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Lasers in Oral and Lasers in Oral and Maxillofacial SurgeryMaxillofacial SurgeryByByghassan Nazik Talebghassan Nazik Taleb44thth stage arab stage arabicic board of oral and board of oral and maxillofacial surgerymaxillofacial surgery

What is Laser?

• LASER

• Light

• Amplification by

• Stimulated

• Emission

• Radiation

properties of Laser

1-Monochromaticity

2-Directionality

3-Coherence

4-Brightness

Photobiology of Laser

1- Wavelength independent interaction mechanism

2- Wavelength dependent interaction mechanism

Wavelength dependent interaction mechanism

PhotochemicalInteraction

Photodynamic therapy

Biostimulation

Photo thermal interaction

Coagulation

Carbonization

Vaporization

Melting

Wavelength independent interaction mechanism

Ultra short pulses

Photo ablation Plasma induced ablation

LASER INTERACTION WITH ORAL BIOLOGIC TISSUE

Thermal effect of laser radiation

Temperature Biological Effect

37 0C Normal

45 0C Hyperthermia

50 0C Reduction in enzyme activity, cell immobility

60 0C Denaturation of proteins and collagen, coagulation

80 0C Permeabilization of membranes

100 0C Vaporization, thermal decomposition

150 0C Carbonization

300 0C Melting

Potential advantages of laser

• 1. No-touch techniques that ensures sterile surgical site.

• 2. Reduced blood loss.

• 3. Limited fibrosis and stenosis.

• 4. Fiber optic delivery.

• 5. Potential reduction in spread of metastasis by sealing lymphatic vessel and killing of malignant cells.

Potential advantages of laser

• 6. Fewer instruments in the field.

• 7. Reduce post-operative pain.

• 8. Sterilization of the impact site.

• 9. Dry surgical field.

• 10. Reduced edema

Potential Hazard of Laser MachinePotential Hazard of Laser Machine

1. Hazard to eye: corneal or retinal burns (or both). Chronic exposure to excessive levels may cause corneal or retinal injury

2. Hazard to skin: Sever burns & scarring.

3. Electrical hazard: High voltage – life threatening.

4. Fire : The solvents used in dye lasers are flammable. High voltage pulse or flash lamps may cause ignition.

Possible Complications of Laser Possible Complications of Laser TherapyTherapy

1. persistent erythema(2-3 months), oedema1. persistent erythema(2-3 months), oedema

2. Pigmentary changes: hyper / hypopigmentation.2. Pigmentary changes: hyper / hypopigmentation.

3.Textural change, atrophy.3.Textural change, atrophy.

4. Scarring, keloid. 4. Scarring, keloid.

Types of laser

CO2 laser-Produce sterile surgical field: bactericidal,

virucidal-has the ability to coagulate, vaporize or

incise tissue-aids in good haemostasis-reduce local tissue trauma & edema-precise energy delivery to diseased area-reduce pain by neuron sealing & decrease

pain mediator release-minimize tumor cell dispersion by lymphatic

sealing-can get access to difficult sites

Argon laser

Argon laser at 488 and 514 nm, respectively, was one of the first laser to be used in the treatment of vascular lesion it gained popularity during the 1970s.

Nd.YAG laser

the continuous-wave Nd:YAG laser emits light in the 1064 nm

In the non contact mode the Nd.YAG has limited value in the oral cavity because of deep penetration and scatter. .

Newer CW Nd:YAG lasers fitted with sapphire tips have overcome many of the drawbacks of using this laser in the oral cavity

Pulsed dye laser

At a wavelength of 575 or 585 nm

there is superselective absorption by vascular tissue and little effect on melanin.

Q-Switched Nd:YAG laser

Q-Switched Nd:YAG laser can produce two wavelength, those being 1064 nm and 532 nm, respectively.

In the treatment of intraoral tattoos, predominantly the amalgam tattoo, it has been found the Q-Switched Nd:YAG laser very useful.

Other laser

*Q-Switched ruby laser: (694 nm)

*Copper vapor laser ( 578-nm for vascular lesions).

*KTP laser (532 nm, for vascular lesions).

*Alexandrite laser ( 755 nm, for melanosomes).

The Clinical Applications

* Laser management of intraoral surface lesions.

* Laser management of malignant lesions of the head and neck.* Laser management of vascular lesions.

* Laser surgery of the temperomandibular joint.

* * Laser and skin proceduresLaser and skin procedures

Laser management of intraoral surface lesions

Frictional hyperkeratosisTo excise smaller questionable lesions the CO2 laser with a 0.2 mm can be set at 10 to 20 W of power .


Nicotinic stomatitis symptoms of the pain burring and ulceration of the palatal tissue

the surgeon may eradicate the lesion using a laser, the CO2 laser can be set in a continuous wave mode and defocused using 10 to 20 W of power to vaporize the lesion.


Solar cheilitis treatment modalities including * chemical peeling, * cryosurgery * lip shave

using the CO2 under microscopic control allow for removal of defined area of the lip at greater depth with

1. less post operative neuropathies 2. less cicatrix formation3. less haematoma and lip distortion or aesthetic compromise.


Leukoplakia

Small lesion can be excised with a focused CO2 laser with 3-4 mm margin.

The main disadvantage of vaporization is inability to generate a specimen for the pathologist.


Erythroplakia

Can Easiley removed by CO2

laser

The laser is set on Ultra Pulse at 10-20 W in a pulse mode to outline the entire lesion.


Lichen planus

Erosive lichen planus doesn’t appear completely controlled by the laser ,the CO2 laser should be used as adjunctive therapy along with selected local and systemic medication, CO2 laser at 10-15 W and using a continuous mode and a defocused application . The contact Nd:YAG with a round probe using 10-15W is also an alternative


Condyloma acuminatum

CO2 laser can be used in a free beam system to excise intraoral lesion.

The base of the lesion can be using a laser in a defocused mode.


Oral melontic macule

There is no way to differentiated some of these lesions from other such as early superficial melanomas therefore they can be biopsies with CO2 laser .

Laser Management of Malignant Lesion of Head And Neck

Carcinoma of the tongue

Most papers has described the use of a free beam CO2 laser with a narrow beam as a cutting instrument for this lesion but more recently report of contact tip Nd:YAG laser has also be used.


Lesions of the lips

exophytic lesion on the vermillion border or cutneous surface of the lip can be excised with a surgical laser

the resulting defect can be left open to epithelialize secondarily with an excellent result .


Lesions of the palate

the laser may be use as a means of outlining the lesion and making the superficial incision dawn to the periosteum.


Verrucous carcinoma

Its adequately removed by means of a laser used either in an excision mode or in vaporization mode, this is carried out under tolidin blue control.


Debulking of lesion

debulking lesion either in vaporization or in excisional mode.

Advantage of laser is lack of bleeding and ability to seal lymphatic, lesion can be debulked in order to more susceptible to radiation therapy or chemotherapy.

Laser Management of Vascular Lesions

Vascular lesions Vascular lesions • Commonly used is pulsed dye laser at 580 nm &short Commonly used is pulsed dye laser at 580 nm &short

pulses 450 microsecondspulses 450 microseconds

• Haemangiomas Haemangiomas

• Venous malformationsVenous malformations

Vascular lesions Vascular lesions

• Port-wine stainsPort-wine stains

• Telangiectasias Telangiectasias

Some Anatomical consideration

Tongue1- high vascularity

2- sensitivity to electrical stimuli

The tongue responds well to the CO2 laser, and powers in the range6 to 8 w for most procedure (at a 0.35 mm spot size) for deeper lesions higher power (8 to 10 w) are justified.

Some Anatomical considerationFloor of mouth1- difficult access2- prominent vascularity3- proximity of the submandibular duct

CO2 hollow waveguide handpieces with contr-angle heads or curved guide tips, or fiberoptic Nd:YAG handpieces make surgery in this area simple. Power in the range of 4 to 6 w of CO2 energy in focused mode (0.1 to 0.35 mm) or 6 to 8 w in defocused mode ( 1.5 to 3 mm) are usually sufficient for excellent cutting and ablating effects.

Laser assisted arthroscopic surgery of Laser assisted arthroscopic surgery of TMJTMJ

most common usedmost common used Holmium:YAG laser

**SynovectomySynovectomy

**Release of anterior disk attachment for clicking or Release of anterior disk attachment for clicking or closed lockclosed lock

**HypermobilityHypermobility

**Recontouring of perforated disk Recontouring of perforated disk

for disk preservation for disk preservation

Laser and skin proceduresLaser and skin procedures

• Acne & acne scar removalAcne & acne scar removal

• Wrinkles & shallow rhytidsWrinkles & shallow rhytids

removalremoval

• Scar revisionScar revision

Laser and skin proceduresLaser and skin procedures

• BlepharoplastyBlepharoplasty

• Removal of tattoosRemoval of tattoos

• Removal of pigmentationRemoval of pigmentation

• Hair removalHair removal

Low-level lasers therapy (LLLT)Low-level lasers therapy (LLLT)• Phototherapy used to deliver small amount of energy to Phototherapy used to deliver small amount of energy to

living cells with minimal heat production & beneficial living cells with minimal heat production & beneficial cellular effects labeled as biomodulation or biostimulationcellular effects labeled as biomodulation or biostimulation

• Effects of LLLTEffects of LLLT Pain modulation (TMD, postherpetic neuralgia)Pain modulation (TMD, postherpetic neuralgia) Increase microcirculationIncrease microcirculation Reduce inflammation & edemaReduce inflammation & edema Accelerate wound healingAccelerate wound healing Muscle relaxationMuscle relaxation Accelerate bone repairAccelerate bone repair Enhance immune reactivity Enhance immune reactivity Increase cellular ATP productionIncrease cellular ATP production Increase cellular membrane transportIncrease cellular membrane transport

laser application in implantology

Recently a pulsed Nd:YAG system to implant dentistry, and most of these procedures can be performed without local anesthesia.

So we can do:*second stage surgery *thinning and contouring flaps during initial implant surgery*removal of necrotic and granulation tissue*soft tissue surgery around implants

REFERENCES

• Neelima oral and maxillofacial surgery 2012

• Secrets oral and maxillofacial surgery2008

• Lewis lasers in maxillofacial surgery and dentistry

• Operative oral and maxillofacial surgery , Langdon 2011

• Internet

Thank you….

laserد.غسان

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