Abstract
BackgroundLasers have become standard tools for the surgical treatment of oral lesions. The purpose of this study is to determine the surgical margins and histologically evaluate the tissue thermal effects induced by different types of surgical instruments. Material and Methods Cuts were made in pork tongues’ mucosa with different lasers (Er:YAG at 2W with and without air / water spray and at 4W with and without air / water spray; CO2 at 3.5W and 7W in pulsed mode and at 7W in continuous mode; the diode laser at 3.5W and boost 3.5W in pulsed mode; Nd:YAG at 6W, 40Hz and electroscalpel at 5W and conventional scalpel as control. Macroscopic and microscopic morphological changes were evaluated. Results The results of this study showed that the surgical instruments that caused greater tissue damage extension were: the Nd:YAG laser (670.68μm), the diode 3.5W and boost PW (626.82μm), the CO2 7W CW (571.18μm), the CO2 at 7W PW (485.45μm), the diode 3.5W PW (456.15μm), the electroscalpel (409.57μm) and lastly the CO2 laser 3.5W PW (306.19μm) and Er:YAG (74.66μm) laser, regardless of power, mode or air / water spray used. An association between the Tissue Damage Extension and the Degree of Carbonization (r = 0.789; P = 0.01), and an association between the Tissue Damage Extension and Regularity of the Incision were found (r = -, 299; P = 0.01). Conclusions The results of this study suggest that lasers can be used in soft tissues biopsies of the oral cavity, enabling a correct histopathological analysis, as long as the biological effects of each laser type are considered. The Er:YAG laser revealed its potential for biopsies of the oral mucosa ensuring a successful histological evaluation and the CO2 laser at 3,5W in pulsed mode presented itself as the best choice for surgeries with hemostasis. Key words:CO2 laser, diode laser, Er:YAG laser, laser surgery, Nd:YAG laser, oral mucosa, thermal effect.
Highlights
Lasers have become standard tools for the surgical treatment of oral lesions
An association was found between the Extent of Thermal Tissue Damage (ETTD) and Carbonization Degree which indicates a strong positive significant correlation (r= 0,789; P = 0.01). -Histological evaluation The values of tissue changes by type of artifact versus surgical instrument, power, spray and mode used are shown in table 2
The present study found a significant association between ETTD and carbonization degree, showing that the higher the degree of charring caused by the surgical instrument, the higher the ETTD induced on the specimen
Summary
Lasers have become standard tools for the surgical treatment of oral lesions. The use of laser technology in the surgical treatment of oral lesions aims to provide benefits to both the surgeon and the patient [1]. The purpose of this study is to determine the macroscopic and microscopic morphological changes in the surgical margins in tongue tissue (ex vivo) induced by different surgical instruments, including various types of laser. Its respective parameters, correspond to each tongue incision: CO2 laser by DEKA® Smart US-20D with a wavelength of 10,6μm was used with a no-contact handpiece for three different types of application: 3.5W in pulsed mode (PW) at 50Hz, 7W PW at 50Hz and 7W in continuous mode (CW). The diode laser of LITEMEDICS® with a wavelength of 980nm was used in contact mode for two different applications: 3.5W and 3.5W Boost PW It was used a Servotome electroscalpel by SATELEC® at 5W of power, and for the specimens control a scalpel blade number 15 by KIATO® was used. The Nd:YAG laser and CO2 laser at 7W CW caused greater tissue carbonization with average values of 4
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