Our First Experience of Using Blue Light Laser for Endoscopic Endonasal Removal of Juvenile Angiofibromas

Abstract

Background. Juvenile nasal angiofibroma (JNA) is a very rare benign lesion originating from the pterygopalatine fossa with distinctive epidemiologic features and growth patterns. The typical patient is an adolescent male with a clinical history of recurrent severe nasal bleedings and blockage the nose. Currently, even though surgery often caused severe operative bleeding, it is considered the ideal treatment for JNA. Refinement in preoperative embolization, which provides significant reduction of intraoperative bleeding. In spite of breakthrough of Endoscopic techniques which minimize the risk of residual disease, the search of new devises which can help to management of JNA is still continue in order to minimize the surgical complications. Laser methods as surgical treatment have been actively used in rhinology during the past decades. We purposed to summarize information about current lasers and their use in rhinology. Aim. The purpose of the study is the literature review and to describe our experience of using new blue laser during JNA removal. Evaluation of advantages and disadvantages, determination of indications and limits of its use in rhinosurgery Methods- A literature review from 2000 to 2022 using the PubMed database was employed. Keywords used included “laser surgery”, “blue light laser”, “photoangiolytic laser”, “laser in rhinosurgery”. The most up to date studies published for each rhinology condition that was treated with laser surgery was reviewed. Then endoscopic removal through the nose was performed. During the surgery TrueBlue laser was used to cut the tissues and coagulate injured vessels. Results. Rhinological conditions appropriate for laser applications are discussed. There are related papers to a number of applications including hereditary hemorrhagic telangiectasia, rhinitis, turbinate surgery, dacryocystorhinostomy, septoplasty, choanal atresia, and sphenopalatine artery ligation, paying attention to the outcomes of the studies. It is the first experience of using blue laser in rhinosurgery and particulary ib removing JNA. Conclusion. Intranasal laser surgery, despite the fact that interventions are performed almost bloodlessly, and often do not require nasal tamponade, indications for their performance are limited, due to deep burns of the nasal mucosa, and alteration of mucociliary clearance therefore lasers are not so often used in rhinology. The short-wave blue laser with a wavelength of 445 nm, used in Europe in oto- and laryngosurgery, may have some potential advantages in rhinosurgery, but the practical dataset are limited yet.