DEPARTMENT

OF
OTORHINOLARYNGOLOGY

LASER IN ENT

LASER IN ENT
(Light Amplification of Stimulated Emission of Radiation)
In Simple words It gives a very concentrated coaxial beam of light energy which is useful in cutting &coagulation of tissues CO2 laser is the most commonly used

LASER
EINSTEIN

1917-THEORITICAL FOUNDATION FIRST LASER-1960-DR.T.MAIMAN

TECHNICAL BACKROUND
MEDICAL LASER DEVICEAN OPTICAL RESONATING CHAMBER FULLY REFLECTING MIRROR AND PARTLY TRANSMITTING THROUGH THIS CHAMBER LASER MEDIUM IS PUMPEDSTIMULATED BY ELECTRIC CURRENTEmission of photons-bounce around the chamber-parallel to the long axis escapes through the partially transmitting mirror as LASER LIGHT

TYPES OF LASER

CO2 LASER 10600 Nd YAG LASER 1064 ORGAN LASER-NEODYMIUMYTTRIUM ALUMINIUM GARNET

MODIFIED Nd-YAG-KTP 532

POTTASSIUM TITANYL PHOSPHATE-VISIBLE GREEN OR BLUE

LIGHT IS MONOCHROMIC-SAME COLOUR COLLIMATED PARELLEL AND UNIDIRECTIONAL-COHERANT-INTENSE ANDINPHASE EXTREMLY POWERFUL HIGH ENERGY BEAM -PASS THROUGH LENSE SYSTEM FOR FOCUSSING-RESULTS IN HEAT

OPTICAL CHAMBER IS SURROUNDED BY WATER JACKET.

TISSUE EFFECTS LOCAL ABSORPTION OF LO ENERGY CA OF HEAT SUBSEQUENT PRODUCTION L LASER BEAM IS EXTREMLY ACCURATE WILL CAUSE THE TISSUE DAMAGEVARRIED PENETRATION

CO2 LASER
0.3mmPENETRRATION KILLING THE CELLS BY BOILING THE WATER CONTENTS OF CELLS 80% WATER SUDDEN INCREASE IN VOLUME& VAPORISE ADV CAN DESTROY SMALL VOLUME OF TISSUES-ACCURATELYMINIMAL SURROUNDING TISSUE INJURY DISADV POOR PENETRATION WILL CERTAINLY NOT COAGULATE BLOOD VESSLS MORE THAN 0.5mm IN DIAMETER

MECHANISM

CO2 laser is invisible being an infrared laser

It emits a beam at wavelength 10,000 nm

This energy is absorbed by water in intra as well as extra cellular water found in all living tissues
The result is conversion of water into vapor causing thermal injury The depth of injury caused is minimal Therefore it is useful for precise and delicate surgery without damage to surrounding tissues

Beam parameters can be changed to suit surgeons need

A focused beam with super pulse mode is used for cutting purposes whereas a defocused beam is used for tissue ablation

Nd-YAG LASER
CRYSTAL

OF NEODYMIUMDOPEDYTTRIUM ALUMINIUM GARNET STIMULATED BY A CRYPTAN ARC LAMP WAVE LENGTH 1064 MODIFIED Nd-YAG IS KTP LASER POTASSIUM TITANYLPHOSPHATE IS STIMULATED

Advantages
1. Hemostasis Blood vessels upto 0.5 mm are routinely sealed

2. Lymphatic channels are blocked so tumor spread I prevented 3. Seals nerve endings so reducing post op pain
4. Injury to tissue is minimal

5. It can be coupled with surgical microscope

6. Can be done under LA

KTP LASER
TISSUE PENETRATION 1mm-532 nm ACCURATELY

RELIABLY COAGULATE VESSELS OF THIS DIAMETER

MORE PRECISE

SAFTY ### CLASS VI NEEDS EXTREEM CAUTION

1 ENVIRONMENTAL DESIGNATED AS LASER AREA-APPROPRIATE WARNING SIGNS

REMOTE-AUTOMATIC DOOR LOCKS-TO PREVENT NON ESSENTIAL PERSONS

2 PERSONNEL

LIMITED-FULLY CONVERSANT-EYE PROTECTION

3 ANAESTHETIC POTENTIAL EXPLOTION RISK-VOLATILE ANESTHETIC AGENTS 4 PATIENT ALL EXPOSED PARTSOF PT ADJCESSANT TO OPERATING AREA-DAMP SWABS-AVOID BURNS

USES in ENT
Micro laryngeal surgeries like removal of juvenile papilloma and arytenoidectomy
Excision of early laryngeal and pyriform fossa growth without compromising voice quality Stapetectomy and ossicular fixation For control of epistaxis turbinate reduction adhesionolysis Excision of Leucoplakia and small benign and malignant lesions

Management of snoring and sleep apnoea syndrome

Laser assisted uvulopalatopharyngoplasty(LAUP) is an office procedure takes 15 to 30 mins