The role of the carbon dioxide laser in treatment of carcinoma of the tongue

Labial Frenectomy using Laser: A Scoping Review

Labial frenectomy is a surgical technique, that aims to remove the frenulum with its attachment to the underlying bone. Frenectomy, is indicated if the frenulum attachment causes midline diastema, gingival recession, hindrance in maintaining oral hygiene, or if it interferes with lip movements and for prosthetic needs. A labial frenectomy can be performed either by the routine scalpel technique, electrocautery, and most recently medical lasers. The aim of this study was to evaluate, whether the laser technique is more effective than the conventional surgical technique, and whether there are differences between the different types of lasers. The scoping review was conducted and prepared on the basis of the indications of the PRISMA guidelines (PRISMA Extension for Scoping Reviews, PRISMA-ScR) of PRISMA checklist, and nine papers were considered admissible to the qualitative analysis for the following outcomes: bleeding during intervention, use of sutures, duration of the intervention, and use of analgesic drugs in the days following the intervention. This review suggests that laser-performed labial frenectomy is faster and offers better intra- and postoperative management; however, due to the limited number of available papers, the final results of the present review are not absolute.

Frenectomy with conventional scalpel and Nd:YAG laser technique: A comparative evaluation

BACKGROUND

Frenectomy is complete excision of the frenum attachment to the underlying bone. Conventional frenectomy with blade has been widely used; however, laser-assisted frenectomy is the most recent alternative.

AIM

The present study aims to compare two methods of frenectomy for the pain experienced, intraoperative bleeding, healing outcome, and need for analgesics.

MATERIALS AND METHODS

Twenty patients with high labial frenum attachment requiring frenectomy were included in this study. Patients were randomly divided into Group A: scalpel group and Group B: neodymium-doped yttrium aluminum garnet (Nd:YAG) laser group. Visual Analog pain score, intraoperative bleeding, number of analgesics used, and healing outcome 3 months postoperatively were recorded.

RESULTS

Group B patients experienced less pain (P = 0.016), less bleeding (P = 0.016), and required fewer number of analgesics (P = 0.008). Healing outcome at 3 months showed no significant difference between the two groups (P = 0.095).

CONCLUSION

Based on the results of this study, it can be concluded that Nd:YAG laser is an efficient and a more comfortable alternative to scalpel for frenectomy.

Comparative study of upper lip frenectomy with the CO2 laser versus the Er, Cr:YSGG laser

Objectives: To compare upper lip frenulum reinsertion, bleeding, surgical time and surgical wound healing in frenectomies performed with the CO2 laser versus the Er, Cr:YSGG laser. Study design: A prospective study was carried out on 50 randomized pediatric patients who underwent rhomboidal resection of the upper lip frenulum with either the CO2 laser or the Er,Cr:YSGG laser. Twenty-five patients were assigned to each laser system. All patients were examined at 7, 14, 21 days and 4 months after the operation in order to assess the surgical wound healing. Results: Insertion of the frenulum, which was preoperatively located between the upper central incisors, migrated to the mucogingival junction as a result of using both laser systems in all patients. Only two patients required a single dose of 650 mg of paracetamol, one of either study group. CO2 laser registered improved intraoperative bleeding control results and shorter surgical times. On the other hand, the Er,Cr:YSGG laser achieved faster healing. Conclusions: Upper lip laser frenectomy is a simple technique that results in minimum or no postoperative swelling or pain, and which involves upper lip frenulum reinsertion at the mucogingival junction. The CO2 laser offers a bloodless field and shorter surgical times compared with the Er,Cr:YSGG laser. On the other hand, the Er,Cr:YSGG laser achieved faster wound healing.

Key words:Frenectomy, upper lip frenulum, CO2 laser, Er,Cr:YSGG laser, laser.

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.

Transoral laser resection with staged discontinuous neck dissection for oral cavity and oropharynx squamous cell carcinoma

Transoral laser resection of oral cavity and oropharynx squamous cell carcinoma (OOSCC) is a widely accepted approach in the absence of cervical lymph node metastases. This study investigated the results of transoral laser surgery and discontinuous neck dissection (ND) for OOSCC with clinically obvious or suspected cervical node metastases. One hundred seventeen patients with infiltrating oral carcinoma were treated for cure with transoral resection of the primary and staged ND. Twenty-nine primaries were classified as T1, 50 as T2, 35 as T3, and 3 as T4. Lymph node metastases were identified in the ND specimen of 36 patients. All patients were followed for a minimum of 3 years unless they died. Estimated tumor-related survival after 5 years is 81% for stage I and II disease of the oral cavity, 86% for stage I and II disease of the oropharynx, 73% for stage III disease of the oral cavity, 65% for stage III disease of the oropharynx, and 21% for stage IV disease of the oral cavity and the oropharynx. Local and regional control of cancer was achieved in 72 (62%) of the 117 patients. Forty-five local and regional recurrences were diagnosed during the follow-up period. Two patients died of distant metastases with no evidence of local or regional recurrence. The combination of transoral laser resection and staged ND for the treatment of OOSCC seems to offer satisfactory cure rates for a selected group of patients. These two minor surgical interventions cause less morbidity than commando-type surgery and lead to low perioperative mortality and morbidity.

Minimally invasive surgery in otorhinolaryngology

Otorhinolaryngology has always strived to improve the diagnostic and therapeutic possibilities of managing afflicted organs by developing technically and conceptually new and advanced treatment techniques. The endeavor to develop methods with minimized patient discomfort during interventional surgery in the head and neck region was an essential motive which gave rise to the discipline of ENT medicine. Since fairly recently, the term "minimally invasive surgery" has become firmly established in the domain of general surgery. The possibility for replacing a substantial number of routine operations by endoscopic procedures with low levels of discomfort for the patient and shorter periods of hospitalization has given the term "minimally invasive" even further wide-ranging significance. The present review endeavors to provide an assessment of the current state-of-the-art in otorhinolaryngology, giving special attention to the historical development and pathophysiological fundamentals of this field.