Laser medicine is a discipline that applies laser technology to study and diagnose and treat diseases. Due to the deep anatomical site of the otorhinolaryngology, laser beams with strong directional and high brightness characteristics can be used to perform fine microsurgery on areas that cannot be reached by the eyes, hands or knives with the help of natural channels of organs such as the otorhinolaryngology or trachea, making it a new minimally invasive treatment method. At present, the types and functions of lasers used for clinical treatment of otorhinolaryngological diseases are increasing, the types and scope of treatment are expanding, and satisfactory results have been achieved. With the popular application of laser technology and the continuous improvement of laser auxiliary equipment, the superiority of laser treatment for otorhinolaryngologic diseases has been recognized.
The laser was a new light source discovered in the 1960s and first applied to medicine in the United States. The first application in otolaryngology was in 1967, when Goldman used the laser to perform mastoid chiseling and middle ear and laryngeal surgery with a quartz rod and optical fiber device, and in 1968, when Strong first used the CO2 laser to treat ear, nose and throat diseases. Currently, CO2, He-Ne, Nd:YAG and Ar ion lasers are mainly used in otorhinolaryngology, among which CO2 laser is more widely used in clinical practice.
CO2 laser is an infrared light with a wavelength of 10.6um, which penetrates deeper into the tissue and can heat the deep tissue for physical therapy after beam expansion. CO2 laser has a very small divergence angle and high energy density, and after focusing, the power can reach several kilowatts per square centimeter. And the unfocused original beam irradiates the focal tissue, which can produce coagulation effect.
The laser microsurgery treatment system is composed of an ultra-pulsed CO2 laser treatment machine and a microscope adapter. The laser beam from the laser treatment machine is conducted to the microscope adapter by the light-guiding arm, and the microscope adapter is a precision optical system that zooms, focuses, turns, and micro-shifts (operator control) the CO2 laser transmitted by the light-guiding arm, and then is introduced into the patient’s throat, etc. for surgery, and the operator can manipulate the The operator can manipulate the laser beam and perform the surgery precisely under microscopic magnification of the diseased tissue.
Advantages of CO2 laser microsurgery
1.Minimally invasive treatment with less damage and better functional preservation
It avoids the large incision and extensive resection of conventional surgery, causes little damage to normal tissues, does not require neck incision and tracheotomy, and can replace many traditional surgeries, such as laryngectomy for laryngeal cancer under tracheotomy; it is simple and fast, with short operation time, little pain for patients and short hospitalization time; it preserves the maximum function without nasal feeding and reduces the difficulty of nursing.
2.Good hemostatic effect
The CO2 laser has the function of hemostasis when cauterizing and cutting. When the laser acts on the tissue, the small blood vessels within 0.5mm in diameter at the edge of the incision will be coagulated and closed, so there is no blood or little blood flow during the operation.
3.High surgical precision
The CO2 laser can reach the deep part of the body cavity under the microscope adapter, and the treatment can be performed in the narrow area. Because of the precise positioning and the smallest spot of about 0.1mm, it can finely cut, cauterize and vaporize the lesioned tissues.
4. Clear field and no mechanical damage
Under the high-powered surgical microscope, the surgical field is clear, and the lesion and normal tissue can be precisely distinguished, so that the lesion can be removed cleanly and thoroughly and the omission can be reduced. The essence of “cutting” is that the tissue is hit by the laser and vaporized point by point, so there is no pulling and tearing of the adjacent tissues and other mechanical intrusion, which is conducive to the protection of fragile or nerve tissue and safer surgery.
5.Low recurrence and metastasis rate
Laser surgery has the effect of closing blood vessels and lymphatic vessels, blocking the diffusion pathway, so the recurrence and metastasis rate is extremely low.
6. Easier for the operator to master
Under the microscope, the laser adapter is easy to lock the lesion, and the surgery can be performed by adjusting the light spot gimbal to project the indicated light spot on the target lesion. The surgeon can complete the surgery easily and precisely, and the normal tissue can be preserved to the maximum extent without causing serious functional damage.
7.Scope of application of otorhinolaryngology-head and neck surgery
Otology: Pseudocysts of the auricle, pigmented nevus of the external ear canal, papilloma of the external ear canal, early squamous carcinoma of the external ear canal, secretory otitis media and otosclerosis.
Rhinology: hypertrophic rhinitis, rhinorrhea, nasal polyps, nasal septal hematoma, nasal hemangioma, chronic sinusitis and nasal and sinus tumors.
Pharyngology: obstructive sleep apnea hypoventilation syndrome, chronic tonsillitis, chronic pharyngitis, pharyngeal keratosis and early pharyngeal tumors.
Laryngology: benign laryngeal lesions (vocal cord nodules, vocal cord polyps, Renk’s edema, vocal cord cysts, vocal cord paralysis, laryngeal stenosis and vocal cord microangioma); precancerous lesions of the vocal cord (chronic hypertrophic proliferative laryngitis, laryngeal leukoplakia, laryngeal papilloma) and early laryngeal cancer.
Tracheal tumor: tracheal stenosis atresia
Oral cavity tumor: early tongue cancer, buccal mucosa cancer, and floor of mouth cancer.