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  • May 22, 2004 at 10:59 pm #3374 Reply

    Benchwmer
    Spectator

    New patient presented with white lesion on hard palate.
    Treatment will be an excisional biopsy.
    Treatment parameters will be using the OpusDuo Erbium. 600 micron conical sapphire contact tip, 12 Hz 500mJ, with air and water spray. Infiltrated w/ a couple drops of 2% Carbocaine w/ 1/20,000 Levordefrin.
    Photo after LA, before Laser:

    Tieran41304.jpg

    Diagnosis is a papilloma.
    Photo after excision:

    Tieran41304B.jpg

    Tissue sent to pathology lab for biopsy.
    Post-op after three weeks:
    Tieran5404A.jpg

    Lab results confirmed diagnosis.
    The Erbium was used to minimize the zones of necrosis, statis and hyperemia in the tissue sample. In my hands it is a quicker, cleaner cut w/ the added cooling affects of the air and water vs. the Nd:YAG or a Diode. Lab at U of Maryland never comments on the use of the laser for excision.
    Note healing at 3 weeks.
    I did another papilloma case in the same time period involving the papilla between 13/14.

    Anerson5304A.jpg

    LA used. The papilloma was excised using the PerioLase free running pulsed Nd:YAG using a contact fiber (360 micron). The papilloma was excised and sent to the lab for biopsy.
    Photo after laze:

    Anderson5304BB.jpg

    The lab confirmed the diagnosis.
    The Nd:YAG was used because of the small size, the proximity to the papilla and not having to protect or worry about damage to the tooth from the Nd:YAG laser.
    Being non-digital I don’t have an after photo, but clinically after 2 weeks you couldn’t tell where the biopsy tissue was removed. Will post later.
    Two biopsies, same diagnosis, two different lasers used for biopsy and the reasons.
    Jeff

    June 1, 2004 at 5:35 am #10651 Reply

    kellyjblodgettdmd
    Spectator

    Jeff – Nice illustration of how there’s more than one way “to skin a cat”. Hopefully, laser users that currently only have one wavelength will start to see the value of having multiple wavelengths. This is a great illustration of using different lasers on the same pathology, but getting slightly different results (obvious less bleeding w/ Nd:YAG).

    My guess is that had the Nd:YAG example been treated w/ a diode, there would have been much greater risk to papilla due to decrease in thermal relaxation time.

    Good post and nice choices.

    Kelly

    June 3, 2004 at 4:40 pm #10654 Reply

    Samuel Moss
    Spectator

    Jeff,

    Nice post. I wanted to know how the patients felt. Was there more treatment discomfort with one over the other? Post operatively, was one more uncomfortalble during healing than the other. I could see the 2 week results, but did you feel that in the first 4 to 7 days one was healing faster or less traumatically than the other?

    Inquiring minds want to know!

    Thanks,
    Mossman

    June 3, 2004 at 7:44 pm #10655 Reply

    Benchwmer
    Spectator

    Hey Sam,
    No reports of discomfort from either patient.
    I didn’t place them on any pain meds.
    I believe using the Erbium w/ a water spray decreases the zone of coagulation(necrosis), therefore healing is more rapid w/ the Erbium. This biopsy using the Nd:YAG was much smaller, so in these cases within 2 weeks healing was faster with the Nd:YAG.
    Both work out great.
    Jeff

    September 9, 2004 at 1:13 am #10658 Reply

    Lee Allen
    Spectator

    Hi,

    It has occurred to me that with the edges of the biopsy being so altered even with the Erbium, there is a minimum size that is readable or useful to send.

    Any ideas on the minimun size limits of biopsy material with the Erbium, Nd YAG,or Diode? Or to phase it another way: What zone of denatured tissue is created? It must be energy level related.

    Should this infuence the extra margin taken in the sample vs excision being the treatment of choice and keepng the margins minimal the goal for minimally invasive surgery?

    D Kimmel where are you? I know you know the answers.

    smile.gif

    September 9, 2004 at 6:11 am #10652 Reply

    lookin4t
    Spectator

    Don’t know a minimum but you’re right. Unless you have a nice piece to send the pathologist will end up playing name that cell.

    I’m not sure of the advantage of an erbium over a scalpel here as the bleeding would be the same. A diode would give a larger area of necrosis as Jeff pointed out.

    Jeff, can you comment as to why an erbium would be better than a scalpel here? I may not agree, but I’d like to see your reasoning.

    September 9, 2004 at 6:53 am #10656 Reply

    Glenn van As
    Spectator

    You can do more without anesthetic with the erbium.

    That is one reason.

    Less bleeding in non inflamed tissue.

    No sutures, which is no big deal for you.

    Many Fibromas can be removed without anesthetic, just topical.

    Just an idea.

    Glenn

    September 9, 2004 at 3:28 pm #10653 Reply

    lookin4t
    Spectator

    With this one sutures wouldn’t be useful.

    And if it’s small and you’re not sure it’s a fibroma…would you still feel comfy using it?

    September 10, 2004 at 3:08 am #10657 Reply

    Glenn van As
    Spectator

    What are you getting at lookin4t

    I am obviously missing something but what difference would the scalpel make vs the laser if you were unsure?

    Glenn

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