Carbon Dioxide Laser Excision Research Articles

Excision of rhinophyma with the carbon dioxide laser: a ten-year experience.

Rhinophyma is a disfiguring disease of the nasal skin, primarily affecting white men in the fifth to seventh decades of life. Hypertrophy of the sebaceous apparatus leads to an enlarged, erythematous nasal tip with comedones. Modalities of treatment include dermabrasion, freehand scalpel shave, cryosurgery, electrocautery, excision and closure with local flaps, and laser resection. A retrospective review of 18 patients treated with carbon dioxide laser excision of rhinophyma from 1983 to 1993 is presented. Discussion includes technique, postoperative care, complications, recurrence, operative blood loss, length of follow-up, time to complete reepithelialization, and pathologic findings. The carbon dioxide laser is a relatively safe, cosmetically efficacious, and curative method of treating rhinophyma.

Treatment of hidradenitis suppurativa with carbon dioxide laser excision and second-intention healing

Background: Hidradenitis suppurativa is a disabling disease. Although medical management can at times control the disease, the treatment of choice is surgical excision. Surgical defects have been managed by second-intention healing, simple surgical closure, or complex surgical repairs. Objective: Our purpose was to determine the benefit of carbon dioxide laser excision with healing by second intention to treat lesions of hidradenitis suppurativa. Methods: We treated seven patients who had axillary and inguinoperineal hidradenitis suppurativa with carbon dioxide laser excision followed by second-intention healing. A total of 12 procedures were performed (five bilateral and two unilateral). Follow-up periods were 10 to 27 months. Results: After a healing time of 4 to 8 weeks, scars were flat and linear. Only one recurrence of hidradenitis suppurativa has been observed; this occurred along the margin of the surgical scar in a previously treated area. Some patients, however, had continued disease activity in untreated areas. All subjects were satisfied with the results of the procedure, and complications were minimal. Conclusion: Carbon dioxide laser excision with second-intention healing is safe and effective for hidradenitis suppurativa.

Patterns of recurrence after carbon dioxide laser excision of intraoral squamous cell carcinoma.

To examine retrospectively consecutive patients treated with carbon dioxide laser excision of intraoral squamous cell carcinoma for the patterns of recurrence based on the location of the initial primary tumor and on the tumor stage. Retrospective chart review. Tertiary care center including a university hospital and a Veterans Affairs Medical Center. PROCEDURES AND PATIENTS: Sixty-one procedures performed on 51 consecutive patients. The only patients not included were three who were unavailable for follow-up. The average follow-up was 32 months. If the patients whose follow-up was limited because of death are excluded, the average follow-up was 40 months. Incidence of recurrence, time to recurrence, development of second intraoral primary lesions or pulmonary metastases, and cause of death. A nearly equal incidence of recurrence irrespective of site of lesion (tongue, 42%; floor of mouth, 40%; and other oral cavity sites, 45%). Determinate survival differed by stage. Patients with T1 lesions showed a determinate survival rate of 80%; those with T2 or T3 lesions had a determinate survival rate of 57%; and those treated for recurrent disease had a determinate survival rate of 44%. Carbon dioxide laser excision of intraoral squamous cell carcinoma is a useful, advantageous method, but it appears to offer no advantage for recurrence over standard methods. Appropriate management of neck disease in patients with intraoral squamous cell carcinoma must be carefully considered. Patients with this potentially aggressive form of cancer deserve long-term follow-up.

Endoscopic laser excisional biopsy for selected glottic carcinomas.

From January 1988 to December 1990, 44 previously untreated patients with squamous cell carcinomas (SCCs) of the true vocal cord (33 T1a, 11 Tis) underwent carbon dioxide laser excision. The mean follow-up was 28 months (range, 12 to 44 months). Endoscopic excisional biopsy was the primary treatment in 38 of the 44 patients, whereas postoperative radiotherapy was added in 6 cases in which the pathology report showed positive margins. Recurrent vocal cord SCC developed in 8 (18%) of the cases, with an average interval of 17.8 months. Re-treatment consisted of a second laser excision in 4 cases, radiotherapy in 1, hemilaryngectomy in 1, and total laryngectomy in 2. The definitive cure rate with endoscopic excisional biopsy for the patients originally treated with laser excision alone was 94.7% (36/38). Endoscopic laser treatment for selected glottic SCC proves to be an excellent alternative to radiotherapy or open neck surgery.

Carbon dioxide laser excision and vaporization of nonplunging ranulas: A comparison of two treatment protocols

A carbon dioxide laser in a defocused beam was used to vaporize four ranulas and four were treated by a combination of focused beam excision of the dome and vaporization of the wall and base. There was no recurrence in any patient at 6 months and no complications were noted.

Carbon dioxide laser vaporization in early glottic carcinoma.

Presently, widely employed treatment modalities for early glottic carcinoma include radiation therapy, surgical excision, and carbon dioxide laser excision. All these treatments have good oncological results, but poor or questionable functional results in terms of quality of voice and mucosal wave patterns as seen via a laryngostroboscope. We assessed the oncological and functional results of carbon dioxide laser vaporization of the diseased mucosa as a more conservative treatment alternative. Case series. Department of Otolaryngology-Head and Neck Surgery in a tertiary care center. Thirty-three patients with early glottic carcinoma (carcinoma in situ and Tla squamous cell carcinoma) who were referred to our center in the period from 1986 through 1990 were selected for carbon dioxide laser vaporization treatment on the criterion of a still recognizable mucosal wave pattern of the affected vocal fold via a laryngostroboscope. Local tumor control, voice quality, and a good appearance via a laryngostroboscope. Two patients were excluded from evaluation because a simultaneously diagnosed, incurable second primary tumor precluded frequent follow-up. Of the remaining 31 patients seen during a median follow-up period of 58 months, seven patients died of unrelated causes. A local recurrence of disease developed in two patients and was treated by radiation therapy. A recurrence of disease developed again in one of these patients but was successfully treated by total laryngectomy. Overall, local control of disease was achieved in all patients, with a 97% laryngeal preservation rate. Functional results in terms of voice quality were good in 97% of the patients, 75% of whom even retained a normal voice. Normal or near normal laryngostroboscopic appearance was achieved in 68% of all patients. Carbon dioxide laser vaporization is a good treatment alternative for early glottic carcinoma in terms of oncological as well as functional results.

Isotretinoin Therapy for Recurrent Respiratory Papillomatosis

Retinoic acid has been advocated for use in several premalignant and malignant epithelial lesions of the head and neck, including benign recurrent respiratory papillomatosis, with varying results. We describe a 24-year-old man with extensive tracheoesophageal and bronchoalveolar papillomatosis that degenerated into squamous cell carcinoma. Multiple endoscopic carbon dioxide laser excisions, at one point performed on a weekly basis, as well as a prolonged trial of interferon, failed to control the progression of his disease. Isotretinoin (13-cis-retinoic acid) therapy (1 mg/kg per day) was instituted, with dramatic clinical, radiographic, and functional improvement. The patient experienced no significant toxic effects and required no endoscopic procedures over a 6-month period. We propose that isotretinoin may be an effective adjuvant therapy for aggressive respiratory papillomatosis.

Outpatient surgery in gynecologic oncology

There has been an enormous change in outpatient-directed surgery for human papillomavirus-related lesions of the anogenital tract over the past 2 years. Concern that a small number of invasive cancers were being missed during evaluation and were being treated as precursors led many investigators to suggest excisional rather than ablative procedures for precursor management. The use of cold-knife or carbon dioxide laser excisions was recommend as the procedure of choice--particularly for high-grade cervical intraepithelial neoplasia lesions. With the introduction of the loop electrosurgical excision procedure, the focus rapidly shifted to electrosurgical excision, which has been found to be clinically useful, although with caveats, and is now the procedure of choice.

Verrucous carcinoma of the larynx: role of human papillomavirus, radiation, and surgery.

There is confusion regarding verrucous carcinoma of the larynx, an enigmatic, well-differentiated variant of squamous cell carcinoma known for local recurrence and anaplastic transformation following irradiation. This report adds 12 new cases and reviews the literature concerning radiation results versus surgical results. Treatment of 37 patients with primary radiotherapy resulted in a 49% cure rate and a 51% failure rate; the death rate from anaplastic transformation was 11%. Primary surgery on 144 patients resulted in a 92.4% cure rate, a 7.6% initial failure rate, and a 3.5% rate of deaths attributed to neoplasm. Isolation of human papillomavirus type 16 (HPV-16) DNA sequences indicates that the lesion is genetically abnormal. Radiation-induced DNA breaks may activate these sequences. These findings support a surgical approach. Treatment recommendation for T1 lesions is carbon dioxide laser excision to minimize tissue trauma and local recurrence. For T2 to T4 lesions, the recommendation is sound oncologic extirpation. Neck dissection is not indicated.

The Effect of Carbon Dioxide Laser Surgery on the Recurrence of Keloids

The efficacy of carbon dioxide laser excision as a primary modality for the treatment of keloids was evaluated. This retrospective study focuses on 31 patients with one or more keloids, 23 of whom were available for follow-up after carbon dioxide laser excision. The patients' ages ranged from 5 to 72 years. There were 16 females and 7 males. One patient was Caucasian, 22 patients were non-Caucasian, and there were no Asians. The keloids that were excised ranged in size from 1 to 30 cm in greatest diameter. One patient had no recurrence of her keloid after carbon dioxide laser excision, 9 patients required steroids to suppress recurrences, and 13 patients were considered failures. Reasons for the failure of this modality, as well as speculation regarding the future of this procedure, are discussed.

Failure of carbon dioxide laser excision of keloids

Failure of carbon dioxide laser excision of keloids

Carbon dioxide laser therapy for benign cervical tumors.

Eight patients underwent carbon dioxide (CO 2) laser excision of benign cervical tumors during a 5-year period. Six patients had symptoms of abnormal vaginal bleeding, and 2 had asymptomatic cervical masses. All but one procedure was performed as outpatient surgery. Blood loss was minimal in 7 patients and less than 50 ml in the other patient. There were no cases of morbidity, and long-term follow-up showed excellent results. The technique to perform CO 2 laser excision of large benign cervical tumors is described.

Recurrent pyogenic granuloma with satellitosis

The development of recurrent pyogenic granulomas as multiple satellite lesions is rare and often associated with trauma or treatment of the primary lesion. At least 34 cases of such lesions after various treatment modalities have been reported, but none occurred in conjunction with laser therapy. We report a case of recurrent pyogenic granuloma with satellite lesions that developed after carbon-dioxide laser excision of a previously recurrent lesion.

Posttracheotomy granulation tissue managed by carbon dioxide laser excision.

The problem of accumulation of granulation tissue and scar at the superior edge of the tracheostoma is a frequent problem in the management of chronic tracheotomy patients. This traditionally has been managed by cup forceps excision or by eversion through the tracheostoma with a skin hook and blind resection. These methods often lead to hemorrhage, and incomplete removal in a bloody field. We have used the carbon dioxide laser via a bronchoscope for ablation of the granulation tissue and/or scar at the stomal edge and at the tracheotomy tube proximal tip without morbidity in 13 pediatric cases. With experience, removal with the laser often proceeds more quickly than conventional methods. The scar and granulation tissue are excised under direct vision with minimal hemorrhage. We believe this to be a reasonable alternative in the management of this recurring problem.

Transoral carbon dioxide laser ablation for cancer, tumors, and other diseases.

A carbon dioxide laser was used on 71 patients for the removal of oral cavity or oropharyngeal cancers, premalignant lesions, benign tumors, or elongated soft palates. Evaluation of patient morbidity, speech, and swallowing, as well as survival data, suggests that the use of this modality for treatment of these conditions is highly successful, with excellent preservation of oral and pharyngeal function and minimal patient morbidity. Deep excisions of tumors that could lead to restricted motion of the tongue and/or jaw tended to have an adverse effect on both speech and swallowing. Immediate reconstruction should be considered, especially for defects created by excision of large tumors in the anterior oral cavity or in the lateral oropharyngeal wall cancers. Multimodality cancer therapy should be considered for large oral cavity and oropharyngeal cancers that have been treated by carbon dioxide laser excision.

Heterotopic lingual brain in the newborn.

Heterotopic brain is a rare entity. Histologically, this lesion resembles mature brain and often contains specialized tissues similar to choroid plexus or glia. Specialized neural stains are necessary to differentiate this rare anomaly from other tumors or conditions found in the head and neck. The differential diagnosis includes squamous cell carcinoma, granular cell tumor, hemangioma, lymphangioma, thyroglossal duct cyst, dermoid cyst, hamartoma, rhabdomyosarcoma, and teratoma. We describe a newborn with heterotopic brain tissue occurring on the dorsum of the tongue. We found only one other description of this developmental aberration in the English literature. Our patient was successfully treated with carbon dioxide laser excision of the mass. There has been no evidence of complication or recurrence after one year of follow-up.

Beneficial effects following carbon dioxide laser excision on experimental neuroblastoma

Treatment of neuroblastoma in children consists of primary excision with adjuvant radiation and chemotherapy. When the tumor invades surrounding structures that cannot be safely excised or when distant metastasis is present, the patient has a poor prognosis. Because the CO2 laser can be used to excise malignant tumors without seeding the surrounding tissue and because the defocused beam can vaporize malignant cells, we compared partial scalpel excision and partial laser excision of C1300 murine neuroblastoma to the growth rate of residual tumor. In 25 mice, 75% of the tumor was excised with a scalpel, and in another 25, the same percentage was excised with the CO2 laser (10 W). CO2 laser excision significantly decreases the growth of residual neuroblastoma (P less than .01). However, the effect appears to be a function of increased tumor immunogenicity after laser excision rather than the increased tumor kill. We conclude that CO2 laser excision of neuroblastoma may prove to be superior to scalpel excision for primary surgical treatment of neuroblastoma.

Failure of carbon dioxide laser excision of keloids

Seven patients with nine keloids have been treated by excision with the carbon dioxide laser. Eight of the nine keloids have recurred to their original or close to original size as early as 10 months following treatment and as late as 22 months. Keloids included in this study were located on the trunk, nuchal region, back, and earlobe. Only one patient (who underwent earlobe keloid excision) has greatly improved keloids after only 9 months follow-up, but this patient needs to wear pressure earrings continuously. The long-term benefits of keloid excision with the carbon dioxide laser is not demonstrated in this case study series.

Combined carbon dioxide laser excision and vaporization in the treatment of rhinophyma

. The carbon dioxide laser can be successfully used in its two different modes of operation to treat rhinophyma in a relatively bloodless fashion. With the focused mode, layers of excess soft tissue are precisely shaved away until the approximate size and shape of the nose has been achieved. Then with the defocused mode, extremely thin layers of soft tissue can be vaporized to provide the final countouring. Minimal blood loss in most cases, rapid healing, and little postoperative pain are significant advantages of this technique.

Combined carbon dioxide laser excision and vaporization in the treatment of rhinophyma.

The carbon dioxide laser can be successfully used in its two different modes of operation to treat rhinophyma in a relatively bloodless fashion. With the focused mode, layers of excess soft tissue are precisely shaved away until the approximate size and shape of the nose has been achieved. Then with the defocused mode, extremely thin layers of soft tissue can be vaporized to provide the final contouring. Minimal blood loss in most cases, rapid healing, and little postoperative pain are significant advantages of this technique.