Usefulness of ND:YAG laser in head and neck surgery

Nd:YAG laser is widely used in surgery as well as in otolaryngology and head and neck surgery for 25 years. This type of laser is characterized by low absorption in water and haemoglobin, deep penetration to the tissue and high ability for vessels coagulation. The laser light can be guided with glassfiber and can be focussed with handpices and micromanipulators. These characteristics make Nd:YAG laser very useful surgical instrument, especially in ORL and head and neck surgery. One institution's experiences, based on 300 operations with Nd:YAG laser are presented and discussed. Main indications to Nd:YAG laser operations in our material were: malignant neoplasms of oral cavity, pharynx and larynx, papillomas and haemangiomas of mucosa of upper respiratory tract, tracheal stenoses, scars of the larynx after partial laryngectomies and snoring and sleep apnoea syndrome. In our opinion, Nd:YAG laser has high usefulness in treatment of malignant and benign head and neck neoplasms, as well as in laryngeal scars and treatment of snoring. In cases of post intubation tracheal stenoses and in cases of post strumectomy bilateral paralysis of larynx the treatment results were not satisfactory. High usefulness of Nd:YAG laser results from very good coagulation ability and wide possibility of transmission of laser light with glassfiber.     

Management of epistaxis in hereditary hemorrhagic telangiectasia by Nd:YAG laser and quality of life assessment using the HR-QoL questionnaire

The purpose of this study was to describe the results of Nd:YAG laser application in hereditary hemorrhagic telangiectasia (HHT) patients and to measure the Health-Related Quality of Life (HR-QoL) in patients with HHT before and after Nd:YAG laser application in a prospective, clinical trial at a university hospital. Twenty-seven consecutive patients with HHT and mild to moderate degrees of epistaxis were followed-up for 2 years after Nd:YAG laser treatments. Recurrence of epistaxis after Nd:YAG laser application and measurement of HR-QoL using the International Quality of Life Assessment questionnaire, version 1.1 (IQOLA 1.1), was found. Eight patients (30%) received only one Nd:YAG laser treatment, 15 (56%) had a recurrence and received a second treatment and 4 (14%) had two recurrences and received three Nd:YAG laser treatments. HR-QoL was improved 2 years after the first Nd:YAG laser application in both its Physical Health Dimension (47.5±2.9 vs. 38.1±2.3 before treatment, P <0.05) and Mental Health Dimension (45.1±2.7 vs. 39.6±2.4 before treatment, P <0.05). Although no curative treatment for HHT exists, Nd:YAG laser treatment seems to constitute a simple and efficient method of epistaxis control, resulting in a significant improvement in quality of life.     

Ergebnisse einer In-vitro-Studie und erster klinischer Anwendung eines kombinierten Ho:YAG-/Nd:YAG-Lasers

BACKGROUND AND OBJECTIVE: A combined Ho:YAG/Nd:YAG laser produces light with properties similar to the beams of the mainly coagulating Nd:YAG laser and the cutting CO2 laser alone. PATIENTS/METHODS: The combined laser was tested in vitro on pig tissue. Additionally, we used this new combined tool for enoral operations. RESULTS: An effect of the pulsed Ho:YAG laser was explosive-like tissue disruption and sprinkling of fragments. Simultaneous use of the Nd:YAG laser resulted in an enlarged zone of coagulation. Clinically, the laser-assisted intervention was inferior to the classic operational methods. CONCLUSIONS: Comparing the established CO2 laser and the Ho:YAG laser, the latter showed only the advantage of delivery via a flexible fiber. Sprinkling of tissue fragments and wide incisions are oncologically problematic. We conclude that this new tool is of minor value for otorhinolaryngologists and head and neck surgeons.     

Bioinhibition of human fibroblast cultures sensitized to Q-switch II dye and treated with the Nd: YAG laser: a new technique of photodynamic therapy with lasers

Kodak Q-switch II dye has recently proven to be an effective biostimulative agent on normal human fibroblast cultures. The potential for this dye as a new chemosensitizing agent for the treatment of connective tissue diseases and wound healing with the Nd:YAG laser was examined. Two normal fibroblast cell lines were first sensitized to a nontoxic dose of Q-switch II dye, then subjected to treatment with an Nd:YAG laser at 1,060 nm, with varying levels of energy and temperatures determined by a reproducible method of dosimetry. The results indicate that Q-switch II dye at nontoxic doses of 0.1 micrograms/ml enhances the cytotoxic effects of the Nd:YAG laser at temperatures as low as 36 degrees C. Furthermore, at physiological temperature ranges as low as 24 degrees C to 34 degrees C, cell duplication was inhibited, but cell viability was not affected. Similar results were not observed when fibroblast cultures were treated with the laser alone. These observations suggest that Q-switch II dye is an effective chemosensitizing agent for the Nd:YAG laser and could potentially be used to reduce collagen deposits in conditions such as keloids and hypertrophic scars.     

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.     

Domestic 1.44 mcm Nd:YAG laser in combined treatment of dacryocystitis complicated by abscess formation

We have treated 12 patients with acute dacryocystitis complicated by abscess formation. All the patients were examined by an ophthalmologist and otolaryngologist. The patients received intravenous antibiotics followed by Nd:YAG laser dacryocystorhinostomy via transcanalicular approach under the endonasal endoscopic control. The treatment resulted in resolution of symptoms and signs of acute dacryocystitis complicated by abscess formation in all the patients. No recurrence of acute dacryocystitis occurred during the median follow-up period of 11 months. Ostium patency defined as the absence of epiphora and observation of irrigated lacrimal fluorescein at the ostium was achieved in 9 patients. Epiphora recurred in 3 cases. Use of Nd:YAG laser reduces the duration of the operation and provides maximal functional and cosmetic results.     

Dose-related tissue effects of the CO2 and noncontact Nd:YAG lasers in the canine glottis

Objectives: The CO₂ laser is the standard for control of recurrent respiratory papillomatosis because of its predictable action on laryngeal tissue. The noncontact neodymium:yttrium aluminum garnet (Nd:YAG) 1064-nm laser is generally not used in the larynx owing to the lack of data on its tissue effects, and its potential lack of safety in the larynx. Combined Nd:YAG and CO₂ laser treatments have been used safely in the tracheobronchial tree to eradicate recurrent respiratory papillomas. The objectives of this study were to describe and evaluate a method for applying the noncontact Nd:YAG laser to the larynx, to compare the tissue effects of the Nd:YAG, CO₂, and combined Nd:YAG and CO₂ lasers in the canine larynx, and to extrapolate canine tissue data to the human. Methods: The CO₂, Nd:YAG, and combined Nd:YAG/CO₂ lasers were applied to the glottis in four mongrel dogs. Laryngectomy was performed and the tissue was examined histologically. The nature and degree of tissue injury were analyzed relative to laser type and energy data. Results: In the canine larynx, the CO₂ laser vaporized the surface epithelium and caused varying degrees of edema and necrosis of the lamina propria. The Nd:YAG laser did not cause ulceration but did show a greater degree of thermal damage to the lamina propria. Combined Nd:YAG/CO₂ applications resulted in separation of the perimysial fibers from the muscle fibers of the vocalis muscle. Conclusion: These findings suggest that the noncontact Nd:YAG laser can be applied in a controlled fashion to the canine larynx at appropriate power densities. Anatomical differences between human and canine larynges are considered. Extrapolation to humans is proposed. Key Words: Laser, larynx, tissue effects, papillomatosis.     

Wedge turbinectomy: a new combined photocoagulative Nd:YAG laser technique

OBJECTIVES: To demonstrate that Nd:YAG laser photocoagulation using a combination of interstitial and contact approaches in the surgical treatment of inferior turbinate hypertrophy yields improved results in terms of postoperative nasal patency, complications, and relapse. STUDY DESIGN: A group of 121 patients with symptoms of nasal obstruction due to hypertrophied inferior turbinates were treated between January 1994 and December 1997 at the Otolaryngology-Head and Neck Surgery Unit of the Main Military Hospital of Rome using the wedge turbinectomy, a new endonasal laser technique. METHODS: This is a combined photocoagulative procedure performed under local anesthesia. In the first surgical step we perform interstitial photocoagulation using Nd:YAG laser and in the second step we use a contact approach, making two strips of photocoagulated mucosa running side by side from the tail to the head of turbinate. RESULTS: At 1-year follow-up, the complication rate in all our patients treated with this laser technique was very low and we achieved a steady improvement in nasal patency in 104 patients (85.9%). The relapse rate was approximately 14%, but we observed that 65% of the patients who experienced long-term failure were affected by allergic rhinitis. CONCLUSIONS: An accurate preoperative evaluation of the cause of the turbinate hypertrophy is fundamental to achieving better results after laser turbinectomy and reducing the risk of relapse.     

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.     

Ultrasound-Guided Interstitial Nd: YAG Laser Treatment of Voluminous Hemangiomas and Vascular Malformations in 92 Patients

In many cases voluminous vascular anomalies of the head and neck region are still treated with conventional surgery, although neodymium:yttrium-aluminum-garnet (Nd:YAG) laser therapy offers a valuable treatment alternative. Ninety-two patients with voluminous hemangiomas and vascular malformations were treated with interstitial Nd:YAG laser therapy (power density, 1300 to 3300 W/cm²), partly complemented by a noncontact-mode Nd:YAG laser light application (energy density, 1000 to 2500 J/cm²). The vascular tumors had a diameter of more than 3 cm in at least two dimensions. Treatment was carried out under ultrasound and manual control. Nearly 60% of the patients (n = 55) showed a complete clinical regression. Thirty-three patients (35.8%) had a partial regression and were satisfied with the treatment outcome. Four patients were treated unsuccessfully with the laser, and three of them subsequently underwent conventional surgery. Only nine of the 92 patients (9.8%) showed cosmetic or functional impairments. The results of this first consecutive series study with a retrospective clinical evaluation of the interstitial Nd:YAG laser therapy of voluminous hemangiomas and vascular malformations in a large patient group demonstrate a high effectiveness of this novel therapy modality.     

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.     

Histological changes in elastic components of soft palate scars after CO2 and contact Nd:YAG laser incisions in the dog as an experimental model

Soft palate stiffening operations — often with CO₂ or contact Nd:YAG lasers — have been used recently to treat patients with pronounced snoring. Differences in soft palate scars formed after CO₂ and contact Nd:YAG laser incisions were studied in an animal model to determine which of these lasers produces a more rigid scar and consequently might be more effective for a soft palate stiffening operation. Six mongrel dogs were placed in each laser group, after which either the CO₂ or Nd:YAG laser was used to make a 1.5-cm-long soft palate incision. The scars produced were then excised and studied histologically 4 weeks postoperatively. Special attention was paid to collagen density and elastin fibers in the scar tissue. After contact Nd:YAG laser incisions scar tissue was found to contain densely aligned collagen fibers and practically no elastin fibers. CO₂ laser incisions produced significantly different scars: irregularly arranged collagen fibers with some elastin fibers also inside the scar tissue. Differences in the shapes of the scars and wound contractions were also found that were only seen after contact laser incisions. These findings suggest that the contact Nd:YAG laser might be more effective for soft palate stiffening operations.     

Flexible Nd:YAG laser palliation of obstructive tracheal metastatic malignancies.

Flexible Nd:YAG endoscopic laser surgery may become an effective new modality for palliation in patients with obstructive endotracheal metastatic malignancies. We report the results of the treatment of two patients with severely obstructing intraluminal tracheal metastatic melanoma and medullary thyroid carcinoma, using the neodymium-YAG laser via the flexible fiberoptic bronchoscope. Both patients complained of significant dyspnea, orthopnea, cough, and hemoptysis and were not candidates for rigid bronchoscopy because of underlying medical contraindications and anatomical problems. Multiple treatment sessions were used with treatment intervals of 1 to 2 weeks. All treatments were performed in the operating room under sedation, without intubation, with topical lidocaine and standard superior laryngeal nerve block. Successful relief of airway obstruction with complete regression of the endotracheal masses was achieved and no recurrences were seen after 9 months' follow-up. Flexible Nd:YAG laser bronchoscopy offered an alternative for the relief of obstructing endotracheal or bronchial malignancies in patients in whom the rigid bronchoscope could not be passed. it seemed to prolong survival in selected cases, and provided definite improvement in quality of life.     

鼻咽癌局部复发或残留病灶的Nd：YAG激光手术挽救治疗

目的 探讨Nd:YAG激光手术挽救治疗鼻咽癌放射治疗后鼻咽局部复发或残留的可行性和临床疗效。方法在鼻内镜下经鼻腔Nd:YAG激光,对35例鼻咽癌经根治性放射治疗后鼻咽局部复发或残留病灶进行治疗。手术在局麻下进行,在鼻内镜直视下,激光功率调整在50W左右,YAG激光光纤经同侧或对侧鼻腔导入鼻咽部,气化切除肿瘤病灶。部分患者术后接受了再放射治疗,放射剂量20-60Gy不等。结果 手术均顺利完成。术后3年、5年生存率分别为51.4%、30.3%。结论 鼻内镜下Nd:YAG激光挽救手术是治疗鼻咽癌放射治疗后鼻咽局部复发或残留的有效手段,丰富了鼻咽癌放射治疗失败后的外科治疗手段。术后是否再需放射治疗,视具体情况决定。     

A comparison of the carbon dioxide and neodymium: YAG lasers in a canine model of acquired subglottic stenosis

In a previously defined canine model of subglottic stenosis, two different wavelength lasers--the carbon dioxide (CO2) and the neodymium-yttrium aluminum garnet (Nd:YAG)--were used as the principal surgical therapy, and the results were compared. Two lathyrogenic agents, colchicine and penicillamine, were also used in a subset of each treatment group in order to determine their effect as an adjunct to laser therapy in the treatment of subglottic stenosis. The CO2 laser treatment group showed an overall improvement; the Nd:YAG laser treatment group showed a worsening of subglottic stenosis. The dogs treated with the lathyrogenic agents had no added benefit from the use of these agents.     

Nd:YAG激光与射频治疗鼻腔利特尔区出血的疗效比较

目的比较Nd:YAG激光与射频治疗鼻腔利特尔区出血的效果.方法576例鼻出血患者,Nd:YAG激光治疗390例,射频治疗186例,随访时间6～12个月.结果两组的治愈率分别是77.4%和95.2%(P＜0.05);治疗后需鼻腔填塞的比例分别是44.4%和12.9%(P＜0.05);需再次治疗比例分别是15.8%和6.5%(P＜0.05).两种治疗方法差异有显著性意义.结论在鼻出血治疗中,射频更方便有效.     

Effects of the autonomic nervous system function on the course of postoperative period in surgical removal of vocal cords polyps with Nd:YAG-laser

The study of the effects of autonomic nervous system (ANS) function on the course of the postoperative period after removal of the vocal cord polyps with Nd:YAG laser has shown that laryngeal operations with utilization of Nd:YAG laser accelerate normalization of structural-functional condition of the vocal cords in patients with adequate autonomic support by 25-40 days compared to those with inadequate ANS function.     

Use of the neodymium/yttrium aluminum garnet laser in middle ear surgery: a preliminary report

Clinical usefulness of the neodymium/yttrium aluminum garnet (Nd:YAG) laser in surgery of the middle ear is unproven. An animal study was designed to examine the influence of Nd:YAG laser irradiation on cochlear potentials following vaporization of the stapes. Electrocochleagraphic changes were observed in two of the five animals studied, and caution is advised before using this instrument in humans.     

CO2激光与掺钕钇铝石榴石激光治疗声门型喉癌手术并发症的比较研究

目的 比较CO2和掺钕钇铝石榴石(Nd:YAG)两种激光治疗声门型喉癌的手术并发症的发生率,并探讨减少并发症的有效方法.方法 采用回顾性分析1999年1月1日至2008年12月31日在北京大学第一医院耳鼻咽喉头颈外科接受支撑喉镜下CO2和Nd:YAG激光治疗的83例患者的临床资料,比较两组并发症的发生率.CO2激光治疗组32例,其中原位癌2例,T1N0M021例,T2N0M0 8例,T3N0M0 1例,采用非接触式脉冲激光;Nd:YAG激光治疗组51例,原位癌3例,T1N0M0 36例,T1N2M0 3例,T2N0M0 9例,采用光纤接触式激光.结果 CO2激光并发症共4例(12.5%),其中喉软骨膜炎1例(3.1%),舌体麻木1例(3.1%),门齿松动1例(3.1%),皮下气肿1例(3.1%);Nd:YAG激光并发症27例(52.9%),其中术后出血2例(3.9%),呼吸困难5例(9.8%),喉软骨膜炎7例(13.7%),肺部感染4例(7.8%),舌体麻木2例(3.9%),咽颈瘘1例(2.0%),声带固定4例(7.8%),喉狭窄2例(3.9%).结论 Nd:YAG激光较CO2激光更易发生手术并发症,少数并发症需要紧急处理,通过适当预防措施可以减轻并发症,避免严重后果.     

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.