2. Introduction and History
• Otolaryngology or ENT (ear, nose and throat) is the branch of medicine
that specializes in the diagnosis and treatment of ear, nose, throat, and head
and neck disorders
• Practitioners are called otolaryngologists-head and neck surgeons, or
sometimes otorhinolaryngologists (ORL).
• In the early 1960s otolaryngologists first considered different methods of
using pulsed-laser systems in the middle ear and labyrinth
• During this time, Geza Jako began studying the effects of laser energy on
human vocal folds.
• Starting in 1967, Polanyi experimented with the CO2 laser in a human
cadaver larynx and was encouraged by its ability to produce discrete
wounds.
3. Lasers used for surgeries in Larynx
• Co2
• Nd:YAG
• KTP
• Argon
• He-Ne
4. Applications of lasers in Larynx
• Congenital disorders
Ex: Laryngomalacia
• Functional dysphonia
Ex: plica ventricularis
• Chronic inflammatory conditions
Ex: Exudative lesions in Reinke’s space
• Chronic trauma
Ex: Ulceration and granuloma
• Recurrent respiratory papillomatosis
• Benign laryngeal tumors
• Leukoplakia
• Excisions for malignancy
5. Lasers for nasal surgery
• Use of Lasers creates relatively bloodless field in endonasal surgery which makes the
surgical field becomes more clear
• KTP laser is better in Nasal surgery because
• Fiber transmissible
• Has a high affinity of absorption for pigmented tissue (hemoglobin)
• Energy conducted into the tissue is well absorbed by the sinusoidal blood
vessels of the turbinate and results in a coagulation zone with very little
intraoperative bleeding
• Has adequate power for ablation of the bony framework of the MMC
• CO2 laser is not commonly used in endonasal laser surgery because of
• Lack of fiber transmissibility
• Poor coagulation
• Poor hemostasis
• Increased risk of synechiae formation post operatively
6. Advantages of using lasers in Nasal surgeries
• Minimally invasive surgery
• Minimal bleeding
• Minimal postoperative edema and crusting
• Ambulatory surgery
• Cost effective
7. Indications of laser nasal surgery
• Reduction of turbinates
• Nasal polyps removal
• Dacryocystorhinostomy
• Laser-assisted septoplasty
• Juvenile angiofibroma
• nasopharyngeal cancer
• nasopharyngeal stenosis
8. Laser selection in otology
• CO2, KTP , Argon , Nd: YAG lasers
• In vascular lesions of ear - The Nd: YAG laser, with its deep scatter, is
the laser of choice
• For debulking of tissue : CO2 laser are used
• The visible KTP laser light is well suited for undertaking temporal
bone surgery
• Fibre transmissibility of the KTP beam gives an added dimension to
guide the light around corners
9. Use of Laser in otology
• External auditory canal
Stenosis of the external auditory canal
Laser reshaping of cartilage
• Tympanic membrane lesions
• Middle ear cleft
Laser - assisted myringoplasty
Graft - welding of tympanic membrane defects
Laser - assisted ossicular surgery
10. Lasers used in orofacial surgeries
• For vaporisation and cutting in soft tissue, a wavelength
such as carbon dioxide (CO2) modality at 10.6 μm is
indicated
• For coagulation in soft tissue, a wavelength which is poorly
absorbed by water but is maximally penetrative is required
(near infrared modality of the Nd: YAG at 1.06 μm)
• For hard tissue such as bone, dentine or enamel,
hydroxyapatite is the chromophore of importance (Erbium:
YAG at 2.9 μm )
11. Indications for orofacial surgeries
• Surgery for snoring and obstructive sleep apnea
Uvulopalatoplasty
Midline glossectomy
Linguloplasty
• Laser palatine tonsillectomy
• Laser lingual tonsillectomy
12. Laser selection in lower airways
• Most common lasers used : CO2 , Nd:YAG
• CO2 laser beam is directed towards the lesion through articulated arm,
limiting its use to rigid bronchoscopy, presently used more for lesions
involving the larynx and proximal trachea
• Nd:YAG laser beam can be passed through a flexible endoscope ,
which affords deeper penetration, better coagulation and produces
better haemostasis
• Its main disadvantage is the unpredictable interaction of the laser
beam with the tissue, making it difficult to determine the depth of
penetration
