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.     

Indication of laser in ENT and head & neck surgery

Indication of LASER in E.N.T. and Head—Neck surgery have been discussed along with some basic knowledge of LASER.     

Postoperative bleeding after laser surgery in head and neck tumors

BACKGROUND: There are different reports in the literature how often postoperative hemorrhage occurs after laser resection of head-and-neck tumours. This retrospective study investigates the frequency of postoperative hemorrhage after laser surgery of head and neck tumours. Time and extent of bleeding have been considered as well as the localization of the primary tumour and possible general risk factors. METHODS AND PATIENTS: Between 1998 and 2001, microscopic laser surgery was performed in 223 patients with previously untreated squamous cell carcinomas of the oral cavity, oropharynx, supraglottic and glottic region and the hypopharynx. In case of ultrasonographic or palpable evidence of cervical lymphadenopathy surgery included subsequent neck dissection. The mean age of the patients was 59.2 year. RESULTS: Postoperative bleeding occurred in 14 out of 223 patients (6 %). It was 9 % for oral carcinoma, patients 10 % for oropharyngeal carcinoma, 5 % for supraglottic carcinoma and none for glottic and hypopharyngeal carcinoma. 5 patients were treated conservatively, 4 patients were controlled bei cautery and ligation, 1 patient was treated with ligation of the lingual artery and in 2 cases ligation of the external carotid artery was performed. 1 patient had a fatal hemorrhage. CONCLUSIONS: Laser-surgical resection of head and neck carcinomas does not lead to a higher incidence of bleeding complications compared to ordinary surgery.     

Twenty-five years experience with laser surgery for head and neck tumors

During the last 25 years, the treatment of tumors arising in the upper aerodigestive tract has changed fundamentally. Whereas surgery in the 1970s aimed at radical block resection and defect repair from outside, the establishment of transoral laser microsurgery marked a new era of organ- and function-preserving therapy. An international symposium, held on 10 and 11 June 2005 in Göttingen, was dedicated to a critical review and assessment of the current role of laser surgery for the treatment of head and neck cancer. Experts from five continents presented their experiences and scientific results and had an intensive exchange with participants from different countries. The topics of the symposium were focused on the surgical principles of laser resection, the oncological and functional results in comparison with traditional therapy, the difficulties and limits of laser surgery in distinct anatomical regions and on the role of radiotherapy. This report summarizes the most important results and statements and gives an overview of actual developments. The names and addresses of the participants mentioned in this report are appended below.     

Same-day-stay head and neck surgery

The purpose of this study was to determine if selective head and neck surgical procedures on a same-day basis are justifiable. Two hundred consecutive head and neck same-day procedures were reviewed, including 84 parotidectomies and 116 other procedures previously managed as inpatients. Of the 200 patients, 36 (18%) were admitted, 33 for overnight observation, and 164 (82%) were discharged the same day. There were no complications reported in the discharged patients and a later questionnaire showed that 97% of the patients were satisfied. The advantages of selective same-day procedures outweigh the disadvantages for otolaryngologist and patient. The study shows that same-day-stay head and neck surgery for selective procedures is safe, reasonable, and cost-effective, but the combined efforts of the otolaryngologists, nurses, and administrators are required. Because of rising healthcare costs, experts are predicting a significant increase in the next few years of outpatient surgery, including surgery of the head and neck.     

Infrared laser tissue ablation: holmium:YAG laser surgery.

The in vivo tissue ablation characteristics of a pulsed holmium:YAG laser (lambda = 1,980 nm) were studied. The laser energy was coupled onto nylon fibers 400 and 600 microns in core diameter. Laser incisions were made on white rats at different sites of the tongue and of the mucous membranes of the oral cavity. Power settings of 500 and 1,000 mJ/2.5-ms pulse at 5 pulses/s were used and the tissue responses examined by light microscopy. Wound healing was studied over a 6-week period. The results of this study are promising for future application of the holmium:YAG laser in otorhinolaryngology.     

Normovolemic hemodilution in head and neck surgery

As the transfusion risks to which patients are exposed are gradually understood, every effort is being made to find both a valid and safe alternative to homologous blood transfusions. Bearing this in mind, the most sensible solution appears to be the practice of a self-donor procedure with normovolemic hemodilution prior to elective surgery. However, even repeated bloodlettings do not modify the oxygen delivery to tissues since, with a reduction in the hemoglobin content of the circulating blood, there is a corresponding increase in oxygen availability. Since the reduction of circulating erythrocytes brings with it a reduction in blood viscosity, there is in turn an improvement in the microcirculation. The generally better tissue oxygenation, the reduction of the blood's viscosity and the increased circulatory perfusion all also favor a prophylaxis against deep vein thrombosis. We have currently performed 72 surgical procedures for head and neck neoplasms that were undertaken at the Clinical ENT Division of Treviso Hospital precisely with the normovolemic hemodilution described above. The self-donor transfusion technique was adopted with the help of the hospital's transfusion service. We have analyzed the data relative to this method and have found that the normovolemic hemodilution represents the treatment of choice in surgery-induced stress, particularly since this approach allows a better tissue oxygenation.     

头颈肿瘤术后并发肺栓塞

目的　提高对头颈肿瘤术后并发肺栓塞的诊断意识。方法　回顾性分析中国医学科学院中国协和医科大学肿瘤医院头颈外科 1993～ 1999年头颈肿瘤手术后发生的 5例严重急性肺栓塞患者的临床资料。结果　同期共行头颈肿瘤手术 5 80 1例 ,手术后死亡 39例 ,发生严重急性肺栓塞 5例 ,其中 4例因漏诊、误诊未能给予及时正确的治疗 ,于 2h内死亡 ,占同期术后死亡的 10 3% (4/39) ;仅 1例得到正确诊断 ,经积极溶栓治疗存活。结论　急性肺栓塞是头颈肿瘤术后导致死亡的严重并发症 ;及时正确诊断与治疗可以挽救患者生命     

Self-retaining retractors in head and neck surgery

The Norfolk and Norwich retractor is a vital tool in head and neck surgery. It is of great aid in training junior surgeons and has become an integral part of the standard neck dissection instrument set in our unit. This retractor enables good exposure of the carotid sheath, its atraumatic blunt tip retracting the carotid sheath without damage. It makes a single skin incision for neck exposure possible, rather than a Y, T or wine glass incision, avoiding a three-point junction, especially in the post-irradiated neck. In thyroid surgery it reduces the need for manual retraction thereby relieving the assistant surgeon and enhancing the quality of the learning experience.     

Ophthalmoplethysmography in head and neck surgery.

Ophthalmoplethysmography (OPG) is a simple, noninvasive diagnostic test in which the cerebral hemispheric blood flow can be indirectly measured. Its use in head and neck surgery is invaluable because it enables the surgeon to predict preoperatively whether a patient will survive carotid artery resection. In a three-year period, nine patients have survived carotid resection on the basis of favorable OPGs, without a death or permanent neurologic complication. A comparison of the results of OPG testing with intraoperative measurement of internal carotid artery pressure showed close correlation in 14 of 20 patients who were tested. Lack of correlation in four patients can be explained by the circumstances of the intraoperative test. This study's findings demonstrate that this test has high clinical reliability.