Trans-oral, Carbon Dioxide-Assisted Excision of an Unusual Schwannoma of the Tongue Base: Case Report and Review of the Literature

Abstract Introduction Schwannomas are benign, solitary, encapsulated tumors that may originate at any site of the peripheral nervous system, with the exception of the olfactory and optic nerves. Schwannomas of the base of tongue are very rare, and only sporadic cases are documented. The tongue base represents a challenge for surgeons. Carbon dioxide (CO2) laser might provide an effective surgical option for such lesions because of the easy access to the lesion, the bloodless surgical field and optimum epithelization of wounds. Objective We present an unusual case of pedunculated schwannoma of the tongue base treated via transoral CO2-assisted excision. We also provide a review of the available literature, in English language, on humans. Data synthesis The authors searched the PubMed database and Google up to July 2018. The following search terms were applied: tongue and lingual, combined with schwannoma and neurilemmoma. Titles and abstracts were screened, and, then, only supraglottic (hypopharyngeal) tongue base masses were considered. Fourteen articles were included in this review, reporting 17 cases. The age of the patients ranged from 9 to 39 years, affecting predominantly females. Dysphagia and lump sensations were the most common presenting symptoms, and the mean follow-up period range was 1.5 to 60 months (mean = 13 months). There was no evidence of recurrence in any of the cases. Conclusion We could conclude that tongue base schwannomas are rare. Transoral complete excision of the tumor is the treatment of choice. CO2 laser surgery is a minimally invasive treatment option that has been performed in few reports with no recurrence and with favorable outcomes.

The clinical application of ultra-pulsed CO2 laser skin abrasion combined with micro-skin grafting in the treatment of skin depigmentation / 中华整形外科杂志

Objective@#To explore the clinical application of ultra-pulsed CO2 laser skin abrasion combined with micro-skin graft in the treatment of skin depigmentation.@*Methods@#From January 2010 to June 2014, depigmented skin specimens were used for ultra-pulsed CO2 laser skin abrasion treatment, at 0, 10, 20, 30, 40, 50, 60 mJ. HE stain was performed to observe the abrasion depth under the 100 times microscope view. The most appropriate parameter was set to completely remove the epidermis, and leave dermis undamaged. From January 2011 to December 2017, 16 patients with skin depigmentation, 12 males and 4 females, aged 12-47 years, were treated with super-pulsed carbon dioxide laser and autologous microdermis transplantation. At 1, 3, 6 and 12 months after the operation, patients′ photos were record. The color improvement was analyzed using Image-Pro Plus 6.0 software.@*Results@#The laser energy for complete epidermis removal is different at different sites. It is 50 mJ for back skin, 40 mJ for face and hand skin and 30 mJ for neck skin. After one year of follow-up, there was no hypertrophy scar caused by over-abrasion in all 16 patients. Combined with the micro-skingrafting, 15 patients with skin depigmentation were completely resolved, with more than 90%color improvement rate. The improvement rate was 75% in a patient with un-uniform appearance, due to part failure of micro-skin graft. The neck movement and uncertain fixation were the reasons.@*Conclusions@#The appropriate energy parameters can control the abrasion depth to avoid the hypertrophic scar. Combined with micro-skin graft, the depigmentation area can be improved with uniform color and reliable effect.

Clinical effects of sequential laser treatments on early stage hypertrophic burn scars / 中华烧伤杂志

Objective@#To observe the clinical effects of sequential treatments of pulsed dye laser (PDL) and ablative fractional carbon dioxide laser on early stage hypertrophic burn scars.@*Methods@#From January 2016 to December 2017, 221 patients with 228 hypertrophic scars in all parts of body within 6 months post healing, conforming to the study criteria and treated in our department, were included in this prospective study. They were first treated by PDL, repeated at an interval of one month until the vascularity score of scar fell below 2 points, and then treated by ablative fractional carbon dioxide laser, repeated at an interval of 3 months. Their start time and numbers of treatment and follow-up time were recorded. Before the first treatment (hereinafter referred to as before treatment) and at the last follow-up (hereinafter referred to as after treatment), the vascularity, thickness, and pliability of scars were scored by a self-made scar rating scale. The scores of patients with the observation time between 6 to18 months post healing were compared among scars of patients grouped by age, body site of scar, starting time of treatment and numbers of treatment. The laser speckle contrast imaging technique was used to measure the blood flow value of scars. The itching symptom of the scars was evaluated by the Verbal Rating Scale. The satisfaction to the final effects of the doctors and patients was investigated and scored separately by Likert scale after treatment. The therapeutic or adverse reactions were recorded during the treatment. Data were processed with paired t test, Mann-Whitney U test, Wilcoxon signed rank sum test, Kruskal-Wallis H test, and Spearman rank correlation analysis.@*Results@#(1) The patients were treated on (64±36) d post healing, by PDL for (2.5±1.3) times and by ablative fractional carbon dioxide laser for (2.2±1.2) times. The follow-up time was (331±189) d. (2) The vascularity, thickness, pliability scores and total scores of scars were (1.4±0.9), (2.0±0.8), (1.7±0.8), and (5.0±2.1) points respectively after treatment, which were significantly lower than those before treatment [(4.1±0.7), (3.1±0.8), (3.0±0.9), and (10.2±2.0) points respectively, t=43.332, 24.968, 28.063, 46.394, P<0.01]. (3) Among the 123 scars from 120 patients with observation time between 6 to 18 months post healing, there were no statistically significant differences in the vascularity, thickness, pliability scores and total scores of scars among patients with different ages after treatment (χ2=4.339, 1.826, 1.375, 2.879, P>0.05). There was only significant difference in the pliability scores of scars among different body sites (χ2=13.530, P<0.05). There were statistically significant differences in the vascularity, thickness, pliability scores and total scores of scars with different starting time of treatment (χ2=30.725, 25.233, 25.119, 35.798, P<0.01). There were significantly positive correlation between starting time of treatment and the vascularity, thickness, pliability scores and total scores of scars (r=0.492, 0.442, 0.446, 0.532, P<0.01). There were statistically significant differences in the vascularity, pliability scores and total scores of scars with different numbers of treatment (Z=4.883, 4.910, 5.049, P<0.05). There were significantly negative correlation between number of treatment and the vascularity, thickness, pliability scores and total scores of scars (r=-0.176, -0.131, -0.191, -0.201, P<0.05). (4) The blood flow values were determined in 18 scars of 18 patients. The results showed that the blood flow values of scars after treatment were significantly decreased compared with those before treatment (t=7.230, P<0.01). (5) The pruritus scores of scars of patients after treatment were significantly decreased compared with those before treatment (Z=12.818, P<0.01). (6) There were significant differences between the satisfaction scores of doctors and the scores of patients after treatment (t=12.130, P<0.01). (7) After PDL treatment, there were some edema and purpura reactions for all the patients, and 11 (5.0%) patients had blisters. After ablative fractional carbon dioxide laser treatment, 4 (1.8%) patients had blisters, 5 (2.3%) patients suffered inflammatory reaction and erosion, and 9 (4.1%) patients suffered pigmentation.@*Conclusions@#The scores of hypertrophic burn scars can be obviously improved by sequential treatments of PDL and ablative fractional carbon dioxide laser. The effects can be more obvious with the earlier starting time and more numbers of treatment. The laser treatments can also decrease the blood flow values and alleviate the pruritus of scars, with high satisfaction of both patients and doctors.

Clinical effects of a combination treatment with narrow-spectrum intense pulsed light and fractional carbon dioxide laser on hypertrophic scar pruritus / 中华烧伤杂志

Objective@#To observe the effects of a combination treatment with narrow-spectrum intense pulsed light and fractional carbon dioxide laser on hypertrophic scar pruritus in clinic.@*Methods@#A prospective randomized controlled study was conducted. A total of 90 patients with hypertrophic scars conforming to the inclusion criteria who were hospitalized in our ward from March to December 2017 were divided into combination treatment group and control group according to the random number table, with 45 patients in each group. For scar pruritus, patients in control group were treated twice by narrow-spectrum intense pulsed light with a one-month interval, while patients in combination treatment group were firstly treated by narrow-spectrum intense pulsed light combined with fractional carbon dioxide laser once, and with narrow-spectrum intense pulsed light once one month later. Before and 3 months after treatment, scar pruritus was evaluated by the Visual Analogue Scale and the Four-item Itch Questionnaire, and the improvement of scar was assessed by photography. Three months after treatment, the treatment satisfaction of scar pruritus was self-rated by patients. Meanwhile, adverse effects were recorded during the procedures and follow-up periods. Data were processed with Chi-square test, paired t test, Wilcoxon rank-sum test, and Fisher′s exact probability test.@*Results@#Before treatment, there was no statistically significant difference in scar pruritus degree evaluated by the Visual Analogue Scale and score distribution of scar pruritus location, extent, frequency, and sleep effect of the Four-item Itch Questionnaire between patients of two groups (Z=-1.08, -0.91, -0.03, -0.69, -1.49, P>0.05). Three months after treatment, there was reducing degree of scar pruritus of patients evaluated by the Visual Analogue Scale in control group or combination treatment group compared with before treatment within the same group (Z=-1.98, -4.65, P<0.05 or P<0.01), while the latter was more obvious than the former (Z=-2.14, P<0.05). There were reducing scores of scar pruritus extent and frequency of patients in control group, along with location, extent, frequency, and sleep effect of patients in combination treatment group compared with those before treatment within the same group (Z=-2.33, -2.34, -3.53, -4.96, -3.32, -4.84, P<0.05 or P<0.01). However, scores of scar pruritus location and sleep effect of patients in control group were similar to those before treatment within the same group (Z=-0.58, -1.34, P>0.05). The scores of scar pruritus location, extent, frequency, and sleep effect of patients were obviously lower in combination treatment group compared with control group (Z=-2.09, -2.69, -1.99, -2.23, P<0.05 or P<0.01). It was much better of scar improvement of patients in combination treatment group compared with control group (Z=-4.00, P<0.01). The percentages of treatment satisfaction of scar pruritus of patients with 0, 1%-25%, 26%-50%, 51%-75%, 76%-100% were 0, 2.2% (1/45), 17.8% (8/45), 48.9% (22/45), and 31.1% (14/45) respectively in combination treatment group, which were obviously better than 0, 11.1% (5/45), 53.3% (24/45), 28.9% (13/45), and 6.7% (3/45) in control group (Z=-4.42, P<0.01). During the treatment and follow-up periods, the adverse effect ratio of patients in control group was 6.7% (3/45), similar to 2.2% (1/45) of combination treatment group (P>0.05).@*Conclusions@#The combination of narrow-spectrum intense pulsed light and fractional carbon dioxide laser can greatly reduce pruritus, improve effect of scar treatment, and bring higher patient satisfaction compared with narrow-spectrum intense pulsed light alone in treating hypertrophic scar pruritus.@*Clinical trial registration@#Chinese Clinical Trial Registry, ChiCTR-ONH-17012350.

Clinical comparative study of pulsed dye laser and ultra-pulsed fractional carbon dioxide laser in the treatment of hypertrophic scars after burns / 中华烧伤杂志

Objective@#To compare the efficacy and safety of pulsed dye laser (PDL) and ultra-pulsed fractional carbon dioxide laser (UFCL) in treating hypertrophic scars after burns.@*Methods@#Two hundred and twenty one patients with hypertrophic scar after burns conforming to the study criteria were admitted to our unit from February 2015 to October 2017, and their data were retrospectively analyzed. Patients were divided into group PDL (n=122) and group UFCL (n=99) according to the treatment method. Patients in group PDL were treated with PDL once every 3-4 weeks. Patients in group UFCL were treated with UFCL once every 6-12 weeks. Patients in both groups were treated until 12 months after having scar. Scars were scored by Vancouver Scar Scale (VSS) before and after treatment. Patients′ pain was evaluated by Visual Analogue Scale (VAS) method before and after treatment. Blood flow in scar was monitored and recorded before treatment and in treatment months 6 and 12. Satisfaction degree of patients was recorded 3-6 months after treatment, and the satisfaction rate was calculated. Adverse reactions including duration of erythema/purpura, VAS in treatment, and loss of working time were recorded. Data were processed with one-way analysis of variance, t test, and Chi-square test.@*Results@#(1) VSS scores of patients in groups PDL and UFCL after treatment were significantly lower than those before treatment in the same group (t=11.34, 12.77, P<0.05). The decreasing VSS scores of patients after treatment in groups PDL and UFCL were (5.8±1.1) and (6.0±1.4) points, respectively, and there was no statistically significant difference between the two groups (t=1.91, P>0.05). (2) VAS of patients in groups PDL and UFCL after treatment were significantly lower than those before treatment in the same group (t=7.12, 5.23, P<0.05). The decreasing VAS of patients after treatment in groups PDL and UFCL were (4.0±0.6) and (3.2±1.3) points, respectively, and there was no statistically significant difference between the two groups (t=1.93, P>0.05). (3) Scar blood flow of patients in group PDL in treatment months 6 had no obvious change compared with that before treatment (t=1.59, P>0.05), while that in treatment months 12 significantly decreased compared with that before treatment and that in treatment months 6 (t=3.17, 6.96, P<0.05). Scar blood flow of patients in group UFCL in treatment months 6 significantly increased compared with that before treatment (t=6.01, P<0.05), while that in treatment months 12 significantly decreased compared with that in treatment months 6 (t=4.52, P<0.05), but had no obvious change compared with that before treatment (t=0.92, P>0.05). (4) The satisfaction degree of patients in group PDL was 80.3% (98/122), which in group UFCL was 76.8% (76/99), and there was no statistically significant difference between the two groups (χ2=0.97, P>0.05). (5) The duration of erythema/purpura of patients in group PDL was (5.2±0.7) d, significantly shorter than (6.1±0.5) d in group UFCL (t=2.49, P<0.05). The VAS of patients in group PDL during treatment was (1.9±0.9) points, significantly lower than (4.7±0.4) points in group UFCL (t=4.85, P<0.05). Loss of working time of patients in group UFCL was (9.17±0.72) d, which was significantly longer than (3.96±0.23) d in group PDL (t=3.17, P<0.05).@*Conclusions@#PDL and UFCL have definite effects on hypertrophic scar, while PDL with light pain, minor wound, and fast recovery time, is safe and effective for treatment of early hypertrophic scar and worthy of clinical promotion and application, especially for children and patients with poor pain tolerance.

Treatment of Recalcitrant Plantar Warts with 5-aminolevulinic Acid Photodynamic Therapy(ALA-PDT)after Preconditioning with Superpulse Carbon Dioxide Laser / 中山大学学报(医学科学版)

[Objective]To investigate the efficacy and safety of ALA-PDT following CO2laser preconditioning for recal-citrant plantar warts.[Methods]Patients with recalcitrant plantar warts were enrolled in this study,and received ALA-PDT treatment following CO2laser preconditioning. Cure rate and side effects were observed.[Results]Twenty patients were en-rolled and 85%(17/20)showed complete clearance of plantar warts after one to three times of ALA-PDT. PDT treatment time was once in two patients(10%),twice in five patients(25%)while three times in 10 patients(50%).No infection or scar tissue was observed.Five(25%)patients were infected with one type of HPV,while 15(75%)patients with two or mul-tiple types of HPV. No difference was observed in complete clearance rate between patients with single or multiple HPV gen-otypes infection.[Conclusions]Superpulse carbon dioxide laser pretreatment enhanced the efficacy of ALA-PDT treatment on recalcitrant plantar warts.Further study is needed to determine the association of HPV genotype with outcome of recalci-trant plantar warts.

The Utilization of Cutaneous Laser Therapy at the Department of Dermatology, Hospital Kuala Lumpur: A 5-year review

Introduction:The Department of Dermatology, Hospital Kuala Lumpur has been providing cutaneous laser therapyservices for over 20 years. We aim to describe the utilization of cutaneous laser therapy at the Departmentof Dermatology, Hospital Kuala Lumpur and the post treatment complications.Methods:We reviewed all patients who received cutaneous laser therapy at the Department of Dermatology, HospitalKuala Lumpur from January 2012 till December 2016. Complications were defined as dyspigmentation,infection, scarring, blisters, ulcerations, skin textural changes or contact dermatitis secondary to post/ pre-lasertopical therapy.Results:A total of 1190 patients with a male to female ratio of 1:2.21 and a mean age of 35.8 years received single,repeated or combination cutaneous laser therapy from 2012 till 2016 for 48 different skin conditions. Annually,an average of 1314 laser sessions were performed. Indications included seborrhoeic keratosis (249, 20.9%),port wine stain (162, 13.6%), solar lentigines (144, 12.1%), syringoma (105, 8.8%), viral warts (88, 7.4%),and Naevus of Ota (82, 6.9%) among others. Majority underwent Q-switched Nd:YAG laser (36.5%) followedby pulsed dye laser (33.6%), ablative conventional carbon dioxide laser (29.2%) and fractional carbon dioxidelaser (0.7%). Over the past 5 years, 3 patients developed severe complication post laser therapy which wasblisters. Pain was tolerable with application of topical 5% EMLA? (lidocaine 2.5% and prilocaine 2.5%) creampre-laser treatment.Conclusion:Q-switched Nd:YAG laser therapy was the most frequently employed laser in the Department ofDermatology, Hospital Kuala Lumpur. Our centre has a high volume of cases with a low rate of posttreatment complication.

Effificacy of autologous platelet-rich plasma combined with fractional ablative carbon dioxide resurfacing laser in treatment of facial atrophic acne scars: A split-face randomized clinical trial.

Background: Autologous platelet-rich plasma has recently attracted signifi cant attention throughout the medical fi eld for its wound-healing ability. Aims: This study was conducted to investigate the potential of platelet-rich plasma combined with fractional laser therapy in the treatment of acne scarring. Methods: Sixteen patients (12 women and 4 men) who underwent split-face therapy were analyzed in this study. They received ablative fractional carbon dioxide laser combined with intradermal platelet-rich plasma treatment on one half of their face and ablative fractional carbon dioxide laser with intradermal normal saline on the other half. The injections were administered immediately after laser therapy. The treatment sessions were repeated after an interval of one month. The clinical response was assessed based on patient satisfaction and the objective evaluation of serial photographs by two blinded dermatologists at baseline, 1 month after the fi rst treatment session and 4 months after the second. The adverse effects including erythema and edema were scored by participants on days 0, 2, 4, 6, 8, 15 and 30 after each session. Results: Overall clinical improvement of acne scars was higher on the platelet-rich plasma-fractional carbon dioxide laser treated side but the difference was not statistically signifi cant either 1 month after the fi rst treatment session (P = 0.15) or 4 months after the second (P = 0.23). In addition, adverse effects (erythema and edema) on the platelet-rich plasma-fractional carbon dioxide laser-treated side were more severe and of longer duration. Limitations: Small sample size, absence of all skin phototypes within the study group and lack of objective methods for the evaluation of response to treatment and adverse effects were the limitations. Conclusion: This study demonstrated that adding platelet-rich plasma to fractional carbon dioxide laser treatment did not produce any statistically signifi cant synergistic effects and also resulted in more severe side effects and longer downtime.

A Case of Aryepiglottoplasty under Conventional Ventilation in Congenital Laryngomalacia Patient / 대한이비인후과학회지

Laryngomalacia is reported as the most common cause of congenital laryngeal stridor. Despite its benign and self-limited aspects, 10% of all cases require intervention. However, endolaryngeal surgery in neonates makes great demands on the anesthesiologist and the surgeon because of the narrowness of the airways. This case report will present a surgical management of severe laryngomalacia in a newborn using the combination carbon dioxide laser and cold instrument to surgically divide the aryepiglottic fold under conventional ventilation.

Principles and Practices of Fractional Carbon Dioxide Laser / 대한피부과학회지

Carbon dioxide (CO2) laser is one of the most widely used lasers in dermatology. CO2 laser can precisely ablate the skin with good hemostasis, which makes it an ideal surgical laser. With the development of pulsed CO2 laser, which enabled cleaner ablation with less residual thermal damage, CO2 laser resurfacing became the gold standard for skin rejuvenation. The rejuvenation effect of full-face CO2 laser resurfacing is unparalleled to other methods; however, it is associated with a relative high incidence of side effects and prolonged downtime. Fractional CO2 laser was developed to overcome this problem. With a new technology of fractionating the laser beam into hundreds of microbeams, fractional CO2 laser resurfacing can improve various skin conditions including skin laxity, photodamage, and acne scars with short downtime and significantly lesser side effects. For optimal treatment results, clinicians have to decide the treatment depth and density based on proper understanding of the laser tissue interaction and underlying skin conditions.

Clinical effect of carbon dioxide laser in the treatment of laryngeal papilloma / 医学研究生学报

Objective Our study was aimed to study the clinical effect of carbon dioxide laser in the treatment of adult laryn -geal papilloma . Methods Clinical data of patients with adult laryngeal papilloma received treatment at our hospital from January 2012 to June 2014 was retrospectively analyzed .Patients were divided into two groups according to the type of treatment , observation group:received carbon dioxide laser treatment;control group:received tumor forceps treatment .Participants included 61 cases of pa-tients, the observation group of 26 cases, control group 35 cases.Compare the general clinical data , short-term clinical effects(opera-tion time, length of hospital stay , complications , short-term curative effect ) , the change of immune inflammation indexes before and after operation and postoperative recurrence in 1 year of two groups patients. Results The operation time and the length of hospital stay in observation group was significantly lower than that in control group[(33.66 ±4.71)min vs (37.19 ±5.21)min,(4.07 ±1.25)d vs (4.83 ±1.38)d, P 4.11) ng/L, (36.16 ±7.37) ng/L, (12.63 ±4.12) ng/L.The differences of these parameters between the two groups were signifi-cant (P<0.001).Observation group patients had a lower rate of recurrence 1 year after surgery than that of control group patients (12.00%vs 37.93%, P=0.029). Conclusion In the treatment of adult laryngeal papilloma , carbon dioxide laser can achieve a better minimally invasive and lower postoperative recurrence when compare to tumor forceps treatment .

A Case of Foreign Body Granulomatous Reaction to a Red Lip Cosmetic Tattoo Successfully Treated with Carbon Dioxide Laser / 대한피부과학회지

No abstract available.

Tuberous sclerosis complex in a 33-year-old Filipino male: Focus on dermatologic manifestations and carbon dioxide laser ablation of facial angiofibromas

Tuberous sclerosis complex (TSC) is an autosomal dominant condition where loss-of-function mutation in 2 tumor suppressor genes, hamartin and tuberin, result in hamartoma formation in multiple organs, notably the skin, brain, kidney, retina, lungs, and heart. Many of the diagnostic features for TSC involve the skin. Because TSC is relatively rare even among Filipinos, there is limited data on the use of any treatment modality which addresses the cutaneous aspects of this disease in this population. A 33-year-old Filipino male presented with multiple skin-colored to hyperpigmented papules and nodules on the centrofacial area, which gradually progressed in size and number since childhood. He had normal growth and development. Family medical history was significant for a brother with similar facial lesions who died of a brain tumor in childhood. Further physical examination revealed shagreen patches, ashleaf spots, confetti macules, periungual fibromas, gingival fibromas and dental pitting. Work-up revealed the presence of renal angiomyolipomas and retinal hamartomas. A diagnosis of TSC was made. Histopathology of a facial nodule was consistent with angiofibroma. Desiring cosmesis, the patient underwent 2 sessions of ablation of the facial angiofibromas using a carbon dioxide laser (ESC/Sharplan) at 1.0W 3mm spot size at continuous mode, spaced one month apart. Follow-up at one month and six months post-treatment showed satisfactory results described as flattening of lesions with no noted recurrence of lesions. The dermatologic manifestations of TSC comprise majority of the features needed for diagnosis, and may warrant treatment because of cosmetic disfigurement. The role of the dermatologist in the recognition, diagnosis and management of this condition is emphasized. This case of a Filipino patient with TSC demonstrates that carbon dioxide laser treatment is effective for the facial angiofibromas of TSC, although the risk for recurrence is high. Definitive treatment still entails addressing the underlying genetic defect.

Clinical study of carbon dioxide laser tonsillectomy / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the therapeutic effect of carbon dioxide laser tonsillectomy.Method:In this prospective,randomized study, One hundred and two patients were divided into laser group or control group. Patients of laser group were cured with carbon dioxide laser tonsillectom,and the control group was cured with routine method. All operations are executed by one person. Observation index included operation time, hemorrhage in operation, ache after operation, inflammatory reaction of raw surface, repair time of raw surface, rehaemorrhagia and scar.Result:Laser group had advantages of less operation time, less hemorrhage, less ache and less inflammatory reaction of raw surface. Laser group have hemorrhage in operation (7.2±2.1)ml, while control group have hemorrhage in operation (92.0±35.0)ml. Laser group have pseudomembrane early but desquamate late.Conclusion:Carbon dioxide laser tonsillectomy is effective to relieve pain, inflammatory reaction and with less time ,it's an safe , efficient and mini-trauma operation.

Three Cases of Earlobe Keloids Treated with Carbon Dioxide Laser Vaporization and Pressure Earring after Partial Keloidectomy / 대한피부과학회지

Keloid is proliferative fibrous growths that result from an excessive tissue response to trauma. The earlobe is a common site for the formation of keloid and the frequent cause is ear piercing. Many modalities are available for the treatment of earlobe keloid. Surgical excision has been the most commonly used therapeutic modality but recurrence following excision is common. Intralesional triamcinolon, radiation therapy, compression device, cryosurgery, D-penicillamine or any combination of them were reported to be successful in the treatment of earlobe keloid. We report three cases of earlobe keloid treated with partial surgical keloidectomy of upper part and carbon dioxide laser vaporizing the residual keloid tissue. And then the defect was covered with a primary closure with flap. Pressure earrings were fitted 2 weeks after surgery, and were maintained for 3 months. There was no recurrence of keloid for follow-up period at least 9 months. We suggest that combined modality of CO2 laser vaporization and pressure earring after surgical keloidectomy may offer a better cosmetic and functional improvement in the treatment of primary and recurrent earlobe keloid.

Treatment of pigmented basal cell carcinoma with carbon dioxide laser.

Seven patients with nine primary well-defined pigmented basal cell carcinomas (BCC), regardless of size, were successfully treated with carbon dioxide laser. There has been no evidence of recurrence in the 3 months to 2 years following surgery. This may be the result of the dermal pigment at the lesion shoulder that more clearly marks the tumor margin. However, if the tumor was located in the reticular dermis, healing occurred with an atrophic scar. Surgical excision is recommended in cases of deep BCCs located in the convex area in terms of cosmetic results. It is therefore suggested that, in addition to the BCC subtype, the depth of invasion should always be stated in the routine histopathological report in order to determine the most appropriate treatment.

A Case of Familial Benign Chronic Pemphigus Treated With Carbon Dioxide Laser Vaporization / 대한피부과학회지

Familial benign pemphigus is a skin disease with recurrent blistering lesions, mainly in the neck and intertriginous areas. The course of the disease is characterized by spontaneous exacerbations and remissions. The many remedies for this disorder include topical and systemic glucocorticosteroids, and antibacterial and antimycotic agents. However, these therapies usually do not prolong the remission periods. Surgical treatments, such as skin graft, have been more successful. Laser treatment has reported to be effective in recurrent familial benign chronic phemphigus. Here we report a case of familial benign chronic phemphigus that was treated with carbin dioxide laser.

A Case of Familial Benign Chronic Pemphigus Treated With Carbon Dioxide Laser Vaporization / 대한피부과학회지

Familial benign pemphigus is a skin disease with recurrent blistering lesions, mainly in the neck and intertriginous areas. The course of the disease is characterized by spontaneous exacerbations and remissions. The many remedies for this disorder include topical and systemic glucocorticosteroids, and antibacterial and antimycotic agents. However, these therapies usually do not prolong the remission periods. Surgical treatments, such as skin graft, have been more successful. Laser treatment has reported to be effective in recurrent familial benign chronic phemphigus. Here we report a case of familial benign chronic phemphigus that was treated with carbin dioxide laser.

A case of nevus comedonicus-treated by carbon dioxide laser / 대한피부과학회지

At twenty two year old female with nevus comedonicus and an increased tendency to form keloids is described. Although example of successful treatment of nevus comedonicus are readily found in the literature none propose reasonable therapeutic models for keloid formers. As our patient clearly demonstrated this tendency. We initated a t,rial with the carbon dioxide laser due to it's ability to cause less thermal damage. Subsequent to completion of this t,rial, the lesion has imprcived with the acceptable cosmetic results and less comedogenic activity.

Clinical Evaluation of Anesthetic Management for CO2 Laser Surgery / 대한마취과학회지

The first laser was developed by Maiman in 1960 using a ruby crystal as an active medium. The word laser is an acronym for Light Amplification by Stimulated Emission of Radiation and this light beam can be focused to a small spot, resulting in precisely controlled coagulation, incision, or vaporization of tissue. The two types of lasers commonly used for airway surgery are the carbon dioxide laser and the neodymium-yttrium-aluminum-garnet (Nd YAG) laser. The light of the former will easily vaporize tissue and can be used to make a precise incision with minimal damage to adjacent tissue and the light of the latter can be conducted through fiberoptic instruments and permits successful endoscopic resection of untreatable recurrent or persistent malignant diseases of the major airways. Airway and endotracheal tube fire are the most feared hazard during laser surgery of the airway. The risk of fire depends on the nature of the tube material, the gaseous milieu, the beam wattage, and its mode of operation. The surgeon should use the laser intermittently at moderate wattage (15W) in a pulsed mode to prevent excessive heat field buildup and tissue dessication. For safe anesthetic management, nitrous oxide should be avoided, and a mixture of oxygen (25%) and air should be used or helium, which is a known flammability quencher may be used during airway laser surgery at a 60 percent He 40 percent 0, mix. Due to the increase in CO2laser treatments, we reviewed the clinical records of 150 patients in whom CO2laser surgery was performed and the anesthetic management was evaluated from April 1987 to December 1988. 1) A total of 150 patients were evaluated, including 81 males and 69 females ranging in age from 10 months to 74 years and averaging 41 years. 2) The operations performed were vocal nodule (26.0%), vocal polyp (16.0%), laryngeal papilloma (16.0%), etc. 3) The methods for keeping the airway open during general anesthesia were orotracheal intubation (67.5%) and intubation through the tracheostomy stoma (32.5%). 4) The main anesthetic agents were halothane, enflurane, and fentanyl. The anesthesia and surgery lasted 60.9+-24.0minutes and 44.5+-28.5 minutes on average respectively. 5) Laryngoscopic laser surgery was carried out in 127 patients (84.7%), bronchoscopic surgery in 14 patients (9.3%) and surgery using a handpiece in only 8 patients (6.0%). 6) Complications were found in 3 cases, including endotracheal cuff ignition and pneumomedias-timum.