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Laser Dictionary 1.

Ecto Derma Polyclinic - Dental - Medical - Laser  Educational and Research Center

1085. Budapest, József krt.37.  Hungary  Tel.: +36 1 3178175 ; +36 1 2350024
Fax.: +36 1 2350025  Email:  titkarsag@ectoderma.hu recepcios@ectoderma.hu

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What are the the fields of medical laser application?

During the past three decades the following major classical branches of the use of lasers in medicine have developed:

  • Laboratory diagnostics
  • Clinical diagnostics
  • Photodynamic therapy
  • Soft laser therapy
  • Laser surgery.

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Traditional medicine or laser ?

As a result of the scientific and technical progress the headway of modern therapeutic procedures (laser, optical instruments, endoscopes, MRI, CT, computers etc.) has not only enriched the means of medicine in Hungary but the introduction of new methods has necessarily brought about a new attitude of mind and has set up a claim for summarizing the relevant knowledge as well.
Medicine founded on century-old traditions has already accepted the laser and optical instruments, thus a progressing laser and optics school preserving the old assets has developed.

What are advantages and disadvantages surgical lasers ?

In comparison with other instruments, the relapse rate is minor following laser application, and it can be repeated several times, with a broad spectrum of indications. The number of postoperative oedema, pain, scar formation is minimal. It has become evident that the use of the surgical laser results in considerable financial savings for the health   service. The most significant disadvantages to laser application derive from the fact that it is troublesome to direct the laser beam to the target area in deep tissues, and sterile conditions must be ensured. Safety precautions must be observed, and the resulting vapour must be drawn off. The instruments are still extremely expensive. These advantages and disadvantages in oral surgery are unelucidated in numerous aspects, although they must be clarified for the routine use of the  laser beam.

Some words about the basic laser surgical methods

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The operations generally are performed under local  anaesthesia (2% lidocaine, 0,001% adrenaline). During surgery for simple benign tumours the lesion was removed with 1 mm, in precancerous cases  with 1-5 mm, and in suspect malignancies or malignant tumours with 5-30 mm of healthy tissue depending the nature of the oncological aspects of disease. Three types of laser operations were performed :
Coagulation 
(simple leukoplakia, cheilitis, ) using a   2-5 W power defocused CO2 laser beam.
(naevus flammeus) using 2 W power argon, KTP, diode laser beam
(cavernosus haemangioma)  20 W Nd YAG, diode, KTP laser beam

Vaporisation 
(verrucous leukoplakia, cheilitis, lichen, haemangioma capillare etc.) using a 
5 to 15 W focused or defocused CO2 laser beam.
(benign tumours of haemophilic patients) 
10 W diode laser beam
(high vascularized tumours)
15 -30 W focused combi laser beam.
Excision 
(ulcerous leukoplakia, cornu cutaneum, erythroplakia, carcinomas, plastic surgery etc.) using a  
6 to 15 W  CO2, 5-6 W diode laser beam  or  30 W Nd YAG laser beam

In the first two types, the tissues are touched only by the laser beam: in the third one, the excision is made by applying continuous traction to the pathologic area. The minor vessels are coagulated by the laser beam during cutting: vessels with a diameter larger than 1 mm  ( CO2) or 2-3 mm ( Nd YAG and combi) are identified and severed between the ligatures.

Bloodless surgery ?

Surgery can be perform on a practically bloodless wound surface. In the case of vaporisation, the laser beam immediately coagulated the vessels less than 1 mm (CO2) or 2-3 mm (NdYAG and combi) in diameter : in the case of excision,  the major vessels exposed on the wound surface were recognised and cut between the ligatures when necessary. The  haemophilic patients were also operated on without any bleeding.

Ablastic operation ?

The application of the laser beam ensures ablastic operation. In our patient population, the embedding histological examination-with  the clinical picture of erosive leukoplakia-verified carcinoma in situ from the laser-excised tissue in 6 cases. Since, in the preoperative histology, we diagnosed erosive leukoplakia, we did not extend the degree of the laser excision. During follow-up  2-7 years postintervention, close observation revealed neither local recurrence nor regional metastasis. Oncological evaluation of our other operations would  be a futile exercise, owing to the oncopathologic character of the lesions.


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