DESCRIPTION:

Endoscopic laser surgery is a technique for treating diseases of the nasal cavities and paranasal sinuses. Diseases of the oral cavity and the upper respiratory passage can be treated using lasers as well. Dornier offers a variety of lasers that are ideal tools for this purpose including the Medilas fibertom 8100 (Nd:YAG laser), the Medilas H20 (Ho:YAG laser) and the diode laser family Dornier Medilas D.

The field of individual applications is extensive:

• Partial resection of the soft palate in the case of sleep apnea syndrome
  (operation to resolve snoring)
• Removal of tonsils
• Treatment of tumors on the tongue
• Increase of the nasal cavity
• Removal of nasal polyps
• Widening of the tear duct (DCR operation)
• Overgrowth of cell on the larynx
• Tumors of the larynx
• Septum ridges and spurs
• Surgical creation of an artificial opening in the bony part of the ear to improve hearing
• Nosebleeds (especially in the case of children)

SYMPTOMS:

A decrease in nasal breathing is the primary symptom that often requires surgical intervention.  Secondary symptoms are recurrent infection, damage to the sense of smell, water or mucous discharge from the mucous membrane and disturbed tubal and middle ear ventilation. 

INCIDENCE AND CAUSES:

Incidence rates for the individual diseases widely differ. Laser surgery on these indications is most beneficial for the patient if there is no underlying cause (e.g. allergy); however, in some cases, laser surgery can be the optimal tool for issues like nosebleeds and Osler’s disease in which the patient’s capillaries dilate to produce mucous membranes.

ANATOMY:

PROCEDURE:

The physician will collect patient history and complete a diagnostic work-up, such as endoscopy.  Based on this information, the physician will determine if laser surgery is the best treatment method. Topical anesthesia is needed for the procedure.

The goal of the surgery is to remove or reduce tissue. The laser energy is transported to the target tissue through a flexible lightguide. This allows surgery in areas including difficult to access areas like the mouth and nasal cavity.

Formations in the upper respiratory tract are small therefore middle range output power is sufficient for most applications. In these cases the Dornier Medilas D LiteBeam+ (output power: 30 W) is the best laser. The diode laser wavelength of 940 nm is extremely well absorbed by hemoglobin. Its penetration depth in well coated mucous membranes is limited to around 1 – 2 mm reducing the risk of damage to neighboring structures.

Application of high laser power (up to 60 W) and short pulses (10 ms) further reduces the effective depth and allows very accurate work. This can be done with the Dornier Medilas D MultiBeam. This allows treatment on hard tissue and structures at risk that are close to the eyes and the base of the skull. 

POST PROCEDURE PROTOCOL:

The best post-operative care is rinsing the nasal cavities with saline solution using a nasal douche. Nasal care might be necessary up to three times a week for about 20 days after the treatment, depending on the extent of the laser treatment and the mucous membrane reaction.

ALTERNATIVE TREATMENT OPTIONS:

• Open surgery – Most of the diseases mentioned above can also be treated by open surgery, which is a more invasive treatment method that is more prone to bleeding. Access to the interior organs is much easier with a laser fiber than with surgical tools, due to the smaller outer diameter and higher flexibility. Side effects are usually greater with open surgery and the healing time for the patient is longer.