Speaking about the CO 2 laser, it is necessary to note its generally recognized effectiveness in soft tissue surgery. The beam of this laser with a wavelength of 10,600 nm is most sensitive to water molecules (H 2 O). Based on the fact that human soft tissues consist of 60–80% water, the absorption of CO 2 laser radiation in them occurs most pronouncedly and efficiently, causing the ablation effect, in other words, the “laser scalpel” effect. Soft tissue ablation is a necessary and clinically significant condition for performing various types of surgery.
The versatility of the “laser scalpel” technique
The versatility of our operating department allows us to use this technique – the “laser scalpel” technique – in surgery, gynecology, plastic surgery, and urology.
Let us highlight the features and advantages of the interaction of the “laser scalpel” with biological tissues:
- there is no direct contact with the tissue, which means there is no risk of infection. The beam cannot be a carrier of viruses and bacteria (including HIV, viral hepatitis B and C). The incision made with a laser is sterile under all conditions;
- sterilization of tissue in the surgical field that has been treated with laser radiation, and the ability to work with infected tissue areas. This opportunity is truly enormous for surgeons.;
- the possibility of one-stage removal of an infected dermal cyst with the application of a primary suture, provided there is no blood loss and fear of a wound hematoma;
- coagulating effect of radiation, allowing to obtain virtually bloodless cuts. Convenience and speed of work. Bloodlessness is a condition that allows the surgeon to work comfortably where necessary. From personal experience: correction of congenital and acquired lip deformations can be performed qualitatively and symmetrically only with a laser beam;
- minimal thermal effects on surrounding tissues and the known biostimulating effect of the laser determine rapid wound healing and a noticeable reduction in the postoperative period.
Thanks to the innovative capabilities of modern CO 2 lasers, namely modulated laser pulse shapes, independent adjustment of ablation depth, power and pulse length, it has become possible to make laser operations as effective and physiological as possible when working with various types of tissues and indications.
It is important to understand that the patient’s safety depends on the competence of the specialist, therefore training doctors in laser technology is a necessary condition for the use of laser technologies in medical practice.
As a classical surgeon, I had an ambivalent attitude towards the laser beam. During professional growth I had to work with several laser systems, but I can consider the beginning of my conscious approach to laser surgery to be the moment when the DEKA CO 2 laser system SmartXide2 was introduced into clinical practice at our Center. The choice of this system was due to its versatility for different areas of medicine and the presence in it of a number of innovative capabilities that directly affect the increase in efficiency and individualization of approaches in surgical practice:
- modulated laser pulse shapes Pulse Shape Design and the ability to select and change them,
- stepwise adjustment of ablation depth, so-called stacks,
- independent adjustment of laser radiation parameters: power, pulse length, distance between points, pulse shape, stacks, geometry of the scanned area, scanning order.
The first use of CO 2 laser in my practice was the removal of benign skin lesions. The use of a laser system has provided undeniable advantages, including the simplicity and speed of the process, clear visualization of the edge of the formation, the ability to work on any part of the body, including the mucous membranes and the mobile part of the eyelid, the aesthetics of the result, and rapid healing.
A disadvantage of laser exposure is the difficulty in taking a biopsy.
Thus, laser exposure can be considered the most acceptable way to remove benign formations.
The use of the SmartXide2 DOT laser to remove subcutaneous formations such as atheroma, fibroma, etc. is also effective. The laser beam allows for precise dissection of layers of skin. The cyst membranes are well visualized. This method is indispensable in the presence of perifocal inflammation and increased bleeding due to tissue plethora. In all of these cases, the formation was completely removed; the postoperative wound was dry and free of bleeding, including capillary bleeding. The wounds were sutured without drainage in all cases. Antibiotic therapy was prescribed. During follow-up examinations, positive dynamics and wound healing by primary intention were noted.
Clinical examples
Clinical case 1
Patient, 32 years old. Transconjunctival bilateral blepharoplasty using laser has been proposed. Through the lower fornix of the conjunctival sac, access was made to the paraorbital tissue (SP 3 W), the excess was ablated (SP 6 W). The wound was closed with single Vicryl 6.0 sutures. In the postoperative period, swelling and bruising were observed to a lesser extent compared to the classical technique. There were no risks of electrical injury to the eye, since an electrocoagulator was not used.
Minuses: the need to use disposable conjunctival screens, which in turn increases the effects of postoperative conjunctivitis.
Conclusions: The technique greatly facilitates the surgeon’s work and ensures less tissue trauma during surgery. For simultaneous fractional laser treatment of the skin of the periorbital area (pseudoblepharoplasty), this method is indispensable.
Rice. 1 a. Photo before surgery
Rice. 1 b. Photo on the 6th day after the operation.
Clinical case 2
Patient, 23 years old. Post-traumatic deformation of the lip. An attempt was made to symmetrize the lips. In an operating room with an electrocoagulator using markings, a simulation was carried out upper lip. The operation lasted 20 minutes, stable hemostasis – +40 minutes. Result: patient is 80% satisfied. After analyzing the results, the patient was offered lip correction using the SmartХide2 laser. In Smart Pulse 6W mode, using a 7” nozzle, ablation of excess and scar tissue of the upper lip was performed. Sutures were placed with Vicryl Rapide 5.0. The patient is recommended to care for the wound until the swelling disappears (up to 14 days). Two months after the operation, the result is 100% satisfactory for the patient and the surgeon.
Minuses laser method corrections: not identified.
Conclusions: At this stage I consider correction of lip deformations with CO 2 laser the best method of the possible.
Clinical case 3
Patient, 44 years old. Plastic surgery of the upper eyelids has been proposed. Excess skin was excised upper eyelid. Ablation of a section of the orbicularis oculi muscle, its dissection and removal of excess paraorbital tissue. The advantages of using a laser are the speed of the operation and the cleanliness of the wound.
Minuses: Due to the large size of the laser handpieces, perfectly calibrated and precise movements by the surgeon are required to obtain a smooth surgical edge.
Rice. 2 a. Photo of the patient before surgery
Rice. 2 b. Photo of the patient 4 months after surgery
Conclusion
The demonstrated clinical cases and results of laser surgery using the SmartXide2 system demonstrated tangible comparative advantage This method is superior to the classical surgical method due to better aesthetics, reduced rehabilitation time, less tissue trauma, excellent wound healing and, as a result, a high percentage of satisfaction with the procedure between the doctor and the patient.
Thus, I consider it clinically feasible and economically justifiable to introduce the considered laser technology into medical practice. I am sure that the dynamic development of laser technologies has already determined a great future for laser surgery.
Lasers have been used in surgical practice for a long time, and many clinics are actively using this technology. But patients still wonder how painless and effective it is? Deputy Chief Physician for Surgery of the MEGI network of clinics for adults and children, Doctor of Sciences Aidar Gallyamov gave an interview to the ProUfu.ru newspaper and answered this question.
– How does a medical laser work?
– A laser device is a unique device that emits a thin beam of light. It contains a huge amount of energy that can cut and weld tissue and stop bleeding. The so-called laser scalpel is based on this operating principle.
Using a laser is actually painless and effective, because it provides:
1. The operation is bloodless, since when making an incision, the edges of the dissected tissues are coagulated and the dissected blood vessels are sealed. Blood loss is practically zero.
2. The accuracy of the surgeon's work. The cut line turns out to be absolutely even, regardless of the density of the tissue (for example, when it hits dense tissue or a bone area, the beam, unlike a conventional scalpel, does not deviate to the side).
3. Complete sterility, it is achieved due to the fact that when manipulating the laser there is no contact with tissues, in addition, the radiation has an antibacterial and antiseptic effect.
4. Painless. Laser treatment is virtually painless and does not require long postoperative rehabilitation.
– There is an opinion that with the help of a laser you can only remove moles, papillomas and treat varicose veins, is this true?
- Only partly. It all depends on the clinic. Some specialize only in data laser procedures, others use the laser for a wider range of operations. In any case, it is very important which medical laser center you choose. The main thing is that the clinic has the most modern equipment. In Ufa, the MEGI network of clinics for adults and children recently opened a Laser Surgery Center. This center presents the latest equipment: seven semiconductor laser systems, four of them from IPG (IPG), the best in the world in terms of quality and equipment capabilities.
– What is the medical use of laser radiation in your center?
- By using laser devices at MEGI you can receive medical care in the following areas: proctology, urology, gynecology, mammology, surgery, phlebology.
In proctology, hemorrhoids are removed with a laser, fissures in the anal canal are excised, neoplasms of the rectum (polyps and condylomas) are removed; minimally invasive operations and vaporization are performed with the help of a laser hemorrhoids without a single cut.
In urology, endourological laser removal of polyps and tumors of the bladder, neoplasms of the urogenital area (polyps and condylomas) is carried out, and is used when performing circumcision. Using a laser to destroy stones urinary tract, this is called contact laser lithotripsy.
In gynecology, lasers are used to remove uterine fibroids and perform ovarian surgeries. It is also used in the treatment of cervical erosion and removal of tumors.
In mammology, almost all operations are performed using laser systems. At cystic mastopathy The puncture method of treatment is widely used - laser ablation of cysts and other neoplasms of the mammary glands.
In surgery, neoplasms of the skin and soft tissues (papillomas, various moles, atheromas, lipomas, fibromas) are removed; used for operations in the abdominal cavity (for endoscopic operations, the laser is indispensable for operations on the liver, spleen, pancreas), eliminating age spots and tattoos.
In phlebology, lasers are used to treat varicose veins, phlebectomy, laser radiofrequency obliteration of veins and spider veins, as well as sclerotherapy.
– How to decide to undergo medical laser surgery?
– As a surgeon, I affirm that there is no need to be afraid of the laser. If you have chosen good clinic With modern operating rooms, where surgical treatments are carried out quickly and painlessly for the patient, you can be sure of an excellent result. Our MEGI center has created all the conditions for this. If necessary and desired, in the early postoperative period the patient can spend some time in the ward under the supervision of experienced medical personnel.
Circumcision (circumcision) is a surgical operation during which the male penis is remove the foreskin. This procedure is optional, but sometimes it is performed for various reasons: medical, religious, etc. Today, circumcision is performed using a traditional scalpel or a modern laser. Which one is better and safer?
The laser method is used not only in circumcision, but also in the removal of various cosmetic defects (moles, papillomas, warts, etc.), erosion of the neck of the shirt. The laser beam “burns” the layers of skin, resulting in the elimination of tumors.
During the operation, the surgeon pulls back the foreskin and pulls it tightly. He then applies a laser beam to the skin and the foreskin is excised. Self-absorbing sutures and a disinfectant bandage are applied to the site of exposure.
The operation is performed under local anesthesia and lasts 20-30 minutes. The advantages of laser circumcision are:
- Minimal trauma. The laser beam excises soft tissue as evenly as possible, without cutting, unlike a scalpel. Thanks to this, pain and swelling in the first days after surgery are not so pronounced.
- No bleeding. The blood vessels are coagulated by the laser, so bleeding does not occur.
- Sterility. Laser radiation heats the layers of the skin, and as a result, all pathogenic microorganisms die under the influence of high temperatures.
- Fast recovery. Rehabilitation after laser circumcision lasts several times shorter than after scalpel circumcision. Patients return to their normal lifestyle (with some restrictions) after 3-5 days.
- High aesthetic result. After laser circumcision, there are no sutures, scars or scars left, since the edges of the wound are sealed and self-absorbing sutures are applied.
- Safety and minimal risk of complications. Inflammatory processes and other pathologies very rarely occur after laser exposure, so this method is the safest.
The only disadvantage of this procedure is its relatively high cost - scalpel circumcision is much cheaper.
The scalpel is the main surgical instrument during operations. It is a small, sharp knife used to cut and excise soft tissue.
Before surgery, the patient must be given painkiller injections. Then the penis is tied with a special thread near the head, so as not to accidentally touch tissue with a scalpel that does not need to be cut off.
After bandaging, the surgeon pulls back the foreskin and excises it with a scalpel. After this, self-absorbing sutures are applied to the site of exposure. Previously, soft tissues were blotted with tampons during surgery to stop bleeding. Today, during the operation, coagulators (electrodes) are also used, which cauterize the blood vessels and stop the bleeding.
Comparison
A laser and scalpel are used to remove the foreskin of the penis, thereby significantly reducing the risk of developing infectious diseases genitourinary system, the hygienic condition of the penis improves (since dirt and various secretions stop accumulating under the head, which are a favorable environment for the proliferation of bacteria), and sexual intercourse is lengthened.
Both methods are equally popular today. The scalpel method is chosen by many patients, since it is more familiar, and many know its principle of action. However, this method, compared to laser, has a number of disadvantages:
- Causes bleeding (but blood droplets are cauterized by electrodes).
- There is a risk of infection.
- The operation takes 2 times longer.
- The doctor may accidentally cut off excess skin.
- Longer rehabilitation period (up to 1 month).
- Unpleasant sensations after surgery are more pronounced than after laser exposure.
Both laser and scalpel circumcision can be performed any age- the operation is performed even on infants a few days after birth.
The contraindications for both procedures are the same:
- Oncological diseases.
- Blood diseases, blood clotting disorders.
- Immune disorders.
- Viral and colds.
- Infectious and inflammatory pathologies.
- Sexual infections.
- Venereal diseases.
- HIV and AIDS.
- Unhealed injuries in the circumcision area.
After circumcision (by any method), visit the sauna, bathhouse, swimming pool, take a bath (wash in the shower), and exercise for some time. Restrictions are usually lifted 2 weeks after surgery.
What's better
Today, laser is safer and in a modern way removal of the foreskin - it does not cause bleeding, carefully excises soft tissue, and has a short rehabilitation period. Therefore, it is preferable to choose this method.
The scalpel method is suitable for those who are not willing to pay a large amount for the procedure. Sometimes surgery for medical reasons is performed free of charge in public hospitals.
Before the operation, you will need to pass some tests (for sexually transmitted infections, HIV, blood and urine tests) and undergo a series of examinations to exclude contraindications. You should also definitely consult your doctor and decide together which method of circumcision to use - laser or scalpel. Sometimes it happens that the foreskin can only be removed with a scalpel. Also, together with the doctor, the patient decides how much foreskin can be removed.
Circumcision must be carried out experienced surgeon. The inexperience of the doctor can lead to serious complications. It is best to pay money and have the operation done in a specialized clinic. It is worth considering that the clinic must have a license.
Developer organization: Federal State Institution "Central Research Institute of Dentistry and Maxillofacial Surgery of the Federal Agency for High-Tech Medical Care."
Medical technology involves the use of a laser scalpel with a working radiation wavelength of 0.97 microns in the surgical treatment of patients with periodontal diseases, oral mucosa and lips, benign neoplasms oral cavity and lips and anatomical and topographical features of the structure of soft tissues of the oral cavity, which allows to increase the effectiveness of treatment, reduce the likelihood of complications and relapses, painful sensations the patient and the time of his incapacity for work.
Medical technology is intended for oral and maxillofacial surgeons who have been trained to operate laser medical devices.
Can be used in dental clinics and departments of maxillofacial surgery.
Reviewers: head Department of Propaedeutic Dentistry of the State Educational Institution of Higher Professional Education "MGMSU Roszdrav" Dr. honey. sciences, prof. E.A. Bazikyan; head Department of Dentistry, State Educational Institution of Further Professional Education "RMAPO Roszdrav" Dr. honey. sciences, prof. I.A. Shugailov.
Introduction
The creation of new medical equipment, based on the achievements of modern science and technology, makes it possible to develop new medical technologies that have undoubted advantages over existing methods. The use of new technologies makes it possible to increase the effectiveness of treatment, reduce the likelihood of complications and relapses, the patient’s pain and the time of his disability. Among these technologies, laser technologies occupy a significant place.
With the advent of new laser surgical equipment in dental practice, it became possible to choose the wavelength of the working radiation and the time mode of operation (continuous, pulsed or pulse-periodic). High reliability, ease of operation, low weight and dimensions allow the use of modern laser scalpels based on high-power semiconductor (diode) and fiber lasers in medical institutions that do not have engineering and technical services, while reducing the cost of their operation. Low sensitivity to external influences combined with low power consumption allows the use of such devices in non-clinical conditions.
Research results have shown benefits laser treatment: coagulation of blood vessels in the incision area, less trauma, asepticity and ablasticity of the wound surface, easier course of the postoperative period, absence side effect on the body, the formation of a thin, delicate, barely noticeable scar.
The laser beam is applied with high precision to areas of biological tissue of any size into groups and individual cells. The most gentle effect on soft tissues and the oral mucosa makes it possible to reduce swelling and the area of thermal damage, and the strength of the edges of wounds after laser exposure allows them to be sutured.
Indications for the use of medical technology
- Periodontal diseases (epulis, hypertrophic gingivitis, pericoronitis).
- Diseases of the mucous membrane of the mouth and lips (long-term non-healing erosion of the mucous membrane of the tongue and cheek, limited hyper- and parakeratosis, erosive-ulcerative form lichen planus, leukoplakia).
- Benign neoplasms of the oral cavity and lips (fibroma, retention cyst of the minor salivary glands, ranula, hemangioma, radicular cyst, candyloma, papilloma).
- Anatomical and topographical features of the structure of the soft tissues of the oral cavity (small vestibule of the oral cavity, short frenulum of the tongue, short frenulum of the upper and lower lips).
Contraindications to the use of medical technology
- Diseases of the cardiovascular system in the stage of decompensation.
- Diseases nervous system with sharply increased excitability.
- Hyperthyroidism.
- Severe and severe pulmonary emphysema.
- Functional kidney failure.
- Severe diabetes mellitus in an uncompensated state or with unstable compensation.
Logistics support for medical technology
Laser scalpel programmable three-mode portable LSP-"IRE-Polyus" with a wavelength of 0.97 microns (NTO "IRE-Polyus", Russia). Registration certificate of the Ministry of Health of the Russian Federation No. 29/01040503/2512-04 dated 03/09/2004.
Description of medical technology
Characteristics of laser radiation and technical characteristics of the laser device
The optimal properties when performing surgical interventions on soft tissues of the oral cavity are laser radiation with a wavelength of 0.97 microns. In Fig. Figure 1 shows the dependence of the wavelength of laser radiation on the magnitude of its absorption in water and whole blood.
This is the main parameter that determines the depth at which laser radiation is absorbed, and therefore the nature of its effect on biological tissues.
Rice. 1.
These dependencies can be used qualitatively to estimate the depth of radiation penetration into real biological tissues. From Fig. 1 shows that the radiation wavelength of 0.97 μm falls on the local absorption maximum in water and blood. In this case, the absorption depth is 1-2 mm. In addition to absorption, the radiation penetration depth is significantly influenced by the dispersion coefficient, the value of which in whole blood exceeds the absorption coefficient and in the specified range is about 0.65 mm -1. Thanks to scattering, radiation in biological tissue propagates not only along the original direction, but also to the sides. In addition, it should be taken into account that during laser exposure the biophysical state of biological tissue and the nature of absorption change. Thus, when heated to a temperature approximately above 150 o C, hydrogen burns out and charring of the biological tissue occurs, at which absorption sharply increases.
The impact of laser radiation on biological tissues can be carried out remotely or through contact. Most often, when working on soft tissues, contact with a fiber instrument is used. During contact action, the distal end of the working quartz fiber, at a distance of approximately 5 mm, is cleared of the protective plastic shell and brought into contact with the biological tissue. The presence of physical contact allows the impact to be accurately localized. Contact with biological tissue eliminates the reflection of radiation into the surrounding space. If the radiation power is sufficient at the point of contact, the light guide becomes contaminated with tissue combustion products and there is an increased release of heat and the resulting heating of the end of the light guide. In this case, the biological tissue is exposed to a combined effect of laser radiation and the hot end of the light guide.
Remote exposure is used mainly for superficial treatment of wound surfaces for the purpose of their sanitation and coagulation. It should be taken into account that the working radiation comes out of the flat end of the light guide in the form of a cone with an apex angle of about 25 o and coincides with the visible radiation of the target laser.
Unique properties laser beam provide undoubted advantages compared to traditional methods of treating oral diseases:
- High precision of laser exposure due to the use of contact technology.
- Minimal blood loss. The good coagulating abilities of laser radiation make it possible to operate on patients with bleeding disorders.
- The shallow depth of the affected area and the evaporation of tissue during laser exposure contributes to the formation of a thin coagulation film on the surface of the tissue, which avoids the risk of bleeding in the postoperative period associated with scab rejection.
- A small zone of thermal damage to adjacent tissues reduces postoperative swelling and inflammatory reaction at the border of the necrosis zone, due to which rapid epithelization occurs, which significantly reduces the time for wound regeneration.
- High local temperature in the affected area creates conditions for sanitation of the operating area and reduces the likelihood of infection of the surgical wound. This helps speed up wound healing and reduces the likelihood of postoperative complications.
- Preservation of the biological tissue structure at the edges of the wound allows the wound to be sutured if necessary.
- Due to the low penetrating power of radiation and minor tissue damage, rough scars are not formed, and the mucous membrane is well restored.
- Treatments performed using laser light are slightly painful, which means the amount of anesthesia can be reduced and, in many cases, eliminated altogether.
Table 1. Specifications LSP-"IRE-Polyus" apparatus.
| Parameter name | LSP |
| Working radiation wavelength, µm | 0,97 + 0,01 |
| Maximum output power at the optical connector, W | up to 30 |
| Targeting laser wavelength, microns | 0,53 (0,67) |
| Diameter of the light aperture in the optical connector, mm | 0,12...0,3 |
| Temporary operating mode | Continuous, pulsed, pulse-periodic |
| Duration of pulses and pauses, ms | 10...10000 |
| Radiation divergence at fiber output | 25 o |
| Optical connector type | SMA |
| Fiber instrument light guide length, m | at least 2 |
| Light transmission of fiber instrument, % | not less than 60 |
| Supply voltage, V | 220+10 |
| Network frequency, Hz | 50 |
| Power consumption, VA no more | 200 |
| Dimensions, mm | 120x260x330 |
| Weight, kg | no more than 9 |
Rice. 2. Appearance LSP-"IRE-Polyus" apparatus.
Methodology
All surgical interventions were performed under local anesthesia using the LSP-IRE-Polyus device (hereinafter referred to as LSP) with a wavelength of 0.97 μm in pulse-periodic and continuous modes, at a power of 2-5 W.
Method for treating patients with benign tumors of the oral cavity
When removing benign and tumor-like neoplasms of the oral cavity and lips (including fibromas, retention cysts of the minor salivary glands, ranulae, hemangiomas, radicular cysts, candylomas, papillomas), two laser methods are used:
- Small tumors (up to 0.2-0.3 cm) are removed using the ablation method (power - 2-4 W, in continuous and pulse-periodic modes with pulse duration - 500-1000 ms, pause duration - 100-500 ms) .
- Neoplasms large sizes(more than 0.2-0.3 cm) are removed using the laser excision method (power - 3-5 W, in continuous and pulse-periodic modes with a pulse duration of -1000-2000 ms and pause duration - 100-1000 ms).
If, according to indications, there is a need to perform a tumor biopsy, it is performed using a laser excision method (laser excision method).
When removing a fibroma, laser excision of the formation is performed using the laser excision method. Under infiltration anesthesia (Ultracaine), the tumor is excised in a pulse-periodic mode with a power of 5 W. The postoperative wound is sutured with Vicryl thread (Fig. 3).
Rice. 3.
A- before treatment;
b- on the 5th day after surgery;
V- on the 10th day after surgery;
G- in 1 month
A laser scalpel can be used to remove almost all types of benign tumors of the oral cavity and lips, including tumor-like formations (radicular cysts). Laser method Treatment of this pathology consists of thorough ablation of the cyst shell in continuous or pulse-periodic modes (pulse duration - 500-1000 ms, pause duration - 100-500 ms) and at a power of 2-4 W. After laser ablation, the cyst shell is easily removed, whereas using the instrumental method this is almost impossible to do without resection of the apex of the tooth root.
Treatment of simple hemangiomas and retention cysts of the minor salivary glands using a laser involves the use of 2 methods of laser exposure:
- Introduction of a light guide into the cavity of a hemangioma or cyst and its ablation. At the same time, the size of the neoplasms: for hemangiomas - 0.5-0.7 cm in diameter, for retention cysts of the minor salivary glands - up to 1 cm in diameter.
- The upper wall of the tumor is opened using a laser beam, the contents are vaporized, and the bed is thoroughly ablated.
When treating this pathology, a continuous or pulse-periodic mode is used with a pulse duration of 500-1000 ms, a pause duration of 100-500 ms and a power of 2.5-4.5 W.
Using the above method, laser excision of the tumor is performed with suturing of the wound by bringing the edges closer together. Under infiltration anesthesia (Ultracaine), two semilunar incisions of the mucous membrane are made with a laser scalpel in a pulse-periodic mode with a power of 4 W. The cyst is removed by semi-blunt exfoliation from the surrounding tissue. For more complete removal After the cyst shell, a thorough ablation of the bottom of the cystic cavity is performed with a laser beam (in the same mode at a power of 2.5 W) (Fig. 4).
Rice. 4.
A- before treatment;
b- during surgery;
V
G- in 1 month
Surgical treatment of patients with periodontal diseases
In the treatment of periodontal tissue diseases, such as epulis, hypertrophic gingivitis, pericoronitis, a power of 3-5 W is used, in continuous and pulse-periodic modes (with a pulse duration of 500-2000 ms and a pause duration of 100-1000 ms).
Among periodontal diseases in outpatient surgical dentistry The most common type of pathology is epulis. In this case, the fiber laser scalpel has the advantage that the laser radiation can be simply applied to any treatment areas via a light guide. Under laser irradiation, the growth point of the epulis in the bone tissue of the interdental septa of the alveoli of the teeth is destroyed. With this method of treatment, relapses are almost completely absent.
When removing the epulis, infiltration anesthesia (Ultracaine) is performed, followed by excision of the formation in a pulse-periodic mode with a power of 6 W (Fig. 5).
Rice. 5.
A- before treatment;
b- immediately after the intervention;
V- in 2 days. after operation;
G- 6 months after surgery.
During treatment hypertrophic gingivitis(Fig. 6) excision of pathologically altered tissue is carried out using laser radiation, also under infiltration anesthesia (Ultracaine) in a pulse-periodic mode with a power of 4 W. Excision of the formation is carried out by laser excision of the soft tissue of the gums to the bone, retreating from the visible border of the pathologically altered tissue by 2 mm. The wound surface is then ablated.
At the site of laser exposure, a coagulation film is formed, which reliably protects the wound surface from saliva and oral microflora. For better fixation of the flap, guide sutures are applied.
Simultaneously (simultaneously) according to indications, plastic surgery of the frenulum of the upper lip is performed (Fig. 6c).
Rice. 6. Treatment of moderate hypertrophic gingivitis
in the area of the frontal group of teeth on the upper jaw,
A- before surgery;
b-immediately after the intervention;
V- after frenulum correction;
G- 1 day after surgery;
d
e- after 6 months after operation.
Pericoronitis is a common complication of difficult eruption of wisdom teeth (according to the ICD 10 classification of the 5th revision, pericoronitis is classified as periodontal disease, therefore pericoronitis is included in this section of pathology). Existing conservative methods of treating pericoronitis are usually unsuccessful, and excision of the hood using the traditional method does not always lead to the desired result. The hood of the wisdom tooth is excised with a laser beam through an oval (edging) incision in the gum 2-3 mm above the neck of the tooth. First, a stroker or spatula is inserted under the hood, slightly pulling the hood away from chewing surface tooth Excision of the hood is carried out with a laser scalpel in continuous or pulse-periodic modes (with a pulse duration of 1000-2000 ms and a pause duration of 100-500 ms) and at a power of 3-4 W. Ablation is carried out with a beam at a device power of 2-3 W.
The advantage of this method is the possibility of excision of the hood with a laser beam, followed by the formation of a coagulation film along the cut line, providing reliable hemostasis, minimal swelling, protection from the macerating effect of saliva and microflora, rapid epithelization, as well as the elimination of the formation of microhematomas, tight fit of the gingival edge to the neck of the tooth, eliminating the formation of a periodontal pocket, suppuration and the occurrence of other complications.
Using the method described above, the wisdom tooth hood is excised with laser radiation under conduction and infiltration anesthesia (Ultracaine) in a pulse-periodic mode with a power of 4.5 W. Then the wound surface is ablated in the same mode at a power of 2.5 W in order to create a protective coagulation film that eliminates bleeding, forms a reliable protective barrier and stimulates effective epithelization of the wound surface (Fig. 7).
Rice. 7.
A- before treatment;
b- after surgery;
V- on the 7th day after surgery;
G
Treatment of patients with anatomical and topographical structural features of the soft tissues of the oral cavity
Using a laser scalpel, surgical interventions are carried out with high efficiency in case of anatomical and topographical features of the structure of the soft tissues of the oral cavity: small vestibule of the oral cavity, short frenulum of the tongue, short frenulum of the upper and lower lips. The following parameters are used for treatment: continuous and pulse-periodic modes (with a pulse duration of 500-2000 ms and a pause duration of 100-1000 ms); power - 2.5-5 W.
After exposure to the laser beam, the wound surface is covered with a coagulation film and, for small defects, no sutures are required.
Under infiltration anesthesia (Ultracaine) in a pulse-periodic mode with a power of 5 W, the frenulum of the upper lip is excised at the site of its attachment. The resulting wound surface is then ablated in the same mode at a power of 2.5 W to create a coagulation film (Fig. 8).
Healing occurs under or without iodoform turunda and without suturing.
Rice. 8.
A- before surgery;
b- after surgery;
V- 7 days after surgery;
G- in 1 month after operation.
Vestibuloplasty according to Edlan-Meicher (Fig. 9) is performed under conduction and infiltration anesthesia (Ultracaine) using the hydropreparation method in a pulse-periodic mode with a power of 4 W. The detached mucous flap is fixed to the periosteum using “laser welding” of soft tissues.
Rice. 9.
A- before surgery;
b- after surgery;
V- on the 2nd day after surgery;
G- 12 days after surgery;
d, f- 1 and 3 months after surgery.
Treatment of patients with diseases of the oral mucosa
In the treatment of diseases of the mucous membrane of the mouth and lips, namely long-term non-healing erosion of the mucous membrane of the tongue and cheek, limited hyper- and parakeratosis, erosive-ulcerative form of lichen planus and leukoplakia, the following are used optimal modes: power - 3.5-5.5 W, pulse duration - 500-2000 ms, pause duration - 100-1000 ms. The essence of the method is layer-by-layer ablation (evaporation) of pathologically changed tissues or removal using the laser excision method. In this case, a coagulation film is formed, which reliably protects the wound surface from the macerating effect of saliva and its microflora and, most importantly, ensures effective epithelization of tissues.
Under infiltration anesthesia (Ultracaine) using the above-described method in a pulse-periodic mode with a power of 3.5 W, laser ablation of the altered area of the mucous membrane is carried out with the formation of a protective coagulation film (Fig. 10).
Rice. 10.
A- before surgery;
b- immediately after surgery;
V- on the 7th day after surgery;
G- 21 days after surgery.
Possible complications when using medical technology and ways to eliminate them
If a pain reaction and swelling occur, analgesic and anti-inflammatory therapy is prescribed.
If the disease relapses, repeated treatment is carried out using laser technology.
Effectiveness of the use of medical technology
This technology is based on the experience of using laser radiation with a wavelength of 0.97 microns in the department of outpatient surgical dentistry of the Central Research Institute of Dentistry in the period 2003-2006. During this period, 200 patients were examined and treated. There were 47 men (23.5%), 153 women (76.5%). The age of patients ranged from 8 to 82 years.
Statistics on the use of the proposed treatment methods, taking into account nosological forms of diseases, are given in Table. 2.
Table 2. Distribution of patients by gender, taking into account the nosological form of the disease.
| Nosological forms of diseases | Distribution of patients by gender |
Total | |
| men | women | ||
| Fibroma | 7 | 42 | 49 |
| Epulis | 7 | 23 | 30 |
| Retention cyst of the minor salivary gland | 3 | 8 | 11 |
| Short frenulum of the upper lip | 5 | 15 | 20 |
| Pericoronitis | 1 | 6 | 7 |
| Ranula | 4 | 7 | 11 |
| Papilloma | 3 | 13 | 16 |
| Hemangioma | 4 | 11 | 15 |
| Hypertrophic gingivitis | 3 | 4 | 7 |
| Erosive-ulcerative form of lichen planus | 1 | 1 | 2 |
| Radicular cyst | 2 | 7 | 9 |
| Short frenulum of the tongue | 1 | 3 | 4 |
| Small vestibule of the oral cavity | 2 | 5 | 7 |
| Limited hyper- and parakeratosis | - | 4 | 4 |
| Long-term non-healing erosion of the mucous membrane of the tongue and cheek | 1 | 1 | 2 |
| Leukoplakia | 2 | 2 | 4 |
| Candiloma | 1 | 1 | 2 |
| Total | 47 | 153 | 200 |
For the treatment of patients with benign neoplasms of the oral cavity and lips laser technology was used in 113 people (fibromas - in 49 people, retention cysts of the minor salivary glands - in 11, ranula - in 11, hemangiomas - in 15, radicular cyst - in 9, candylomas - in 2, papillomas - in 16 people) . There were 89 women, 24 men.
An analysis of the results of treatment of 113 patients with benign formations of the oral cavity and lips was carried out. In 16 (14.1%) patients, a slight pain reaction was observed after laser exposure, and in 36 (31.8%) patients there was slight swelling of the surrounding soft tissues.
In the long-term postoperative period, no complications were observed in any case.
After excision of the tumors, all the obtained material was sent for histological examination. Histology was confirmed.
After 1 month During the follow-up examination, tumor recurrence was detected in 4 (3.5%) patients. In 2 cases a simple hemangioma was found, and in one case each - fibroma and ranula.
In 3 patients (2.6%) histological examination revealed malignancy. The patients were referred to specialized institutions for further treatment.
Laser technology was used in 44 patients with periodontal tissue diseases(epulis - in 30 people, hypertrophic gingivitis - in 7, pericoronitis - in 7 people). There were 33 women, 11 men.
Analysis of the results of treatment of patients with periodontal diseases showed that all patients had no bleeding during surgery. Minor collateral soft tissue swelling was observed in 8 (18.2%) patients. In 11 (25%) patients, after laser exposure there was a slight pain reaction in the postoperative area. Difficulty opening the mouth, pain and swelling of soft tissues occurred in 3 (6.8%) patients and persisted for several days after surgery.
Relapse was observed in 3 (6.8%) patients in this group. Recurrence of epulis was found in 2 patients and pericoronitis in one case. Also, in one (2.3%) patient, a malignant neoplasm was detected after histological examination. The patient was sent to a specialized institution for further treatment.
Laser technology was used in 31 patients with anatomical and topographical features of the structure of soft tissues of the oral cavity(short frenulum of the upper lip - in 20 people, small vestibule of the oral cavity - in 7, short frenulum of the tongue - in 4 people). There were 23 women, 8 men.
After laser exposure, the pain reaction in the postoperative area was mild or absent, and minor swelling of the soft tissues adjacent to the surgical area was observed in only 8 (25%) patients. Hyperemia of the mucous membrane around the wound surface was also mild or absent. The integrity of the oral mucosa was completely restored on the 10-14th day after surgery.
The treatment results after laser treatment were good in all 31 patients. Close and long-term control showed the presence of a thin, barely noticeable scar at the site of laser exposure and the absence of signs of an inflammatory process in the tissues.
To treat patients with diseases of the oral mucosa, laser radiation with a wavelength of 0.97 microns was performed in 12 patients. There were 8 women, 4 men.
Analysis of the results of treatment of 12 patients with diseases of the oral mucosa (long-term non-healing erosion of the mucous membrane of the tongue and cheek - 2 (1.3%) patients, limited hyper- and parakeratosis - 4 (2.7%), erosive-ulcerative form of lichen planus - 2 (1.3%), leukoplakia - 4 (2.7%) patients) using a diode laser scalpel showed that 5 (41%) patients had mild pain after laser exposure, 1 (8.3%) patient The pain in the postoperative area was severe. Minor soft tissue swelling was observed in 7 (58%) patients. The mucous membrane around surgical field was hyperemic as a border in 7 (58%) patients. The integrity of the oral mucosa was completely restored by 10-14 days.
Recurrence of leukoplakia was observed in one case (8.3% of patients). In one patient, a malignant neoplasm was detected after histological examination. The patient was sent to a specialized institution for further observation and treatment.
Thus, an analysis of the clinical use of the LS-0.97-"IRE-Polyus" device with a wavelength of 0.97 microns for the treatment of patients with various nosological forms of diseases of the oral mucosa and periodontal disease showed that the proposed medical technology is highly effective. Of the 200 patients who received treatment, positive results were achieved in 197 (98.5%) people.
The use of laser technologies makes it possible to improve the technique of surgical treatment of patients with diseases of the soft tissues of the oral cavity, oral mucosa and periodontal disease. Laser radiation when exposed to biological tissue provides a combination of good cutting and coagulating properties. Controlling the operating modes of laser devices makes it possible to perform operations on the soft tissues of the oral cavity atraumatically, with minimal damage to surrounding and underlying tissues.
New generation laser devices have a number of advantages, which, along with reducing the consumption of medicines and increasing labor productivity, provides a significant economic effect.
Operations performed using laser radiation are easily tolerated by patients and can be used both in hospital and outpatient setting. It is necessary to widely introduce new generation laser technology into dental practice, mainly at mass outpatient appointments, as one of the highly effective methods of improving the quality of dental care.
