In-office Laryngeal Procedures: a Modern Perspective for Vocal Fold Interventions

Introduction: The purpose of this article is to discuss in-office laryngeal procedures as an alternative to surgical intervention under general anesthesia. In-office procedures have become more common due to technological advancements. As a result, these approaches are less invasive and more patient-friendly, with increased pain tolerance and reduced procedure time and cost. Methods: We conducted a thematic analysis of published reports regarding the best known and performed in-office laryngeal interventions. Three questions guided our analysis: What laryngological procedures can be performed in the office setting? What are the advantages of in-office laryngology procedures compared to operating room surgical procedures? Why aren't more in-office procedures performed in some Latin American countries? Discussion: Despite being performed more frequently, there is still controversy whether in-office procedures should be performed as often due to the risk of complications. Furthermore, procedures that are done in the office setting are more popular in some countries than in others, even though their benefit has been well demonstrated. This article describes various in-office procedures, including biopsy, vocal fold injections, and laser surgery. We also discuss what factors might contribute to having office-procedures being performed more frequently in some countries than others. Conclusion: Awake interventions offer numerous benefits, including shorter procedure time, reduced costs, and lower patient morbidity. These advantages have significantly transformed the treatment of laryngeal diseases in modern laryngology practice in a global manner.

Introducción: El propósito de este artículo es discutir los procedimientos laríngeos en el consultorio como una alternativa a la intervención quirúrgica bajo anestesia general. Los procedimientos en consultorio se han vuelto más comunes debido a los avances tecnológicos. Como resultado, estos enfoques son menos invasivos y más amigables para el paciente, con mayor tolerancia al dolor y reducción del tiempo y costo del procedimiento. Métodos: Realizamos un análisis temático de los informes publicados sobre las intervenciones laríngeas más conocidas y realizadas. Tres preguntas guiaron nuestro análisis: ¿Qué procedimientos laringológicos se pueden realizar en el consultorio y cuales sin los más frecuentes?, ¿cuáles son las ventajas de los procedimientos laringológicos fuera del quirófano frente a los que se realizan bajo anestesia general?, ¿por qué no se realizan más procedimientos laringológicos en el consultorio en la mayoría de los países en Latinoamérica? Discusión: A pesar de que se realizan con mayor frecuencia, aún existe controversia sobre si los procedimientos en consultorio deben realizarse con tanta frecuencia debido al riesgo de complicaciones. Además, los procedimientos que se realizan en el consultorio son más populares en algunos países que en otros, aunque sus beneficios han sido bien demostrados. Este artículo describe varios procedimientos en el consultorio, incluida la biopsia, las inyecciones de cuerdas vocales y la cirugía con láser. También se discutieron los factores que podrían contribuir a que los procedimientos en el consultorio se realicen con más frecuencia en algunos países que en otros. Conclusión: Las intervenciones con pacientes despiertos ofrecen numerosos beneficios, incluido un tiempo de procedimiento más corto, costos reducidos y una menor morbilidad para el paciente. Estas ventajas han transformado significativamente el tratamiento de las enfermedades laríngeas en la práctica de la laringología moderna a nivel mundial.

CO2 Laser Marsupialization for Internal and Combined Laryngocele

Abstract Introduction Laryngoceleisan air-filled dilatation of the laryngeal saccule that can be classified according to its extent (internal, external, or combined) and contents (laryngocele or laryngopyocele). To date, there is no consensus on the best treatment for laryngocele. Objective The present study aims to demonstrate for the first time the effectiveness of CO2 laser marsupialization for internal and combined laryngoceles. Methods A retrospective study was accomplished in our ENT Clinic of the University Hospital, from 2010 to today, recruiting patients according to strict criteria. All patients had internal or combined laryngocele/laryngopyocele treated with CO2 laser marsupialization. Results A total of 15 patients were enrolled for a total of 17 laryngoceles; 66.67% of the patients were males and the mean age was 54.4 (±14.12) years old. Internal laryngoceles accounted for 64.71% of the total, and only 7 cases were laryngopyoceles. At the 3-year follow-up, no signs of recurrence were found. Conclusion CO2 laser marsupialization is efficacious in the treatment of laryngocele or laryngopyocele, both internal and combined, in terms of efficiency, safety, and fast postoperative recovery, without need for tracheotomy or open surgery.

Impact of resection margin status and revision transoral laser microsurgery in early glottic cancer: analysis of organ preservation and local disease control on a cohort of 153 patients / Impacto do status da margem de ressecção e microcirurgia transoral a laser de revisão no câncer glótico inicial: análise da preservação do órgão e controle local da doença em uma coorte de 153 pacientes

Abstract Introduction Transoral laser microsurgery represents the treatment of choice for early glottic cancer. Its use and effectiveness are mainly related to laryngeal exposure and deep extension of tumor. Histopathologic assessment of surgical margin presents a main issue about transoral laser microsurgery and complete oncological excision. Objective The aim was to analyze the impact of revision surgery on organ preservation and local disease control in patients with early glottic cancer treated by transoral laser microsurgery. Methods We carried out a retrospective study on a cohort of 153 patients with early glottic cancer (Tis, T1, T2) treated by transoral laser microsurgery. Resection margins were classified as follows: "free" if macroscopic margin-tumor distance was at least 2 mm, as "close" if it was less than 2 mm and "positive" if the margin was involved by carcinoma. Patients were divided into two groups: patients with free resection margins (Group A) and patients with positive, close or not-evaluable resection margins (Group B). Group A (36) underwent periodic followup. Group B (117) underwent a second look laser CO2 2 months after surgery. Fifteen patients of Group A with suspected persistence of carcinoma during followup underwent a second laser resection after a time interval of 4-8 months after first surgery. Overall survival, disease-free survival, disease-specific survival, ultimate local control with laser alone and organ preservation rates were estimated. Results Five-year overall survival rate and 5-year disease-specific survival were 100% in both groups. The five-year laryngeal preservation rate was 100% in Group A and 95.2% in Group B. Five-year disease-free survival was 92.15% and 5-year ultimate local control with laser alone in 92.15% of patients. Conclusion This study has demonstrated that revision Transoral Laser Microsurgery is able to confirm the oncological radicality in most cases, even in the case of positive, close or non-evaluable margins. Considering our results, according to our experience, the second look with CO2 laser is a therapeutic strategy to consider, even in the case of close or non-evaluable as well as positive margins.

Resumo Introdução A microcirurgia transoral a laser representa o tratamento de escolha para o câncer glótico inicial. Seu uso e sua eficácia estão relacionados principalmente à exposição laríngea e à profundidade da extensão do tumor. A avaliação histopatológica da margem cirúrgica representa uma das principais questões sobre a microcirurgia a laser transoral e excisão oncológica completa. Objetivo Analisar o impacto da cirurgia de revisão na preservação de órgãos e controle local da doença em pacientes com câncer glótico inicial tratados por microcirurgia a laser transoral. Método Fizemos um estudo retrospectivo em uma coorte de 153 pacientes com câncer glótico inicial (Tis, T1, T2) tratados por microcirurgia transoral a laser. As margens de ressecção foram classificadas da seguinte forma: livre, se a distância margem macroscópica-tumor fosse de pelo menos 2 mm; próxima, se fosse menor do que 2 mm; e positiva se a margem fosse afetada pelo carcinoma. Assim, os pacientes foram divididos em dois grupos: com margens de ressecção livres (grupo A) e com margens de ressecção positivas, próximas ou não avaliáveis (grupo B). O grupo A (36) foi submetido a seguimento periódico. O grupo B (117) foi submetido a uma cirurgia de revisão com laser de CO2 2 meses após a cirurgia. Quinze pacientes do grupo A com suspeita de persistência do carcinoma durante o seguimento foram submetidos a uma segunda ressecção a laser após um intervalo de 4 a 8 meses após a primeira cirurgia. A sobrevida global, a sobrevida livre de doença, a sobrevida doença-específica, o controle local final com laser isolado e as taxas de preservação de órgãos foram estimados. Resultados A taxa de sobrevida global em cinco anos e a sobrevida doença-específica em 5 anos foi de 100% em ambos os grupos. A taxa de preservação laríngea em cinco anos foi de 100% no grupo A e 95,2% no grupo B. A sobrevida livre de doença em cinco anos foi de 92,15% e o controle local final em 5 anos com laser isolado em 92,15% dos pacientes. Conclusões A revisão da microcirurgia transoral a laser é capaz de confirmar a radicalidade oncológica na maioria dos casos, mesmo em caso de margens positivas, próximas ou não avaliáveis. Considerando nossos resultados, de acordo com a nossa experiência, a cirurgia de revisão (second look) com laser de CO2 é uma estratégia terapêutica a ser pensada mesmo no caso de margens próximas ou não avaliáveis, bem como em margens positivas.

Neurofibromatosis laríngea: a propósito de un caso / Laryngeal neurofibromatosis: a case report

Resumen El neurofibroma laríngeo es poco frecuente, representa menos del 0,1% de las neoplasias benignas de la laringe. Puede presentarse aislado, o más comúnmente asociado a neurofibromatosis tipo I. Se presenta el caso de un paciente varón de 40 años, ya diagnosticado de neurofibromatosis tipo I, que presenta masa supraglótica submucosa asintomática, diagnosticada como hallazgo casual en una intubación por una cirugía previa programada.

Abstract Laryngeal neurofibroma is rare, representing less than 0.1% of benign tumors of the larynx. It can occur in isolation or more commonly associated with type I neurofibromatosis. The case of a 40-year-old male patient, already diagnosed with type I neurofibromatosis, is presented with an asymptomatic submucosal supraglottic mass, diagnosed as a chance finding in intubation due to a previous scheduled surgery.

Safety and efficacy of 980nm diode laser in the treatment of scrotal angiokeratoma / 中华泌尿外科杂志

Scrotal angiokeratoma(Fordyce angiokeratoma)is often seen in elderly men presenting nodular hemorrhage. In this study, 8 cases of scrotal angiokeratoma were treated with 980nm diode laser. All the operations were successfully completed under local anesthesia without obvious complications and local symptoms improved. The results showed that 980nm diode laser is an alternative operation for the treatment of scrotal angiokeratoma.

Management of Early Glottic Cancer Treated by CO2 Laser According to Surgical-Margin Status: A Systematic Review of the Literature

Abstract Introduction Transoral laser microsurgery (TLM) is the treatment of choice for Tis-T2 squamous cell glottic carcinomas due to its advantages compared with open surgery and radiotherapy. However, the CO2 laser beam causes changes and damage on the specimens, making the histological assessment of resection margins, the gold standard for confirming radical tumor resection, sometimes difficult. Objective To assess the different ways to manage patients depending on the status of the histopathological margin according to recent studies to detect the most commonly shared therapeutic strategy. Data Synthesis We analyzed the literature available on the PubMed and Web of Science databases, including only articles published since 2005, using specific keywords to retrieve articles whose titles and abstracts were read and analyzed independently by two authors to detect relevant studies. Therefore, we focused on disease-free survival, overall survival, local control, laryngeal preservation, and disease-specific survival. Thus, 17 studies were included in the present review; they were grouped according to the status of the histological margin, and we analyzed the different management policies described in them. This analysis showed that there is not a shared strategy, though in most studies the authors performed a second-look surgery in the cases of positive margins and a close follow-up in cases of negative ones. The main disagreement is regarding the management of close or non-valuable resection margins, since some some authors performed a second-look surgery, and others, a close follow-up. Conclusions Definitely, the most shared policy is the second-look surgery in case of positive surgical margins, and a close follow-up in case of close or non-valuable resection margins. Key Points To date, TLM is the treatment of choice for Tis-T2 squamous cell glottic carcinomas. The CO2 laser beam could impair the histological assessment of the resection margins, which is the gold standard to confirm radical tumor resection. Second-look TLM is the most performed strategy in case of positive surgical margins. Close follow-up is the most shared policy in case of close or non-valuable resection margins. In cases of negative resection margins, follow-up represents the best approach.

The efficacy and safety of green laser enucleation of prostate with end-fire fiber in treating benign prostatic hyperplasia / 中华泌尿外科杂志

Objective:To investigate the efficacy and safety of green laser vaporization enucleation of the prostate with end-fire fiber in the treatment of benign prostatic hyperplasia.Methods:The clinical data of 218 patients with benign prostatic hyperplasia admitted to Zhejiang Provincial People's Hospital from August 2018 to July 2019 were retrospectively analyzed. All 218 patients presented symptoms of varying degrees of frequent voiding, urgency, nocturia, and progressive dysuria, with age of(76.2±8.4) years, prostate volume of(77.3±21.6) ml, and preoperative PSA of (3.5±0.9)ng/ml, preoperative maximum urine flow rate (Qmax)of(7.9±1.8)ml/s, residual urine volume of(82.3±26.3)ml, quality of life score(QOL) of(4.9±1.1)points, and International Prostate Symptom Score (IPSS) of (25.4±7.6) points. Lithotomy position was used intraoperatively, and intravenous combined general anesthesia or intraspinal anesthesia was performed before the green laser vaporization enucleation of the prostate. Intraoperatively, green laser equipment used a vaporization power of 80W, an optical fiber with a end-fire fiber of 800μm in diameter, and hemostasis power of 20W. The surgical procedure was firstly to vaporize and cut 3 grooves from the bladder neck to the ejaculatory hole plane of the prostate at 5, 7 and 12 o'clock, reaching deep enough to expose the surgical capsule, in order to set up" three lines and one side" anatomical landmarks. A combination of sheath peeling and vaporization cutting along the envelope layer was used to enucleate the hyperplastic glands according to the " three-leaf " method. After enucleation, the tissue was pushed into the bladder, and the enucleated tissue was crushed and aspirated with a tissue morcellation. Perioperative and postoperative parameters including vaporized enucleation time, tissue morcellation time, hemoglobin changes, bladder irrigating time, indwelling catheterization time, postoperative hospital stay, postoperative Qmax, residual urine volume, postoperative complications, IPSS and QOL were recorded. Urgency with involuntary urine leakage was diagnosed as urge incontinence, involuntary urine leakage after coughing was diagnosed as stress urinary incontinence, and the incontinence degree was defined according to the amount of pad used, with mild of 1-2 pads/day, moderate of 3-4 pads/day, and severe of 5 or more pads/day.Result:All 218 operations were successfully completed. Capsule perforation occurred in 8 cases(3.7%), and there was no bladder perforation. The time of vaporization and enucleation was (42.5±8.3)min, and the time of tissue morcellation was(12.1±3.4)min. The intraoperative and postoperative hemoglobin loss was(4.7±1.3)g/L, and there were no blood transfusion or re-operation for stopping bleeding. The average bladder irrigation time after operation was(6.3±1.6)h, the average indwelling catheterization time was(1.2±0.2)days, and the average postoperative hospital stay was (2.2±0.7)days. The Qmax 1 month after operation was(18.5±4.8) ml/s, and the residual urine volume of the bladder was(6.4±1.9)ml, which showed a statistical difference compared with the preoperative parameters( P<0.01). In addition, the QOL(2.1±0.4) and IPSS(7.1±2.1)showed a statistical difference at 3 months follow-up, compared with the parameters before or 1 month after the operation( P<0.01). The volume of the prostate at 3 months after the operation was(34.6±6.3) ml, and the PSA was(2.4± 0.5) ng/ml, which was statistically different from the preoperative corresponding parameters( P<0.01). During the follow-up within one year, 11 cases were detected incontinence during the 1-month follow up, including 6 cases of urge incontinence. After drug treatment, good continence achieved 3 months after the operation. The other 5 cases had stress urinary incontinence, 3 of whom got good continence after the drugs treatment and pelvic floor muscle exercise, and two patients recovered to one pad per day. A total of 24 cases of urethral stricture were found during the 12-month follow-up, including 16 cases of anterior urethral stricture, which was treated with 3 months of regular urethral dilation. Another 8 cases had bladder neck contracture, and were treated by bladder neck resection and regular urethral dilatation. All of them did not recur 6 months after the procedure. Conclusions:The end-fire green laser vaporization enucleation of the prostate has the advantages of short operation time, less intraoperative bleeding, and obvious improvement in postoperative symptom scores. The short-term effect is obvious, and the long-term effect still needs further study to confirm.

Treatment of Carcinoma in Situ of Glottis by KTP Fiberoptic Laryngeal Laser Surgery Under Local Anesthesia

The optimal treatments of carcinoma in situ of glottis include radiotherapy, laser surgery and vertical partial laryngectomy. Conventional surgical treatments need general anesthesia and radiotherapy has several complications. Recently, the effectiveness of 532 nm potassium titanyl phosphate (KTP) laser has been proven and widely used in vocal fold diseases even some cases of vocal fold dysplasia. A patient with difficult laryngeal exposure underwent fiberoptic laryngeal laser surgery using KTP laser under local anesthesia, showed improved voice outcome and the glottic lesion was removed successfully without local recurrence and regional metastasis 18 months after surgery.

Perceptual and Acoustic Outcomes of Early-Stage Glottic Cancer After Laser Surgery or Radiotherapy: A Meta-Analysis

Laser surgery (LS) or radiotherapy (RT) is normally recommended in early glottic cancer. The objective of this study was to perform a comprehensive meta-analysis of acoustic and perceptual outcomes to compare voice quality of LS or RT in early-stage glottic cancer. Data sources were obtained after searching PubMed, Google Scholar, EBSCO, and RISS using the following search terms: glottic cancer, glottic carcinoma, endoscopic surgery, laser surgery, radiotherapy, radiation, voice, voice quality, and grade, roughness, breathiness, asthenia, and strain (GRBAS) scale. Articles that compared voice outcomes between LS and RT were identified. This meta-analysis included 15 articles with 744 patients, including 400 in the LS group and 344 in the RT group. Random effects models were selected. Forest plots included standardized mean differences, standard errors, variance, 95% confidence intervals (lower limit to upper limit), z-values, and P-values. In perceptual analysis, grade (G) and asthenia (A) of RT were significantly better than LS. There was no statistically significant difference in roughness (R), breath (B), or strain (S) between LS and RT groups. Jitter, shimmer, and noise to harmonic ratio measurements showed significant differences, resulting in enhanced posttreatment effect of RT compared to LS. Results of our meta-analysis suggested that RT might lead to superior voice quality than LS in early glottic cancer.

A Case of Hamartoma of the Subglottis / 대한이비인후과학회지

Hamartoma is a developmental anomaly or non-neoplastic malformations composed by an excessive growth of indigenous mature tissue present in wrong proportions and abnormal arrangements. Hamartomas may develop in all areas of the body but it is extremely rare in the larynx. The treatment of hamartomas consists of adequate surgical excision leading to an excellent prognosis. We present an incidentally detected subglottic mass during intubation in a 70-year-old male patient. The mass was excised by transoral laser surgery. Histopathologic examination of the lesion revealed that it consisted of hamartoma.

Comparison of two techniques for transpharyngeal endoscopic auditory tube diverticulotomy in the horse

Auditory tube diverticula, also known as guttural pouches, are naturally occurring dilations of the auditory tube in horses that communicate with the nasopharynx through a small ostium. Infection and select other conditions can result in inflammation and narrowing of the nasopharyngeal ostium, which prevents drainage of fluid or egress of air and can lead to persistent infection or guttural pouch tympany. Auditory tube diverticulotomy allows continuous egress from the auditory tube diverticula and is a feature of disease treatment in horses, in which medical treatment alone is not successful. Transpharyngeal endoscopic auditory tube diverticulotomy was performed using a diode laser either at a single dorsal pharyngeal recess location or bilaterally caudal to the nasopharyngeal ostium in 10 horse head specimens. Both methods resulted in clear communication between the nasopharynx and auditory tube diverticula. Diverticulotomy performed in the dorsal pharyngeal recess required less laser energy and activation time and had a shorter surgical duration than diverticulotomy performed caudal to the nasopharyngeal ostium. Further study related to the clinical application of both techniques is warranted.

Clinical curative effect and changes of serum immunology of Traditional Chinese Medicine combined with surgical treatment on the adult onset recurrent respiratory papillomatosis / 临床耳鼻咽喉头颈外科杂志

To observe the outcomes of Traditional Chinese Medicine combined with CO_2 laser surgery on the clinical course and serum immunological indexes of Adult onset Recurrent Respiratory Papillomatosis.69 cases of adult recurrent respiratory papilloma patients who enrolled in Beijing Tongren Hospital from September 2014 to March 2016 were divided randomly into two groups.The Chinese medicine surgery group were treated with traditional Chinese medicine combined with CO_2 laser surgery and the surgery group were treated with CO_2 laser surgery alone.All patients were followed up for more than one year.Relapse time and Derkay score were examed and analyzed between two groups before and after treatment.The detection of aperipheral blood immunoglobulin,T cell subsets,percentage of B cell and NK cell and IgG subtype examed every six month.There was no significant difference between two group in Derkay score,lesion recurrence time and the index of immunology before the treatment(>0.05).However,the recurrence time after treatment [(14.11±1.57)months]prolonged than before treatment[(10.85±2.33)months]in the experimental group.The examination of IgG [(1 539.84±388.20)mg/dl],percentage of total T lymphocytes[(85.14±22.24)%],Th cells[(47.34±19.07)%],B lymphocytes[(12.55±5.26)%]in treatment of traditional Chinese medicine was higher than that before treatment of serum IgG [(1 225.14±260.27)mg/dl],T cells [(69.68±11.12)%],Th [(41.97±10.92)%],B lymphocytes[(10.30±5.45)%].The difference was statistically significant(<0.01).The curative effect of traditional Chinese medicine combined with laser surgery for the treatment of adult recurrent respiratory papillomatosis,can effectively prolong the recurrence time of patients,improve their immune cell antiviral ability and be worthy of clinical popularization and application.

The use of CO2 laser in treatment of the malformation of ossicular chain / 中国耳鼻咽喉头颈外科

OBJECTIVE To share surgical experience of ossicular chain malformations with CO2 laser.METHODS A retrospective analysis was performed.9 patients with clinical diagnosis of ossicular malformations underwent ossicular reconstruction with CO2 laser-assisted from May 2010 to Mar 2016,the results were evaluated by comparing preoperative and postoperative audiometric outcomes and the rate of postoperative complications.RESULTS 8 cases with complex lesion combining incus and stapes were found intraoperatively,the deformity located on stapes was showed in one case.The mean postoperative air conduction (AC) value was (26.53 ± 12.28) dB,the mean postoperative air-bone gap (ABG) was (9.44 ± 9.62) dB,the postoperative AC and ABG value improved considerably comparing with the preoperative value in all the patients,the difference was statistically significant.CONCLUTION CO2 laser is a suitable and effective adjunct in surgery for ossicular malformations such as otosclerosis.The use of the laser improves hearing results and operation efficiency and is not likely to increase side-effects to patients.

Two-micrometer thulium laser resection of the prostate-tangerine technique in benign prostatic hyperplasia patients with previously negative transrectal prostate biopsy / 亚洲男科学杂志(英文版)

The 2-μm thulium laser resection of the prostate-tangerine technique (TmLRP-TT) has been introduced as a minimally invasive treatment for benign prostatic hyperplasia (BPH). This study was undertaken to assess the clinical efficacy and safety of TmLRP-TT for the treatment of BPH patients with previously negative transrectal prostate biopsy. A prospective analysis of 51 patients with previously negative transrectal prostate biopsy who underwent surgical treatment using TmLRP-TT was performed from December 2011 to December 2013. Preoperative status, surgical details, and perioperative complications were recorded. The follow-up outcome was evaluated with subjective and objective tests at 1 and 6 months. TmLRP-TT was successfully completed in all patients. Mean prostate volume, operative duration, and catheterization time were 93.3 ± 37.9 ml, 69.5 ± 39.5 min, and 6.5 ± 1.3 days, respectively. The mean International Prostate Symptom Score, quality of life score, maximum urinary flow rate, and post-void residual urine volume changed notably at 6-month follow-up (22.5 ± 6.9 vs 6.1 ± 3.2, 4.8 ± 1.3 vs 1.1 ± 0.9, 7.3 ± 4.5 vs 18.9 ± 7.1 ml s-1 , and 148.7 ± 168.7 vs 28.4 ± 17.9 ml). Two (3.9%) patients required blood transfusion perioperatively, while 3 (5.9%) patients experienced transient hematuria postoperatively, and 2 (3.9%) patients received 3 days recatheterization due to clot retention. TmLRP-TT is a safe and effective minimally invasive technique for patients with previously negative transrectal prostate biopsy during the 6-month follow-up. This promising technology may be a feasible surgical method for previously negative transrectal prostate biopsy in the future.

Clinical effects of Er:YAG fractional laser for facial rejuvenation / 局解手术学杂志

Objective To evaluate the clinical effects and safety of Er:YAG fractional laser for facial rejuvenation.Methods Altogether 559 patients aged from 32 to 58 years old with obvious pigmentary lesions and wrinkles in the face were given 2 courses of restoration treatment with the Pixel Er:YAG fractional laser.The patients paid a return visit a month later after the last treatment.With the results of clinical observation and photograph-based comparison,the therapeutic effects were graded by disappearance of pigmentary lesions and elimination of facial wrinkles.Complications such as hyperpigmentation,depigmentation and hyperplastic scar were observed.Results Among the 559 patients, there were 103 cases (18.4%) of slight effect, 378 cases (67.6%) of moderate effect, and 78 cases (14%) of excellent effect,with the total effective rate of 100% and a satisfactory rate of 81.6%.The was no complication such as hyperpigmentation,depigmentation and hyperplastic scar occurred.Effective maintaining rate within 6 months was 67%.Conclusion Er:YAG fractional laser is safe and effective for facial rejuvenation and worthy of promotion.

Maxillary Labial Frenectomy Using 810nm Diode Laser- A Case Report

Frenectomy is one of the common oral surgical procedures performed in Pediatric dentistry. This case report presents the management of a maxillary high labial frenum attachment in a child patient using 810nm Diode laser.

Resultados perinatales en el síndrome de transfusión feto fetal manejados con la técnica de Solomon: revisión de la literatura / Perinatal outcomes in fetal-fetal transfusion syndrome managed with the Solomon technique: literature review

INTRODUCCIÓN: Entre 15-20% de los embarazos gemelares monocoriales biamnióticos se complican con el síndrome de transfusión feto/fetal el cual se asocia con mortalidad superior a 90% y morbilidad significativa en el 50% del gemelo sobreviviente. La técnica láser que coagula la superficie de la placa coriónica entre los principales canales a lo largo del ecuador (técnica de Solomon), se ha sugerido para disminuir la recurrencia, prevenir complicaciones secundarias sin incrementar resultados adversos. Métodos: REVISIÓN de la literatura existente en las bases de datos MEDLINE, EBSCO, OVID, PROQUEST, COCHRANE, Lilacs, SciELO, desde el año 2000 al 2015. Se incluyeron los artículos de revisión e investigaciones originales que compararon la técnica estándar de fotocoagulación secuencial con láser y la técnica de Solomon, el resultado primario fue la reducción de la incidencia Secuencia Anemia Policitemia, recurrencia del síndrome de transfusión feto/fetal, mortalidad perinatal y morbilidad neonatal severa. RESULTADOS: Se encontraron 200 artículos, se seleccionaron seis: 1 ensayo clínico y su análisis secundario, 2 estudios de cohorte retrospectivos, 1 revisión sistemática y un estudio que compara los resultados del neurodesarrollo. Los estudios sugieren una mejoría en la sobrevida de algunos de los fetos con la técnica Solomon, menor recurrencia del síndrome de transfusión feto/fetal y Secuencia Anemia Policitemia, sin la presencia de eventos adversos. CONCLUSIÓN: La técnica de Solomon mejora la sobrevida de algunos gemelos, sin embargo no puede concluirse que haya mejoría en la mortalidad pues los estudios no tienen el suficiente poder para determinarlo.

INTRODUCTION: Between 15 to 20% of monochorionic diamniotic twin pregnancies are complicated by the twin-twin transfusion syndrome. It has a mortality greater than 90% and a significant morbidity, 50% in the surviving twin. The Solomon technique (laser photocoagulation of the main vascular channels of the chorio-nic plate surface along the entire vascular equator) has been suggested to reduce the recurrence, and pre-vent secondary complications without increasing adverse results. METHODS: Systematic review of electronic searches of the literature from 2000 to 2015 (MEDLINE, EBSCO, OVID, PROQUEST, COCHRANE, Lilacs, and SciELO). We included review articles and original investigations comparing the standard photocoagulation technique with laser ablation against the Solomon technique. The primary results were reduction of Anemia Polycythemia Sequence incidence, twin-twin transfusion syndrome recurrence, perinatal mortality and severe neonatal morbidity. RESULTS: Of 200 articles, we selected six: one clinical essay and its secondary analysis, two retrospective cohort studies, one systematic review and a study comparing neurodeve-lopmental outcomes. The studies suggested a survival improvement in some fetuses using the Solomon technique, less twin-twin transfusion syndrome recurrence and Anemia Polycythemia Sequence without the presence of adverse effects. CONCLUSION: Solomon technique improves the survival of some twins, although we cannot conclude there is mortality improvement, because the studies do not have enough power to determine that.

Preliminary investigation of the effect of CO2 laser assisted stapedotomy on the treatment of advanced otosclerosis / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the outcomes of CO2 laser assisted stapedotomy with artificial stapes prostheses in the treatment of advanced otosclerosis. METHODS Between January 2010 and January 2014, 15 patients (16 ears) diagnosed as advanced otosclerosis accepted CO2 laser assisted stapedotomy with artificial stapes implantation in our department. The averaged preoperative air conduction threshold of the speech frequency was 70.21 dB HL, the averaged bone conduction threshold was 38.49 dB HL, the averaged air-bone gap (ABG) was 31.72 dB HL. All cases were followed up for more than 6 months after operation. RESULTS All cases accepted auditory follow up after 6 months postoperatively. The speech frequency average air conduction threshold was 43.7 dB HL, the average bone conduction threshold was 28.95 dB HL, the average ABG was 14.75 dB HL. The ABG≤20 dB was achieved in 9 ears (56.3%) and ABG closure (≤10 dB) was achieved in 6 ears (37.5%). No cases appeared intractable vertigo, sensorineural hearing loss, secondary facial paralysis and other serious complications. CONCLUSION CO2 laser assisted technique reduced the probability of serious complications of stapedotomy, most patients with hearing level improved significantly. It's a safe, practical, relatively economical choice for advanced otosclerosis.

Clinical efficacy of 2 μm continuous wave laser treatment on patients with bladder neck contracture after benign prostatic hyperplasia operation / 中国综合临床

Objective To investigate the clinical efficacy of RevoLix 2 μm continuous wave laser treatment on bladder neck contracture after benign prostatic hyperplasia operation. Methods A total of 21 cases were enrolled in current research and they all accepted 2 μm continuous wave laser treatment of bladder neck contracture after benign prostatic hyperplasia operation in the 252th Hospital of the Chinese People's Liberation Army. The clinical efficacy was recorded. Results The operation of the 2 μm continuous wave laser vaporesections were successfully performed on 21 cases. The maximum urine flow rate was increased from(6. 86 ± 1. 97)ml/ s to(16. 31 ± 1. 61)ml/ s,and the difference was significant(t = 15. 49,P < 0. 01). After 3 to 23 months(median 14 months)follow-up,20 cases were cured and 1 case was combined with bladder residual urine 110 ml. Conclusion The therapy of 2 μm continuous wave laser is a superior micro-invasive surgery method for patients with Bladder neck contracture,which shows little blood loss,high level safety,convenient operation and infrequent complications.

Observation of effect of laser and intubation applied in recurrent nasolacrimal duct-blok / 中国基层医药

Objective To observe the effect of laser and intubation applied in recurrent nasolacrimal duct-blok.Methods 116 cases of recurrent nasolacrimal duct-blok patients were selected and divided into the observation group and control group by random number table.Only laser was given in the control group,and intubation added in the observation group.All the cases were followed up more than 1 year,and the effects in both group were compared. Results There were 63 effective cases in the observation group,and efficacy rate was 83.33%.And 17 effective cases in the control group,efficacy rate was 41.56%.The efficacy rate in the observation group was higher than that in the control group (χ2 =31.915,P <0.05).There was no false passage in both groups after laser given.Conclusion The effect of laser combined with intubation was better than that of laser alone in recurrent nasolacrimal duct-blok treatment.It was valuable to refractory and recurrent nasolacrimal duct-blok treating.