Lasers in Rhinology-An Update

OBJECTIVES

A wide and evolving range of lasers and their applications often makes it difficult for a busy surgeon to choose the ideal laser for a specific indication. With this in mind, this article aims to summarize the most recent literature concerning laser application in rhinology.

METHODS

A literature search from 2000 to 2020 using the PubMed database was employed. Keywords used included "laser," "rhinology," "endonasal endoscopic surgery," "hereditary haemorrhagic telangiectasia," "rhinitis," "refractory rhinitis," "Inferior turbinate hypertrophy," "dacryocystorhinostomy," "septoplasty," "cartilage reshaping" and "choanal atresia." The most up to date studies published for each rhinology condition that could potentially be treated with laser surgery was included.

RESULTS

Rhinological conditions appropriate for laser applications are discussed. We identified articles related to a number of applications including hereditary hemorrhagic telangiectasia, rhinitis, turbinate surgery, dacryocystorhinostomy, septoplasty, choanal atresia, and sphenopalatine artery ligation, paying attention to the outcomes of the studies and their limitations.

CONCLUSIONS

There is currently no one-size-fits-all laser and therefore being up to date on the latest clinical application results can help the clinician decide which are the best treatments to offer their patients.

Laser-Assisted Control of Epistaxis in Hereditary Hemorrhagic Telangiectasia: A Systematic Review

BACKGROUND AND OBJECTIVES

Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu disease, causes recurrent mucous membrane hemorrhage, especially epistaxis. In this systematic review, we discuss the efficacies of the three most common laser photocoagulation treatments for HHT-related epistaxis.

STUDY DESIGN/MATERIALS AND METHODS

A systematic literature search was conducted in PubMed and MEDLINE from database inception to March 2019. Studies reporting epistaxis outcomes following argon, neodymium-doped yttrium aluminum garnet (Nd:YAG), and diode laser photocoagulation for HHT were included. χ² and Barnard's exact tests were utilized to detect differences in reduced epistaxis frequency and intensity rates.

RESULTS

Fifteen out of 157 published studies met our eligibility criteria, spanning a collective 362 patients. Argon, Nd:YAG, and diode laser therapy reduced epistaxis frequency in 90.4%, 88.9%, and 71.1% of patients, respectively, and reduced epistaxis intensity in 87.8%, 87.2%, and 71.1% of patients, respectively. Diode laser photocoagulation significantly underperformed in both outcome measurements when compared with argon (frequency: P = 0.005; intensity: P = 0.034) and Nd:YAG (frequency: P = 0.012; intensity: P = 0.041). There was no significant difference between argon and Nd:YAG in reducing HHT epistaxis frequency (P = 0.434) or intensity (P = 0.969). Categorizing HHT patients by clinical severity demonstrated a higher rate of improvement in the mild-moderate group compared with the severe group in both argon (P < 0.001) and Nd:YAG (P < 0.001) therapeutic methods. While no significant differences were found in rates of improved epistaxis outcomes between argon and Nd:YAG in mild-moderate HHT patients (frequency: P = 0.061; intensity: P = 0.061), Nd:YAG demonstrated greater rates of reduction in epistaxis frequency (P = 0.040) and intensity (P = 0.028) than argon among severe HHT patients.

CONCLUSIONS

HHT is a lifelong disease, plaguing patients with debilitating epistaxis. Intranasal laser photocoagulation of telangiectasias using argon or Nd:YAG laser therapy can yield improved epistaxis outcomes compared with diode laser photocoagulation. In severe cases of HHT, Nd:YAG laser therapy provides greater improvements in epistaxis outcomes than argon photocoagulation. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Applicability of the constitutive equations for the determination of the material properties of optically active materials

For the description of the optical response of optically active media, different constitutive equations have been proposed and are still used in literature. Here, we demonstrate on potassium titanyl phosphate (KTiOPO₄) by means of ellipsometry that only the symmetric constitutive equation describes the observed spectra properly and allows the unique determination of the gyration tensor.

A Novel Approach to Brachycephalic Syndrome. 2. Laser-Assisted Turbinectomy (LATE)

OBJECTIVE

To introduce a new surgical procedure based on interventional, laser-assisted removal of obstructing turbinate tissue to improve endonasal airway patency in brachycephalic dogs and to confirm the short and long term results using computed tomography (CT) and rhinoscopy.

STUDY DESIGN

Prospective clinical study.

ANIMALS

Brachycephalic dogs (n = 158; 70 Pugs, 77 French Bulldogs, 11 English Bulldogs) referred for treatment of severe respiratory distress because of brachycephalic syndrome.

METHODS

Computed tomography and anterior and posterior rhinoscopy were performed to evaluate endonasal obstruction. Laser-assisted turbinectomy (LATE) using a diode laser was performed as part of a multilevel surgery. Nasal conchae that were causing airway obstruction were removed.

RESULTS

The obstructing parts of the conchae were safely and efficiently removed by LATE, shaping a patent nasal airway in all dogs. The newly developed surgical procedure involved 3 steps: turbinectomy of the (1) concha nasalis ventralis; (2) rostral aberrantly growing turbinates (RAT); and (3) caudal aberrantly growing turbinates (CAT). Complications of the procedure included transient intraoperative hemorrhage in 51 of 158 dogs (32.3%); however, a temporary tamponade was necessary in only 2/158 dogs (1.3%). After 6 months, regrowth of turbinates required resection of possibly re-obstructing tissue in 25/158 dogs (15.8%; 1 Pug and 24 French Bulldogs).

CONCLUSION

LATE is an effective method for creating a patent nasal airway in brachycephalic dogs with intranasal obstruction.

Comparative study of management of inferior turbinate hypertrophy using turbinoplasty assisted by microdebrider or 980 nm diode laser

OBJECTIVE

This study aimed to compare the outcomes of turbinoplasty assisted by microdebrider and by diode laser (980 nm wavelength).

METHODS

Forty patients suffering from bilateral nasal obstruction were randomly divided into two equal groups. One group was managed with microdebrider-assisted turbinoplasty and the other with diode laser assisted turbinoplasty. The patients were followed up for six months post-operatively.

RESULTS

After six months, total success rates were 90 per cent for the microdebrider group and 85 per cent for the diode laser group. There were no significant differences between the two groups regarding success rate, post-operative complications or operative time.

CONCLUSION

These two techniques are equally safe, reliable, successful and non-invasive.

[Selected applications of diode laser in laryngological surgery]

Diode laser due to emitted wavelength and achieved tissue effect appear to be universal tool for broad range of applications in laryngological surgery. The aim of the study was to present variety of applications of this type of laser in the treatment of selected pathologies of the nose, pharynx and oral cavity.

MATERIAL AND METHOD

45 patients with various pathologies of the nose, pharynx and oral cavity were subjected to diode laser treatment under control of endoscopes and video routing system. In the studied group diode laser was used for hyperplastic turbinates treatment, correction of concha bullosa and septum deformations, ablation of nasal polyps and synechiae inside nasal cavity including cicatrical stenoses in the orifice of common lacrimal canalliculus, coagulation of vascular hemorrhagic diathesis, ablation of bleeding granulomas and polyps and treatment of vascular malformations. Results. Endoscopic diode laser surgery enabled for precise and save removal of the pathology accompanied only by minimal intraoperative bleeding. Healing and reepithelization process were normal and even in large postoperative defects do not exceeded 12 weeks. Postoperative complications in the form of cicatrix and synechiae were found in 3 patients.

CONCLUSIONS

Various pathologies may be treated effectively with diode laser if appropriate laser beam parameters and surgical technique is applied.

Mast cell concentration in the wound healing process of incisions made by different instruments

The aim of this study was to compare the concentration of mast cells (MCs) in the healing process of incisions. Thirty rats were submitted to six linear incisions each, performed in the dorsal skin by carbon dioxide (CO(2)) and diode lasers, electrocautery and conventional scalpel. The animals were euthanized at intervals of 0 h, 24 h, 48 h, 72 h, 7 days and 14 days after the incisions had been made. Histological sections were obtained and stained with toluidine blue for identification of MCs, which were manually counted by conventional microscopy in 20 microscopic fields in the border of the incision, near the granulation tissue, or in the area of new collagen formation, depending on intervals. The concentration of MCs was significantly higher in the wounds made by scalpel than in those made by other techniques at 48 h and 72 h. After 72 h the number of MCs was also significantly higher after electrocautery than after incisions made by 4 W CO(2) laser. On days 7 and 14, there was no significant difference in the MC count among the different types of incisions. In summary, the MC concentration varied after different surgical incisions at early phases of wound healing. At the end of the healing process, however, there were similar MC concentrations around the incisions, suggesting that, in standard incisions in the surgical techniques studied, the wound healing process ultimately occurred in a similar pattern.

[Laser vaporization of the prostate: all as it should be?]

Laser vaporization of the prostate currently occupies a prominent place among the surgical options for treatment of benign prostatic syndrome. Particularly the so-called GreenLight laser vaporization with the KTP (80 W) or LBO (120 W) laser has become remarkably widespread throughout the world. There are already 100 of these GreenLight laser systems in use in Germany alone. The introduction of a separate DRG for "laser vaporization" is expected to further increase the significance of this surgical technique. The aim of this study is to evaluate laser vaporization as a whole and to identify possible differences between the different lasers.

Current role of lasers in the treatment of benign prostatic hyperplasia (BPH)

OBJECTIVE

Evaluate the current role of lasers in the treatment of benign prostatic hyperplasia (BPH).

METHODS

The results of a MEDLINE search for randomised trials and case series of the last 5 yr and published review articles were analysed for the safety and efficacy of neodymium:yttrium aluminum garnet (Nd:YAG), potassium-titanyl-phosphate (KTP), and holmium (Ho):YAG laser prostatectomy. The analysis includes 12 reports on randomised clinical trials, 2 comparative studies, 10 review articles, and a total of >5000 patients.

RESULTS

Laser treatment of BPH has evolved from coagulation to enucleation. Blood loss is significantly reduced compared with transurethral resection and open prostatectomy. Visual laser ablation of the prostate and interstitial laser coagulation cause coagulative necrosis with secondary ablation. Long postoperative catheterisation, unpredictable outcomes, and high reoperation rates have restricted the use of these techniques. Ablative/vaporising techniques have become popular again with the marketing of new high-powered 80-W KTP and 100-W Ho lasers. Vaporisation immediately removes obstructing tissue. Short-term results are promising, but large series, long-term results, and randomised trials are lacking. Holmium laser enucleation (HoLEP) allows whole lobes of the prostate to be removed, mimicking the action of the index finger in open prostatectomy. Prostates of all sizes can be operated on. It is at least as safe and effective as transurethral resection of the prostate and open prostatectomy, with significantly lower morbidity. It is the only laser procedure that provides a specimen for histologic evaluation.

CONCLUSIONS

HoLEP appears to be a size-independent new "gold standard" in the surgical treatment of BPH.