窥镜下应用Nd:YAG激光治疗鼻深部出血

目的探讨鼻内窥镜下治疗鼻深部出血的临床效果.方法鼻深部出血43例于鼻内窥镜下找到出血点后,用YAG激光治疗,并观察疗效.结果43例中,37例治疗后止血,5例治疗后第1天少许渗血,此后未再出血,1例无效,填塞出血部位后止血,治愈率为97.67%(42/43).随诊3月余,尿毒症1例治疗后半月又出血,再次治疗后未再复发,其余41例无复发.结论在鼻内窥镜下寻找出血点并应用YAG激光治疗,视野清楚,定位准确,治疗方便,创伤及痛苦小,疗效好,是治疗鼻深部出血的有效方法.     

Neodymium YAG Contact Laser in the Treatment of Cancer of the Mobile Tongue

The aim of this study was to evaluate the usefulness of a contact neodymium YAG laser for the treatment of squamous cell carcinoma (SCC) of the mobile tongue in 35 patients. The TNM stage and histologic grade were as follows: T1, n = 20; T2, n = 11; T3, n = 4; and N0, n = 33; N1, n = 2; G1, n = 20; G2, n = 10; and G3, n = 5. The surgical treatment consisted of a hemiglossectomy or resection with adequate margins in 28 cases, and an ipsilateral neck dissection was also performed in 7 patients. Radiotherapy to a mean tumor dose of 62-64 Gy and an elective dose of 50 Gy to the cervical lymph nodes was given to 14 patients. The radiotherapy was preoperative in 12 patients and postoperative in 2. Tongue resection was easily performed using the contact neodymium YAG laser, with a mean operation time of 31 min and intraoperative bleeding varying from negligible to 100 cm 3 . During postoperative follow-up no major complications occurred: cases with minor hemorrhage were easily controlled on the ward and 1 patient had a bleed on the 14th postoperative day necessitating hospitalization. The resection was histologically radical in all cases. During follow-up one patient had a local recurrence (T2N0, G3) and four failed in the neck (T1N0 G2, T1N0 G2, T1N0 G2, T2N0 G2), three of whom were successfully salvaged with a neck dissection and radiotherapy. One patient with osteoradionecrosis was diagnosed and treated curatively. Two patients died of their tongue cancer (T2N0 G3, T2N0 G2), 1 died from a second primary tumor (T2N0 G1) and 2 of intercurrent disease with no evidence of cancer; 30 patients (86%) are still alive with no evidence of disease. The function of the tongue in all patients in this sample was good to satisfactory. The major complaint was xerostomia in the irradiated patients. In conclusion, the contact neodymium YAG laser appears to be suitable for resection of T1-T2 SCCs of the oral tongue. In this limited patient sample T stage or grade did not predict failures in the neck. Biologic predictive markers need to be evaluated.     

Skin approximation using Nd: YAG laser in head and neck surgery

Laser is useful for surgery to cut, coagulate, vaporize and weld the tissue. Recently, low power laser was utilized for the treatment of ulcer, pain and vascular anastomosis. We applied low power Nd: YAG laser irradiation for skin approximation. An experimental study was carried out by using the Nd: YAG laser in approximating the surgically cut skin wound of guinea pigs. Healing of the wound was observed on post operative days of 3, 7 and 21, respectively. Laser approximation for the incised skin showed less scaring and faster healing than conventional suture technique. This laser technique will be beneficial as one of the new procedures of skin suture in clinical practice. The results were discussed from either technical or cosmetic standpoint.     

Nd:YAG 激光结合下鼻甲部分切除治疗常年性变应性鼻炎

目的:总结Nd:YAG激光结合下鼻甲部分切除治疗常年性变应性鼻炎的疗效.方法:应用Nd:YAG激光结合下鼻甲部分切除治疗常年性变应性鼻炎131例.结果:所有病例术后症状和体征均明显改善,1个月后显效率100%;6个月后显效率96.2%,有效率3.8%;1年显效率为93.1%,有效率为6.9%;1.5～2年显效率为87.8%,有效率为12.2%.结论:用本方法治疗常年性变应性鼻炎可获得很好的疗效.     

激光钩突切除术治疗前组鼻窦炎

目的探讨脉冲式NdYAG激光切除钩突治疗前组鼻窦炎的方法和效果.方法为6例前组鼻窦炎患者行表麻后用脉冲式NdYAG激光烧灼钩突,炭化后取出(输出功率10W,25次/s).然后行筛窦开放术和上颌窦开口扩大术.术后随访,行内窥镜检查和复查鼻窦CT.结果6例均痊愈,无并发症发生.结论激光切除钩突结合常规手术治疗前组鼻窦炎有效、安全,方便易行.     

Biostimulative effects of Nd:YAG Q-switch dye on normal human fibroblast cultures: study of a new chemosensitizing agent for the Nd:YAG laser

Kodak Q-switch II is a new chemical with an absorption maxima at 1,051 nm, designed to be used as an Nd:YAG dye laser. The potential for this dye as a new chemosensitizing agent in the treatment of connective tissue diseases and wound healing with low energy Nd:YAG laser was examined. Two normal fibroblast cell lines were tested for sensitivity to various levels of this dye in vitro. These cells were exposed to Q-switch II dye at concentrations of 0.01, 0.1, 1, 10, 50, and 100 micrograms/ml for 1 and 24 hours. Cell viability was assessed by the trypan blue exclusion test. Cell duplication and DNA synthesis were measured by the incorporation of [3H]-thymidine at 6 and 24 hours postexposure to Q-switch II dye. At concentrations up to 10 micrograms/ml, both cell lines tested showed no changes in cell viability. However, at concentrations equal or higher than 50 micrograms/ml, more than 40% of the fibroblasts incorporated trypan blue after 24 hours of exposure to this dye, indicating significant cell destruction. The results indicate that Q-switch II dye is nontoxic to normal human fibroblast cultures and showed significant biostimulative effects on cell duplication at concentrations equal to or lower than 10 micrograms/ml. Further studies will be required to determine the usefulness of Q-switch II dye as a new photochemosensitizing agent for potential biostimulation of wound healing and/or treatment of connective tissue diseases with the Nd:YAG laser (near infrared, 1,060 nm) at "nonthermal" levels of energies.     

YAG激光联合中药治疗常年性变应性鼻炎

对42例常年性变应性鼻炎患者采用YAG激光一次性凝固双侧下鼻甲前端及相对应的鼻中隔前部粘膜，同时加服中药温阳化饮汤治疗。结果：显效19例，有效15例，无效8例，总有效率81％，经6个月随访观察，疗效基本稳定。认为激光加中药疗法有疗程短、痛苦小、简单易行及疗效可靠的优点。     

Effectiveness of Nd: YAG laser therapy on Japanese cedar pollinosis

Many have reported on the effectiveness of laser surgery therapy for perennial allergic rhinitis. However, the suppressive effects of laser irradiation on allergic rhinitis and its symptoms have not been reported in patients with pollinosis. This is because therapeutic effects on pollinosis are difficult to evaluate. The amount of pollen in the air varies during the year, and from year to year. Also, allergic symptoms develop due to exposure to the amount of pollen which is markedly influenced by the weather. In this study, the severity of allergic symptoms in the pollen season was compared between patients treated with early medication, non-treated patients and patients treated with preseasonal contact Nd: YAG laser surgery. Results suggests that laser surgery was effective in reducing the severity of symptoms in patients with cedar pollinosis. Symptoms were milder in the laser group than in the medication group and non-treated group for 3-4 weeks after the start of seasonal pollinosis, although no differences were noted in the early weeks. This may be explained by the fact that laser irradiation reduces the lamina propria of the nasal mucosa, the site of allergic reactions. This also suggests that allergic pollen can't penetrate the mucosal surface which shows squamous epithelization after laser irradiation.