Principles and Practice of Lasers in Otorhinolaryngology and Head and Neck Surgery

Foreword

The addition of lasers to the surgical armamentarium of otolaryngology-head and neck surgery has allowed our specialty to offer patients new and exciting ways of approaching disease management, to improve on conventional surgical techniques, and to expand its scope. While certain distinct advantages are associated with the use of lasers in otolaryngology-head and neck surgery, these must be weighed up against the possible complications of laser surgery. Thirty-one years have passed since Jako and Strong first introduced the carbon dioxide laser, and its applications in the upper aerodigestive tract, to our specialty. Applications for this laser have been refined, and outcomes have improved in association with advances in laser technology and improvements in delivery systems. Today we have several laser systems to choose from, and our understanding of laser biophysics and laser tissue interactions determine which laser we wish to use for the many applications for which this technology has proven efficacious. The Principles and Practice of Lasers in Otolaryngology and Head and Neck Surgery, edited by Drs. Oswal and Remacle, presents the reader with a comprehensive overview of the modern use of lasers in otolaryngology-head and neck surgery. The organization of the book, with each section covering a different anatomical area and/ or laser application of otolaryngology-head and neck surgery, enables the reader to find the desired area of study easily. In Section I, the authors cover the fundamentals of laser surgery, including its history, as well as how lasers work and interact with tissue. Equipment and instrumentation are appropriately reviewed, including specific discussions of air-way and endotracheal tube protection and safety, operating room protocols, and anesthesia considerations as they relate to laser surgery of the upper aerodigestive tract.

Section II covers the use of lasers in the larynx, with specific reference to applications and indications for laser surgery. Included in this section of the book are chapters on the use of lasers for benign and malignant laryngeal pathology. Also included is a chapter devoted to the use of lasers for voice surgery.

Section III is devoted to the use of lasers in nasal and sinus surgery. Dr Krespi, the section editor, is well known for his work in this area. In addition to the typical rhinological applications for lasers in our specialty, the authors cover miscellaneous applications and laser DCR. Otological laser surgery is the focus of Section IV. Its organization parallels the rest of the book; chapters are devoted to specific otological laser applications, with emphasis on appropriate laser wavelengths where indicated. Section V is devoted to orofacial surgery, and includes chapters on LAUP and laser tonsil surgery. Section VI covers laser surgery in the lower airway. The quality of the illustrations and photographs nicely complements the written text, and these allow the reader more easily to understand the operative approaches and intentions of the authors of these chapters. This new textbook on laser surgery in otolaryngology- head and neck surgery is a welcome addition to the literature of our specialty, and one that you will find to be both informative and helpful in your practice.

Robert H. Ossoff, DMD, MD
Associate Vice Chancellor for Health Affairs
Director, Vanderbilt Bill Wilkerson Center for Otolaryngology and Communication Sciences
Guy M. Maness Professor and Chairman
Department of Otolaryngology
Vanderbilt University Medical Center
Nashville, Tennessee

Table of Contents

Preface
Foreword
About the Editors
List of Contributors

SECTION I: Basic Science
Section Editor: V. Oswal

1. History of Laser Light
J. Abitbol and R. Sataloff

2. Laser Biophysics
H. Moseley and V. Oswal

3. Equipment and Instrumentation
V. Oswal and M. Remacle

4. Theatre Protocol and Surgical Technique
V. Oswal and M. Remacle

5. Anaesthesia for Laser Airway Surgery
N. Puttick

SECTION II: Laryngology
Section Editor: V. Oswal

6. Lasers in Laryngology
V. Oswal and M. Remacle

7. Laser Surgery for Benign Laryngeal Pathology
V. Oswal and M. Remacle

8. Voice Surgery and Lasers
J. Abitbol, R. Sataloff and P. Abitbol

9. Lasers in the Management of Laryngeal Malignancy
M. Remacle, V. Oswal and G. Lawson

SECTION III: Rhinology
Section Editor: J. Krespi

10. Endonasal Laser Applications
V. Oswal, J.U.G. Hopf, M. Hopf and H. Scherer

11. Laser-Assisted Dacryocystorhinostomy
V. Oswal, P. Eloy, N. Jones and T. Dowd

12. Nasal Turbinate Surgery
V. Oswal, J. Krespi and A. Kacker

13. Laser-Assisted Functional Endoscopic Sinus Surgery
S. Kaluskar, J.U.G. Hopf, M. Hopf and H. Scherer

14. Miscellaneous Laser Applications in Rhinology

A. CO 2 Laser Management of Rhinophyma
S. Jovanovic
B. Laser Management of Recurrent Epistaxis
J.U.G. Hopf, M. Hopf and H. Scherer
C. Hereditary Haemorrhagic Telangiectasia
V. Oswal, J. Krespi and A. Kacker
D. Laser Surgery in the Posterior Nose/Nasopharynx
V. Oswal, F. Martin and T. Stefanos
E. Laser Management of Choanal Atresia
V. Oswal, F. Martin and T. Stefanos
F. Laser Cartilaginous Eustachian Tuboplasty
O. Kujawski, J. Fasel and R. Romanowicz

SECTION IV: Otology
Section Editor: S. Jovanovic

15. Lasers in Otology: General Considerations
V. Oswal

16. An Overview of Lasers in Otology
V. Oswal and P. Garin

17. The KTP Laser in Cholesteatoma
J. Hamilton

18. Laser Myringotomy
B. Sedlmaier and S. Jovanovic

19. CO 2 Laser in Stapes Surgery
S. Jovanovic

SECTION V: Orofacial Surgery
Section Editor: V. Oswal

20. The Orofacial Region: Laser Practice
P. Bradley

21. Laser-Assisted Surgery for Snoring and Obstructive Sleep Apnoea
Y.V. Kamami, J. Krespi, R. Simo and A. Kacker

A. Laser-Assisted Uvuloplasty
J. Krespi and A. Kacker
B. Laser-Assisted Septoplasty
J. Krespi and A. Kacker
C. Laser Midline Glossectomy and Lingualplasty for Obstructive Sleep Apnoea Syndrome
J. Krespi and A. Kacker

22. Laser Tonsil Surgery

A. Laser Tonsillectomy
S. Kaluskar
B. Laser-Assisted Serial Tonsillectomy
J. Krespi and A. Kacker
C. Laser Management of the Lingual Tonsils
J. Krespi and A. Kacker
D. Cryptolysis for Halitosis
M. Remacle

SECTION VI: Lower Airway Laser Surgery
Section Editor: V. Oswal

23. Lasers in the Lower Airways
A. Rafanan and A. Mehta

SECTION VII: Miscellanea
Section Editor: V. Oswal

24. CO 2 Laser Endoscopic Microsurgery of Zenker’s Pharyngo-oesophageal Diverticulum
M. Remacle and V. Oswal

25. Spectral Imaging for the in-vivo Detection and Mapping of Tissue Lesions: Implications in Laser
Treatment Planning
C. Balas, E. Prokopakis and E. Helidonis

26. Preparing a Business Case for the Purchase of a Laser
R. Llewellyn

27. Local Rules for the Safe Operation of Lasers in the ENT Theatre
I. Morgan and D. Mason

28. Glossary of Laser Terminology
V. Oswal and T. Galletta

Subject index
Index of Authors

CD-ROM - table of contents

I. Basic Science

1. Laser tissue interactions

2. Aiming beam (HeNe spot)

3. Protection from non-target strikes (trachea)

4. Protection from non-target strikes (Vocal folds)

5. Heat sink

6. Wound toilet

7. Reflected beam

8. Fire Hazard

9. Third hand technique

10. Acublade-New accessory for CO2 Laser - Sharplan CD

II. Laryngology

1. Benign laryngeal lesions

1. Recurrent respiratory papilloma
2. Reinke's oedema
3. Epidermoid cyst
4. Anterior glottic web
5. Anterior glottic web and stent

2. Phonosurgery

1. Vocal nodule
2. Dysphonia
3. Alteration of pitch

3. Cancer of larynx

1. Subepithelial cordectomy
2. Subligamentous cordectomy Type II-1
3. Transmuscular cordectomy
4. Extended cordectomty - Va
5. Supraglottic laryngectomy
6. Debulking tumour

III. Rhinology

1. Transcanalicular endonasal combined DCR

2. Endonasal Laser Dacryocystorhinostomy

3. Turbinate surgery

4. Hereditary haemorrhagic telangectasia

5. Middle meatal antrostomy

6. Eustachian tuboplasty

7. Revision functional endoscopic sinus surgery

8. Dornier 940nm laser in nasel pathology

IV. Otology

1. Otolam myringotomy

2. Stapes surgery

1. Stapedotomy
2. Floating footplate
3. Obliterative footplate

V. Oral surgery

1. Laser surgery for snoring

1. Laup
2. Interstitial shortening with diode laser

2. Laser tonsil surgery

1. KTP Tonsillectomy
2. Tonsil ablation

VI. Miscellaneous laser applications

1. Zenker's diverticulum

VII. Appendix

1. Laser glossary

2. Classification of common lasers

3. Parameters of various clinical lasers

4. Laser courses

1. Abitbol
2. Jovanovic
3. Kaluskar
4. Kujawski
5. Oswal
6. Remacle

5. Local rules

6. Book table of contents

Laser Courses

Dr Jean Abitbol

The International Workshop on Laser Voice Surgery and Voice Care
Paris, France
Annually: April

Prof S Jovanovic

Laser Course in Otolaryngology, Head and Neck Surgery
Berlin, Germany
Annually: October

Mr S. Kaluskar

Functional Endoscopic Sinus Surgery Course and KTP/532 Laser Workshop
Co Tyrone, N. Ireland
Twice-yearly: April & September

Course Director: Mr S. Kaluskar

Mr O. Kujawski

Laser Eustachian TuboPlasty (LETP)

Course Director: Mr O. Kujawski

Mr. V.H. Oswal, FRCS

The Cleveland International Hands-On Course
Middlesborough, Cleveland, UK
Annually: 3^rd weekend of October.

Prof Dr Med Marc Remacle

International Course on Lasers in Otorhinolaryngology
Yvoir, Belgium
Annually: June 

This five-day hands-on course started in 1988. It is hosted by the University Hospital of Mont-Godinne, Yvoir, Belgium. This annual course covers all areas of laser applications in otology, rhinology, and laryngology. It runs for five days. The first three days cover lectures, live surgery, and discussions. The last two days are available for hands-on training on human cadavers. 

The annual theme of the course is to present new developments in laser technology in ENT micro- and ambulatory surgery.

The course is suitable for those who are new to laser technology, as well as for those who are more experienced, but wish to broaden their laser applications in order to keep pace with up-to-date state-of-the-art techniques.

The course is approved by the European Laser Association and the British Medical Laser Association for its educational content.

Book reviews

To be published in Lasers in Medicine, exact date yet unknown

This is an excellent comprehensive, good readable reference book for the otorhinolaryngologist who has an interest in laser surgery or has already own clinical practices. It should be ready on hand in each ENT-clinic where lasers are used. ' The publication has two co-editors: S. Jovanovic and J. Krespi and 37 contributors from Europe and the U.S.A. and an interactive CD-ROM is included. The table of contents gives 7 sections and the first section described history and biophysics of the laser modalities; equipment and instrumentation; theatre safety protocols and surgical and anesthesia techniques. The five following sections covering a different anatomical area, the seventh is miscellanea (including Zenker's diverticulum treatment). Each section is divided in chapters with adequate references and the book is considerable illustrated with drawings and clear colour photographs. Each chapter started with introductions such as about anatomy; (patho)physiology; equipment; preoperative preparation; indications and contraindications and choice of laser for surgical lasers procedures are described. Much attention is given on patient risks and benefits and patient selection. I am contented with the authors skill in textual criticism. For example they propound rightly that know-how about lasers and training will be essential but likewise clinicians not only needs to be familiar with laser techniques but also the theatre staff. The use of lasers in phonomicrosurgery are discussed in detail and well documented and illustrated. There are mentioned a lot of indications in rhinology (more than I know before reading the book) and all endonasal applications, including dacryocystorhinostomy, are comprehensive described and illustarted. In my experience patients with hereditary haemorrhagic teleangiectasia (HTT) have indeed great benefit of laser applications but not only for the nasal mucosal lesions also for facial skin lesions. (Completion on my part.) I encounter new laser applications described in the otology and orofacial sections. Laser assisted surgery for snoring and OSAS was interested to read as well as the possibilities for laser surgery of the tonsils. The authors very properly observed that indications and patient selection for laser use of the lingual tonsils are important components of patient care. I would strongly recommend this publication for otorhinolaryngologists who want to acquire a complete up-to-date reference book dealing with any aspect of lasers in ORL.

Jos J.M. van Overbeek