[Laser surgery in ENT surgery].

Abstract

From a number of medically useful lasers, mainly the neodymium YAG and the carbon dioxide laser are employed in otorhinolaryngology. Until now, the neodymium YAG laser has been used only for coagulation of vessels in Osler's disease and for palliative treatment of malignant tracheo-oesophageal disease. However, the deep coagulation necrosis of the adjacent tissues severely restricts its use. The most widely utilised laser in ENT surgery is the carbon dioxide laser. Its main effect of precise cutting with an extremely fine zone of coagulation reduces bleeding after incision considerably. Secondary tissue reactions, delayed healing, decreased fibroblast activity and maybe more prominent subepithelial scarring, limit its use especially in the glottic region. Therefore, minor vocal cord alterations such as vocal nodules, cysts or polyps suitable for excision with scissors, should not be removed by laser. Optional indications are Reinke's oedema, intubation granulomas and contact pachydermas. Clear advantages of laser use are seen in the treatment of juvenile papillomas of the vocal fold and of smaller vocal cord carcinomas or recurrences after irradiation therapy of these. The carbon dioxide laser is superior to all other indications in the removal of large and obstructing laryngeal carcinomas to prevent tracheostomy. Very reliable is its use in the ablation of lingual tonsillar tissue to improve or eliminate symptoms in recurrent lingual tonsillitis. Transoral resection of small malignant lesions in the oral and pharyngeal cavity may be performed in analogy to electric cautery. The advantages of the laser compared to electrical surgery are a smaller postoperative oedema and less pain, as well as good spontaneous epithelialisation of defects.(ABSTRACT TRUNCATED AT 250 WORDS)