1. Lasers in Oral andLasers in Oral and
Maxillofacial SurgeryMaxillofacial Surgery
ByBy
ghassan Nazik Talebghassan Nazik Taleb
44thth
stage arabic board of oral andstage arabic board of oral and
maxillofacial surgerymaxillofacial surgery
2. What is Laser?
• LASER
• Light
• Amplification by
• Stimulated
• Emission
• Radiation
9. Thermal effect of laser radiation
Temperature Biological Effect
37 0
C Normal
45 0
C Hyperthermia
50 0
C Reduction in enzyme activity, cell immobility
60 0
C Denaturation of proteins and collagen, coagulation
80 0
C Permeabilization of membranes
100 0
C Vaporization, thermal decomposition
150 0
C
Carbonization
300 0
C
Melting
10. Potential advantages of laser
• 1. No-touch techniques that ensures sterile surgical site.
• 2. Reduced blood loss.
• 3. Limited fibrosis and stenosis.
• 4. Fiber optic delivery.
• 5. Potential reduction in spread of metastasis by sealing
lymphatic vessel and killing of malignant cells.
11. Potential advantages of laser
• 6. Fewer instruments in the field.
• 7. Reduce post-operative pain.
• 8. Sterilization of the impact site.
• 9. Dry surgical field.
• 10. Reduced edema
12. Potential Hazard of Laser MachinePotential Hazard of Laser Machine
1. Hazard to eye: corneal or retinal burns (or both). Chronic
exposure to excessive levels may cause corneal or retinal
injury
2. Hazard to skin: Sever burns & scarring.
3. Electrical hazard: High voltage – life threatening.
4. Fire : The solvents used in dye lasers are flammable. High
voltage pulse or flash lamps may cause ignition.
14. Types of laser
CO2 laser
-Produce sterile surgical field: bactericidal,
virucidal
-has the ability to coagulate, vaporize or
incise tissue
-aids in good haemostasis
-reduce local tissue trauma & edema
-precise energy delivery to diseased area
-reduce pain by neuron sealing & decrease
pain mediator release
-minimize tumor cell dispersion by lymphatic
sealing
-can get access to difficult sites
15. Argon laser
Argon laser at 488 and 514 nm,
respectively, was one of the first
laser to be used in the treatment
of vascular lesion it gained popularity
during the 1970s.
16. Nd.YAG laser
the continuous-wave Nd:YAG
laser emits light in the 1064 nm
In the non contact mode the
Nd.YAG has limited value in the
oral cavity because of deep
penetration and scatter. .
Newer CW Nd:YAG lasers fitted with
sapphire tips have overcome many of the
drawbacks of using this laser in the oral
cavity
17. Pulsed dye laser
At a wavelength of 575 or 585 nm
there is superselective absorption
by vascular tissue and little effect
on melanin.
18. Q-Switched Nd:YAG laser
Q-Switched Nd:YAG laser can produce
two wavelength, those being 1064 nm
and 532 nm, respectively.
In the treatment of intraoral tattoos,
predominantly the amalgam tattoo, it
has been found the Q-Switched Nd:YAG
laser very useful.
19. Other laser
*Q-Switched ruby laser: (694 nm)
*Copper vapor laser ( 578-nm for vascular lesions).
*KTP laser (532 nm, for vascular lesions).
*Alexandrite laser ( 755 nm, for melanosomes).
20. The Clinical Applications
* Laser management of intraoral surface lesions.
* Laser management of malignant lesions of the head
and neck.
* Laser management of vascular lesions.
* Laser surgery of the temperomandibular joint.
* Laser and skin procedures* Laser and skin procedures
21. Laser management of intraoral surface lesions
Frictional hyperkeratosis
To excise smaller questionable lesions the CO2 laser with a 0.2
mm can be set at 10 to 20 W of power .
22. Laser management of intraoral surface lesions
Nicotinic
stomatitis
symptoms of the pain
burring and ulceration of the
palatal tissue
the surgeon may eradicate
the lesion using a laser, the
CO2 laser can be set in a
continuous wave mode and
defocused using 10 to 20 W
of power to vaporize the
lesion.
23. Laser management of intraoral surface lesions
Solar cheilitis
treatment modalities including
* chemical peeling,
* cryosurgery
* lip shave
using the CO2 under microscopic control allow for removal of
defined area of the lip at greater depth with
1. less post operative neuropathies
2. less cicatrix formation
3. less haematoma and lip distortion or aesthetic compromise.
24. Laser management of intraoral surface lesions
Leukoplakia
Small lesion can be excised
with a focused CO2 laser
with 3-4 mm margin.
The main disadvantage of
vaporization is inability to
generate a specimen for the
pathologist.
25.
26. Laser management of intraoral surface lesions
Erythroplakia
Can Easiley removed by CO2
laser
The laser is set on Ultra Pulse
at 10-20 W in a pulse mode to
outline the entire lesion.
27. Laser management of intraoral surface lesions
Lichen planus
Erosive lichen planus doesn’t
appear completely controlled by
the laser ,the CO2 laser should be
used as adjunctive therapy along
with selected local and systemic
medication, CO2 laser at 10-15 W
and using a continuous mode and
a defocused application . The
contact Nd:YAG with a round
probe using 10-15W is also an
alternative
28. Laser management of intraoral surface
lesions
Condyloma
acuminatum
CO2 laser can be used in a free
beam system to excise
intraoral lesion.
The base of the lesion can be
using a laser in a defocused
mode.
29. Laser management of intraoral surface lesions
Oral melontic
macule
There is no way to
differentiated some of these
lesions from other such as
early superficial melanomas
therefore they can be
biopsies with CO2 laser .
30. Laser Management of Malignant
Lesion of Head And Neck
Carcinoma of the
tongue
Most papers has described the use
of a free beam CO2 laser with a
narrow beam as a cutting instrument
for this lesion but more recently
report of contact tip Nd:YAG laser
has also be used.
31. Laser Management of Malignant
Lesion of Head And Neck
Lesions of the
lips
exophytic lesion on the
vermillion border or
cutneous surface of the lip
can be excised with a
surgical laser
the resulting defect can be
left open to epithelialize
secondarily with an
excellent result .
32. Laser Management of Malignant
Lesion of Head And Neck
Lesions of the
palate
the laser may be use as a means of
outlining the lesion and making the
superficial incision dawn to the
periosteum.
33. Laser Management of Malignant
Lesion of Head And Neck
Verrucous
carcinoma
Its adequately removed by means
of a laser used either in an
excision mode or in vaporization
mode, this is carried out under
tolidin blue control.
34. Laser Management of Malignant
Lesion of Head And Neck
Debulking of lesion
debulking lesion either in
vaporization or in excisional
mode.
Advantage of laser is lack of
bleeding and ability to seal
lymphatic, lesion can be
debulked in order to more
susceptible to radiation
therapy or chemotherapy.
38. Some Anatomical consideration
Tongue
1- high vascularity
2- sensitivity to electrical
stimuli
The tongue responds well
to the CO2 laser, and
powers in the range6 to 8 w
for most procedure (at a
0.35 mm spot size) for
deeper lesions higher
power (8 to 10 w) are
justified.
39. Some Anatomical consideration
Floor of mouth
1- difficult access
2- prominent vascularity
3- proximity of the submandibular duct
CO2 hollow waveguide handpieces with contr-angle heads or curved guide tips, or
fiberoptic Nd:YAG handpieces make surgery in this area simple. Power in the range of 4
to 6 w of CO2 energy in focused mode (0.1 to 0.35 mm) or 6 to 8 w in defocused mode ( 1.5
to 3 mm) are usually sufficient for excellent cutting and ablating effects.
40. Laser assisted arthroscopic surgery ofLaser assisted arthroscopic surgery of
TMJTMJ
most common usedmost common used Holmium:YAG laser
*Synovectomy*Synovectomy
*Release of anterior disk attachment for clicking or*Release of anterior disk attachment for clicking or
closed lockclosed lock
*Hypermobility*Hypermobility
*Recontouring of perforated disk*Recontouring of perforated disk
for disk preservationfor disk preservation
43. Laser and skin proceduresLaser and skin procedures
• BlepharoplastyBlepharoplasty
• Removal of tattoosRemoval of tattoos
• Removal of pigmentationRemoval of pigmentation
• Hair removalHair removal
44. Low-level lasers therapy (LLLT)Low-level lasers therapy (LLLT)
• Phototherapy used to deliver small amount of energy toPhototherapy used to deliver small amount of energy to
living cells with minimal heat production & beneficialliving cells with minimal heat production & beneficial
cellular effects labeled as biomodulation or biostimulationcellular effects labeled as biomodulation or biostimulation
• Effects of LLLTEffects of LLLT
Pain modulation (TMD, postherpetic neuralgia)Pain modulation (TMD, postherpetic neuralgia)
Increase microcirculationIncrease microcirculation
Reduce inflammation & edemaReduce inflammation & edema
Accelerate wound healingAccelerate wound healing
Muscle relaxationMuscle relaxation
Accelerate bone repairAccelerate bone repair
Enhance immune reactivityEnhance immune reactivity
Increase cellular ATP productionIncrease cellular ATP production
Increase cellular membrane transportIncrease cellular membrane transport
45. laser application in implantology
Recently a pulsed Nd:YAG system to
implant dentistry, and most of these
procedures can be performed
without local anesthesia.
So we can do:
*second stage surgery
*thinning and contouring flaps during
initial implant surgery
*removal of necrotic and granulation
tissue
*soft tissue surgery around implants
46. REFERENCES
• Neelima oral and maxillofacial surgery 2012
• Secrets oral and maxillofacial surgery2008
• Lewis lasers in maxillofacial surgery and
dentistry
• Operative oral and maxillofacial surgery ,
Langdon 2011
• Internet
