Scalpel Technique Research Articles

Comparative evaluation of two surgical techniques using conventional scalpel method and diode laser for treatment outcome of depigmentation: 6 months follow-up study

Background: Various surgical techniques can be done for depigmentation but recurrence is the limiting factor for many surgical procedures, and the aim of the present study was to evaluate quantitatively the rate of repigmentation postoperatively after using scalpel and diode lasers for depigmentation. Materials and Methods: A total of 20 systemically healthy patients of 18 males and two females, within the age group of 18-40 years with an esthetic complaint of hyperpigmented gingiva were enrolled in this study. The patients were briefed about the surgical procedure and obtained the informed consent; they were randomly divided into two groups. Group A: 10 patients - depigmentation with scalpel technique. Group B: 10 patients - depigmentation with diode lasers (Biolase; ) and followed for 6 months. Results: The results of this study had shown that there is a statistically significant difference in the pre- and post-operative values in scalpel surgical technique with a (P = 0.005), and there is no statistically significant (P = 0.20) difference in the diode laser technique. Statistical Analysis Used: Wilcoxon Signed rank test and Mann-Whitney test. Conclusion: By using diode lasers, the rate of repigmentation is higher than scalpel method; however, it has been documented that there is minimal postoperative bleeding, pain, wound healing, discomfort, and ease of the procedure with diode laser and finally, each technique has its own advantages and disadvantages.

Evaluation of Patient Perceptions After Vestibuloplasty Procedure: A Comparison of Diode Laser and Scalpel Techniques.

Inadequate vestibular depth results in poor plaque control owing to an insufficient width of keratinized gingiva. Vestibuloplasty provides the necessary vestibular depth and can be performed either with a scalpel, electrocautery or lasers. To evaluate the patient perceptions related to pain and discomfort on the 1(st), 3(rd) and the 7(th) day post vestibuloplasty and also assess the healing outcomes related to the treatment of inadequate vestibular depth either with the diode laser or the scalpel. Twenty patients who had inadequate vestibular depth and required vestibuloplasty were assigned randomly to undergo the procedure either with the scalpel or the laser. The data obtained was analysed for intergroup comparison with an independent paired t-test and intragroup comparison was determined by a paired t-test. Intragroup comparison within the laser group for VAS scores of pain and discomfort within all the reported days exhibited a significant difference (p<0.05). Inter group comparison revealed that the patients in the laser group had lower VAS cores for pain and discomfort compared to the scalpel group (p<0.05). Analysis of the three pointer scale for healing revealed that the patients in the laser group exhibited better healing outcomes on the 1(st), 3(rd) and the 7(th) day compared to the scalpel group. Observations from the study highlight the opinion that laser can be a safe and effective alternative to traditional vestibuloplasty performed with the scalpel.

Comparison of efficacy of depigmentation of gingiva in terms of ImageJ intensity values and surface area of repigmentation using scalpel and diode laser

Background: For an attractive smile, health and color of the gingiva are essential components. Hyperpigmented gingiva is considered unaesthetic and unsightly by many, and there is an increasing demand for depigmentation of gingiva from patients. Many techniques are available for gingival depigmentation. Aims and Objectives: To compare the effectiveness of scalpel and laser techniques for depigmentation in terms of patient comfort using visual analog scale (VAS) for pain, changes in ImageJ intensity values of gingival pigmentation, and to compare the frequency and area of repigmentation postoperatively between two groups up to a period of 3 months using Adobe Photoshop. sMaterials and Methods: The study was conducted in the Department of Periodontics, Indira Gandhi Institute of Dental Sciences. Fifty individuals, aged between 18 and 30 years, with an esthetic complaint of hyperpigmented gingiva were enrolled in the study. The study comprised two groups of 25 individuals each. One group was taken up for scalpel method of depigmentation and the other for laser depigmentation. Results: The difference between the mean pain scores of scalpel and laser group on day 1, day 4, and day 7 were recorded, with a P value of 0.123, 0.000, and 0.037, respectively. The difference in intensity values between baseline and 90 days for both scalpel and laser groups was highly significant, with a P value of 0.000. When surface area of repigmentation was compared between two groups, scalpel group (557.20 mm2) of patients had less repigmentation than laser group (737.08 mm2). Conclusion: The patient apprehension for anesthetic infiltration, bleeding during the procedures, and VAS scores for pain were less in laser group as compared to scalpel group. Efficiency of depigmentation and frequency of recurrence of gingival pigmentation were similar in both the groups. However, in terms of patient's comfort, laser appeared to have a significant advantage over scalpel.

Paralleling technique for frenectomy and oral hygiene evaluation after frenectomy.

Background:High frenum attachment is a very common problem in the population. Various conventional techniques are available which has certain disadvantages; in addition to that high frenum also hinders oral hygiene maintenance. This study aims to evaluate patient's response to two different frenectomy technique, and oral hygiene maintenance before and after frenectomy.Materials and Methods:Twenty patients with high labial frenum were randomly selected from the outpatient department. Patients were divided into two groups according to the technique used. Each group contained ten patients. One group was treated by “conventional scalpel technique” and other group by “new paralleling technique”. To evaluate patients response, visual analogue scale for pain and speech were taken at first postoperative day, 1-week and 1-month. In other part of the study the oral hygiene maintenance was evaluated by using plaque and gingival bleeding index at baseline before frenectomy, 1-week and 1-month after frenectomy.Results:Results showed that new paralleling technique for frenectomy causes less postoperative discomfort and also there was significant improvement in the oral hygiene maintenance by the patient after frenectomy.Conclusion:High maxillary frenum causes hindrance in oral hygiene maintenance. Paralleling technique for frenectomy causes less discomfort to the patient during healing phase when compared with the conventional technique.

Comparison of Outpatient Harmonic Scalpel Tonsillectomy and Traditional Tonsillectomy in Sleep Disordered Breathing

ABSTRACTIn this prospective study of 43 patients, 20 patients were operated by the outpatient harmonic scalpel tonsillectomy. The outpatient harmonic scalpel technique was performed by local injection with 2% Xylocaine with 1:80,000 adrenaline solution around palatine tonsils and using harmonic scalpel for dissecting tissue at superior pole until inferior pole of tonsil. Harmonic scalpel will cut and stop bleeding simultaneously and then, using plain catgut 3-0 ligation at the inferior pole of tonsil stops bleeding from tonsil branch of facial artery. All of the patients were followed up for 1 and 3 weeks postoperatively; 19 of 20 (95%) patients who were operated by the outpatient harmonic scalpel tonsillectomy felt satisfied and in one case, the patients wound healing delayed for 3 weeks. All patients were discharged on the day of admission with no major complication. Twenty-three patients were operated by the traditional tonsillectomy as an inpatient. Twenty of 23 (87%) patients were satisfied and in three cases, the patients had delayed wound healing for 3 weeks. The results of the study conclude that the outpatient harmonic scalpel tonsillectomy is satisfactory and medical treatment cost also is cheaper than the traditional tonsillectomy for the majority of patients.How to cite this articleChanvimalueng W. Comparison of Outpatient Harmonic Scalpel Tonsillectomy and Traditional Tonsillectomy in Sleep Disordered Breathing. Int J Otorhinolaryngol Clin 2016;8(1):18-21

Diode laser surgery versus scalpel surgery in the treatment of fibrous hyperplasia: a randomized clinical trial

Fibrous hyperplasia is treated by surgical incision using a scalpel, together with removal of the source of chronic trauma. However, scalpel techniques do not provide the haemostasis that is necessary when dealing with highly vascular tissues. Diode laser surgery can be used in the management of oral tissues due to its high absorption by water and haemoglobin, and has provided good results in both periodontal surgery and oral lesions. The aim of the present study was to compare the effects of diode laser surgery to those of the conventional technique in patients with fibrous hyperplasia. A randomized clinical trial was performed in which surgical and postoperative evaluations were analyzed. On comparison of the laser-treated (study group) patients to those treated with a scalpel (control group), significant differences were observed in the duration of surgery and the use of analgesic medications. Over a 3-week period, clinical healing of the postoperative wound was significantly faster in the control group as compared to the study group. In conclusion, diode laser surgery proved to be more effective and less invasive when compared to scalpel surgery in the management of fibrous hyperplasia. However, wound healing proved to be faster when using scalpel surgery.

Management of Gingival Hyperpigmentation by Scalpel Technique

Oral melanin pigmentation is well documented in the literature and is considered to have multifaceted etiologies including genetic factors, tobacco use, systemic disorders and prolonged administration of certain drugs especially antimalarial agents and tricyclic antidepressant. Melanin, non-hemoglobin derived brown pigment, is the most common of the endogenous pigments and is produced by melanocytes present in the basal layer of epithelium. Although melanin pigmentation of the gingiva is completely benign and does not present a medical problem, cosmetic concerns are common, particularly in patients having a very high smile line (gummy smile). Various depigmentation techniques have been employed, such as scalpel surgery, gingivectomy with free gingival autografting, cryosurgery, electrosurgery, chemical agent such as 90% phenol and 95% alcohol, abrasion with diamond burs, ND:YAG laser, semiconductor diode laser, and CO2 laser. One of the first and still popular techniques to be employed is the surgical removal of undesirable pigmentation using scalpels. The present case report shows a simple and effective surgical depigmentation technique that does not require sophisticated instruments or apparatus, yet yields esthetically acceptable results.

Comparison of labial frenectomy procedure with conventional surgical technique and diode laser

Background: An Aberrant frenum encroaches the gingival health when it is attached too closely to the gingival margin, either due to interference in the plaque control or due to a muscle pull. Such condition has to be treated by frenectomy which can be performed by scalpel, electrocautery, or with soft tissue lasers. Hence, the aim of the study is to compare the degree of postoperative pain and healing experienced by patients during frenectomy procedure with surgical scalpel and diode laser technique. Materials and Methods: A total of 20 subjects ranging from 16 to 40 years of age group with papillary or papillary penetrating frenal attachment in the maxillary anterior region were selected. Enrolled subjects were randomly divided into two groups as follows Group A (n = 10): Comprised of 10 subjects selected for conventional scalpel technique. Group B (n = 10): Comprised of 10 subjects selected for diode laser technique. Various parameters such as pain, inflammation, swelling, difficulty of procedure, and wound healing were evaluated at intervals of 1 week, 1 month, and 3rd month. Results: The results indicated patients treated with the diode laser had less postoperative pain (P < 0.0001) and required fewer analgesics (P < 0.001) as compared to patients treated with the conventional scalpel technique. Wound healing at 7th day and after 1 month for both the groups showed statistical significant difference with better outcome in Group A. However, wound healing at the end of 3 months did not show any significant difference between the groups. Conclusion: Based on current findings and clinical outcome, diode lasers provide better patient perception and an efficient and satisfactory option for procedures such as frenectomy.

The Comparative Evaluation of Patient's Satisfaction and Comfort Level by Diode Laser and Scalpel in the Management of Mucogingival Anomalies.

Surgical correction of mucogingival anomalies is required to enhance patient's compatibility to maintain oral hygiene or to improve facial aesthetics or both. Laser has become a desirable and dependable alternative for traditional surgical techniques because it is simple and painless with more predictable outcomes. The aim of this study was to compare the effects of the conventional scalpel technique and the laser technique on the degree of discomfort, satisfaction, healing and postoperative pain experienced by patients after correction of mucogingival anomalies. In the present study 70 patients were enrolled and randomly distributed in two groups i.e. surgical correction of mucogingival anomalies by scalpel and by laser. Patient's comfort level, pain and satisfaction level was assessed by using Visual analogue scale (VAS) and healing was evaluated by healing index. The results indicated patients treated with the diode laser had less postoperative pain and discomfort with remarkable satisfactory results and healing compared to patients treated with the conventional technique. Laser is a desirable therapeutic alternative to correct soft tissue anomalies. It allows good control of haemorrhage with comfortable healing phase and appreciable satisfactory outcomes.

Pinch, Burn, Cut Parathyroid-sparing Thyroidectomy Saves Recurrent and Superior Laryngeal Nerves (Conventional, PBC and Harmonic Scalpel Techniques Compared)

ABSTRACT Introduction Recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN) have been and continue to be the Achilles tendon of thyroidectomy. Many anatomical landmarks described and taught. How to cite this article Prasad RG, Rao JVS, Hameed MAR. Pinch, Burn, Cut Parathyroid-sparing Thyroidectomy Saves Recurrent and Superior Laryngeal Nerves (Conventional, PBC and Harmonic Scalpel Techniques Compared). Int J Phonosurg Laryngol 2015;5(2):48-52.

Evaluation of patient perceptions after labial frenectomy procedure: A comparison of diode laser and scalpel techniques

Abstract Background: Frenectomy is the complete excision of the frenum along with its attachment to the underlying bone. It can be done by conventional technique, electrosurgery or soft tissue lasers. Aim: To evaluate the effects of diode laser and scalpel technique on degree of post-operative pain and discomfort experienced by patients on the 1st, 3rd and the 7th post-operative days after frenectomy. Materials and Methods: Ten patients who required frenectomy were randomly assigned to undergo treatment with diode laser or scalpel. The data were analyzed with paired t-test and intragroup comparison was determined by ANOVA. Results: Intergroup comparison of the mean VAS scores for discomfort and pain for both the groups showed significant difference. The VAS scores of pain and discomfort within scalpel group between 1st and 3rd day did not show any significant difference, however between 7th day versus 3rd and 1st day difference was highly significant. The VAS scores of pain and discomfort within laser group between all the days showed significant difference. Conclusion: Taking into consideration the clinical outcome, the diode laser is a dependable alternative as it is an efficient and satisfactory option for procedures like frenectomy.

Clipping the (tongue) tie

Ankyloglossia is an uncommon congenital oral anomaly that can cause difficulty with breast-feeding and speech articulation. For many years, the subject of ankyloglossia has been controversial with practitioners of many specialties having widely different views regarding its significance and management. This study is about a series of five cases of ankyloglossia subjected to surgical correction by frenectomy procedure. Three cases were treated with electrocautery, one case with diode laser and one case with conventional scalpel technique. 1 week and 1 month post-operative follow-ups were done and healing was compared with the available literature. Manipulation of tissues was better in laser and electrocautery techniques when compared with scalpel. Post-operative complication of swelling and pain was seen in scalpel technique whereas it was largely uneventful in other techniques. Though, there was no difference in healing at the end of first month clinically, scalpel technique has shown better results in organization of muscle fibers. This clinical study indicates that laser and electrocautery treatment used for frenectomy operations provides better patient perception in terms of postoperative pain and function than that obtained by the scalpel technique. Considering the above advantages, when used correctly, the laser and electrocautery offers a safe, effective, acceptable and impressive alternative for frenectomy operations.

Comparative evaluation of gingival depigmentation using a surgical blade and a diode laser

Aim: A comparative evaluation of the gingival depigmentation by using a surgical blade and a diode laser; 6 months follow-up. Materials and Methods: Four systemically healthy patients who were aged 21-28 years were selected for the study and were treated with different gingival depigmentation techniques. Diode laser and surgical blade was used for the depigmentation in either of the arches. Pain levels were assessed using a visual analog scale (VAS) during the surgery, 1 day, 3 days and 1 week postoperatively. The recurrence of pigmentation was assessed with melanin pigmentation index (MPI). Results: The gingiva appeared pink and healthy after both the procedures and there was no recurrence of pigmentation. The clinical results obtained with the diode laser were esthetically pleasing with great patient comfort and satisfaction compared to the surgical blade. There was a statistically significant difference between the levels of pain during the procedure and 3 rd postoperative day between the two groups. Conversely there was no difference in the levels of pain 24 hours postoperatively and 1 week postoperatively among the two groups. Conclusion: The laser approach resulted in not as much of bleeding and pain as with scalpel technique. Although no difference in effectiveness and esthetic outcome were found between the two approaches, further well-conducted randomized trials would assist to make the absolute conclusion.

Evaluation of patient response and recurrence of pigmentation following gingival depigmentation using laser and scalpel technique: A clinical study.

Aim:The present study was undertaken to evaluate patient response and recurrence of pigmentation following gingival depigmentation carried out with a surgical blade and diode laser.Materials and Methods:Twenty patients who were esthetically conscious of their dark gums and requested treatment for the same were selected for this study. Complete phase I therapy was performed for all the patients before performing the gingival depigmentation procedures with laser and scalpel on a split-mouth basis. Patients were evaluated for pain (1 day, 1 week), wound healing and melanin repigmentation (Melanin Pigmentation Index) immediately and at 1 week, 1 month and 3 months, respectively.Results:The final results were statistically analyzed and significance was evaluated. The results of this study indicated that both scalpel and laser were efficient for gingival depigmentation. Comparative pain assessment (P = 0.148) and repigmentation scores (P = 0.288) at various time intervals between the two groups did not show any statistical significance.Conclusion:Both the procedures did not result in any post-operative complications and the gingiva healed uneventfully. When compared, both the techniques were found to be equally efficacious. Care must be taken to assess the gingival biotype and the degree of pigmentation in deciding which technique is to be used.Clinical Significance:Various methods of depigmentation are available with comparable efficacies. Depigmentation is not a clinical indication but a treatment of choice where esthetics is a concern and is desired by the patient.

Harmonic Scalpel versus Conventional Technique of Tonsillectomy- A Prospective Study

Tonsillectomy is the one of the most commonly performed surgical procedure in the department of otorhinolaryngology. There are different methods of tonsillectomy techniques used today with the aim of providing more comfort and less morbidity to patients. Postoperative bleeding and Pain are the most common complications. This study evaluated the Operative time, Intraoperative blood loss, Postoperative pain ,Hospital stay and Cost effectiveness of tonsillectomy performed by Harmonic scalpel as compared to Conventional dissection technique. This is a prospective randomized study where in fifty patients were divided into two groups of equal number. In one group, the tonsillectomy was performed by Harmonic scalpel and in the other group by Conventional dissection technique. Amount of blood loss is significantly reduced in the harmonic group. Total postoperative pain and operative time slightly higher for harmonic scalpel group. There is no significant difference in hospital stay and post operative complications. Harmonic scalpel tonsillectomy has shown to be useful, safe, easy and reliable method of performing tonsillectomy.

Gingival Melanin Depigmentation: A Review and Case Report

The color of the gingiva has a tremendous impact on the esthetics of the smile. Clinically gingival melanin hyper pigmentation is presented as ‘black gum’ which is a common esthetic problem especially for those who have gummy smile. Several attempts have been made for removal of gingival pigmentation by different techniques. Each technique had its own supremacy in efficiency and also draw back. In the present cases, an effort has been made to assess the procedure of melanin depigmentation using surgical scalpel technique.

A comparative evaluation of management of melanin pigmented gingiva using a scalpel and laser

Objective: There are only a few case reports in the literature evaluating the effects of the diode laser on gingival melanin pigmentation. This study was performed to evaluate the efficacy of melanin depigmentation using a scalpel and diode lasers based on effective removal of gingival pigmentation, recurrence, and patient acceptability. Study Design: Gingival melanin pigmentation at the anterior maxillary or mandibular gingiva at 20 sites from 7 patients was included. Pigmented areas were measured on pre-and post-operative 1 and 6 months using Dummett Oral Pigmentation Index. This was a split mouth study where gingival depigmentation was carried out using a scalpel and diode laser. For one quadrant scalpel techniques were used and for other quadrant laser ablation was done. Results: Ablation of the hyperpigmented gingiva was accomplished with minimal carbonization and almost no bleeding. Postoperative healing was uneventful with no significant postoperative pain. Statistical analysis of the data revealed a significant difference between pre- and post-operative measurements of pigmented area. No significant changes in pigmentation were seen between 1 and 6 months follow-up with both the procedures. Conclusion: Application of diode laser appears to be an effective and safe method for the elimination of gingival melanin pigmentation.Clinical Relevance To Interdisciplinary Dentistry Esthetics plays an important role in treatment planning

Video-assisted thoracoscopic right lower lobectomy for lung cancer using the Harmonic scalpel.

A 68-year-old lady felt chest pain with tenderness of three years duration, who was a diagnosis of adenocarcinoma cell lung cancer. The accesses employed were based on the use of three ports through thoracoscope. With Harmonic scalpel all the hilar structures were isolated and separately sectioned, and systemic lymph node dissection was performed. Postoperative pathologic diagnosis was T2bN0M0 adenocarcinoma. Harmonic scalpel technique with video-assisted thoracoscopy surgery (VATS) has many advantages over traditional open thoracotomy and use of electrocautery for lobectomy in lung cancer surgery. Chief among these is greater patient safety. With Harmonic scalpel dissection, blood loss is minimal and this speeds patient recovery. It allows better visualization of key anatomic structures and permits better lymph node dissection, which is essential to reducing metastatic spread of the cancer.

Postoperative quality of life after two different methods of tonsillectomy

Tonsillectomy is a very painful procedure. Pain may be severe, and patients are often unable to perform in school or eat regular food for a number of days after the surgery. The aim of this study was to compare the quality of life after undergoing two different surgical techniques of tonsillectomy, harmonic scalpel and classic tonsillectomy with bipolar cauterization. Prospective randomized double-blind, clinical trial study conducted in the ENT Department, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia. Data were collected, according to the type of operation, on pain persistence and intensity and returning to normal eating with tonsillectomy patients during the first seven postoperative days. Group A consisted of 50 children submitted to classic tonsillectomy with bipolar cauterization, while group B included 50 children operated on using the harmonic scalpel. Data on pain intensity were obtained using pain measuring scales adjusted to children's age (Faces scales, visual analog scale). The first day of normal oral food intake was recorded. The analysis of variance revealed that the grade of pain significantly differs by a surgical technique employed, and that it significantly varied over the first seven postoperative days. The pain was more severe after undergoing the harmonic scalpel technique and children started to eat later compared with the classic tonsillectomy. The classic tonsillectomy method with bipolar cauterization is the method of choice due to lower postoperative pain levels and sooner normal eating. The quality of life is better after undergoing the classic tonsillectomy method.

Esthetic treatment of gingival hyperpigmentation with Nd:YAG laser or scalpel technique: a 6-month RCT of patient and professional assessment

This double-masked, randomized controlled trial with a split-mouth design aimed to compare patient- and professional-centered outcomes using different therapeutic approaches-neodymium-yttrium aluminum garnet (Nd:YAG) laser or scalpel technique-for gingival depigmentation. Patients presenting bilateral melanin gingival hyperpigmentation and who requested cosmetic therapy were recruited. Contralateral quadrants were randomly assigned to receive Nd:YAG laser (settings: 6W, 60mJ/pulse, and 100Hz) or scalpel technique. Patient morbidity experienced at intratherapy and during the first postoperative week was evaluated. In addition, after 6months, the cosmetic results achieved for the different therapeutic approaches were evaluated by patients and professionals. The chair time of each technique was also calculated. Patient-oriented outcomes concerning intratherapy morbidity did not demonstrate any differences between groups (p > 0.05), although a higher extent of discomfort/pain was experienced in the side treated by the scalpel technique compared to the Nd:YAG laser procedure during the first posttherapy week (p < 0.05). Regarding to cosmetic outcomes, no differences between techniques were observed for patient and professionals (p > 0.05). Significantly higher chair time was required for the scalpel technique than for the Nd:YAG laser therapy (p < 0.05). The Nd:YAG laser or the scalpel technique may be successfully used for the treatment of melanin gingival hyperpigmentation. However, the use of the Nd:YAG laser has presented advantages in terms of less discomfort/pain during the posttherapy period and a reduction of treatment chair time.