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OTORHINOLARYNGOLOGY
LASER
By:INDERDEEP SINGH
ARORA
LASER HISTORY
ACRONYM FOR Light Amplification by Stimulated Emission
of Radiation
A laser is a device that produces and amplifies light by
stimulated emission. It can produce light in the
ultraviolet, visible, and infrared region of the
electromagnetic spectrum.
1960: Theodore Maimen develops first laser (ruby with
694 nm wavelength.
1961: Neodymium-doped (Nd): glass laser.
1964: Nd:YAG and argon ion (Ar).
1965: CO2 laser.
LASER
random.
Contd
A photon released from an excited
fluorescein)
Semiconductors Gallium-Arsenide-Diode laser
Excited dimer(Eximer Laser)-- Argon fluoride (193 nm)
and
Nd:YAG
Argon
KTP
532
Wavelength (nm)
10,600
1060
488-514
Tissue absorption
high
low
selective
high in blood
Tissue penetration
0.1
Coagulation
low
high
medium
Cutting effect
high
low
low
selective
high in blood
1
medium
low
Laser-tissue interactions
The active lasing medium in the laser tube
The delivery system
Reflection
Absorption
Photothermal effects
Photomechanical effects
Photoablation
Photochemical effects
Conduction
Coagulation
Laser crator
When laser radiation strikes
a tissue, the temperature begins to rise.
10 C 45 C: Conformation change of proteins.
50 C: Reduction of enzyme activity.
60 and 99C: Coagulation begins.
Vaporisation takes place when the temperature
rises to 100C.
Char starts to burn at around
400-500C.
MODES OF LASER
CONTINUOUS :The laser is continuously pumped
Different types of
laser
CO2 Laser
10,600 nm wavelength
Focus to <500 m
Seals blood vessels less than 0.5 mm
Pulsed to accommodate thermal relaxation time, less pain and less
edema
Used in majority of procedures except those requiring coagulation of
larger vessels
No current optical fiber to carry beam
Nd:YAG Laser
1064 nm wavelength (neodymium-doped yttrium aluminum
garnet )
Application
Limitations
KTP Laser
532 nm wavelength (potassium-titanyl-phosphate)
Frequency doubling
Nd: YAG laser passes through a KTP crystal
emission is its wavelength
Oxyhemoglobin is primary chromophore
Fiber optic carrier
Continuous wave (CW) mode to cut tissue
Pulsed mode for vascular lesions
Q-Switched mode for red/orange tattoo pigment
Delivery
HELIUM NEON
LASER
Helium-Neon (He-Ne) laser: The He-Ne laser
Argon Laser
488 - 514 nm wavelength (ion laser) (BLUE GREEN
SPECTRUM)
Oxyhemoglobin is target chromophore
Small spot size (0.1 1 mm) variable in size and
intensity
Flexible delivery system
DIODE LASER
Micromanipulator delivery
The micromanipulator is a device
consisting of a system of lenses
and a mirror with a joystick
attachment.It is attached to the
microscope
Theatre protocol
Illuminated warning signs All
Contd.
Fire extinguishers for
electrical fires A fire
extinguisher containing
CO2 gas or dry powder,
together with a fire
blanket, is positioned in
close proximity to the main
entrance door of the
operating theatre
Protective eye wear
Wavelength-specific eye
wear is provided for all
staff working in the theatre
How anaethesist
manage!
Intubation anaesthesia
Water is fire retardant as well as being a
polyps
Reinkes
oedema
Mucosal bridge
Anterior microwebs
Chorditis vocalis
Chronic trauma-
Contd..
Ulceration and granuloma
Scarring
Subluxation of the arytenoid cartilage
Contd.
Webs and synechiae
Laryngo-tracheal synechiae
leucoplakia
erythroplakia,
speckled erythroplakia
Micro-invasive carcinoma
Verrucous carcinoma
Contd
The KTP/532 wavelength (KTP) is fibre
Minimal bleeding
Minimal postoperative oedema and
crusting
Revision surgery
Ambulatory surgery
Cost benefit
INDICATIONS
Reduction of turbinates
Nasal polypi
Residual peritubal adenoid tissue, stenosis, and cysts
Dacryocystorhinostomy
Laser-assisted septoplasty
Indications for laser functional endoscopic sinus
Surgery
Removal of polypi as a preliminary procedure
to FESS
Manipulation of middle turbinate
Solitary sphenoid or frontal sinus disease
Intraoperative haemostasis
Revision endoscopic sinus surgery
Contd.
Excision of the uncinate process,removal of
bone surgery.
Fibre transmissibility of the KTP beam gives an added dimension to
Laser in otology
External auditory canal
Vascular lesions haemangiomas
,telangiectasias
Aural polyps and granulations
Stenosis of the external auditory canal
Debulking of large, inoperable EAC
carcinoma
Laser reshaping of cartilage
Tympanic membrane lesions
Epidermoid cysts of the tympanic
membrane.
Middle ear cleft
Laser-assisted myringoplasty
Perforations of the tympanic membrane
hearing aids
Cholesteatoma surgery
Laser applications in the inner ear
Cochleostomy
Laser labyrinthectomy
Orofacial Surgery:laser
preference
For vaporisation and cutting in soft tissue, a
Indications
High intensity laser treatment(HILT)
Oral mucosal premalignant leucoplakia
Mucosal haemangiomatous lesions of the
mouth
Temporomandibular joint :Division of
adhesions, coagulation of redundant capsule
in recurrent dislocation, and shrinkage of
retrodiscal tissue, as an aid to retrieval of an
anteriorly displaced meniscus.
Laser hemiglossectomy
Temporomandibular joint disorder pain
Low intensity laser therapy (LILT)
Post-herpetic neuralgia
Idiopathic neuralgia
Intractable ulcerations :Of Pemphigus
vulgaris, Crohns disease, and AIDS
Hazards of laser
Damage caused unintentionally by laser
as laser-generated smoke.
Laser malfunction such as electric shock
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temporally),
high collimation (light waves are parallel
with minimal divergence and thus minimal
dissipation
of energy), and monochromacity (uniform
wavelength).
Monochromatic
Coherent
Collimated
A chromophore may be defined in the broad sense
CRYOTHERAPY:kryos=c
That branch of therapeutics
old
which relies upon its value on
local tissue changes,produced by
rapidly achieved ,profoundly low
temperature.
Procedure based on
JOULE THOMPSON EFFECT-Rapid
expansion of compressed gas
through a small hole produces
cooling.
Dehydration
D if e
frent types of spray
techniques
Cryosurgery Procedure.
As the temperature falls to less than 0C, water
Cryosurgery Procedure.
a continuous
wave. At a given power, it provided
continuous output.
The continuous exposure resulted in
much heating of
collateral, nontarget tissue by
conduction. To minimize
the thermal effect; a pulsed mode
was developed for the