Lajos Gáspár D.D.S., Ph.D., and Péter Vágó DDS., Ph.D.
Department of Oral and Maxillofacial Surgery, Central Military Hospital, Budapest,
Department of Stomatology, Haynal University of Health Sciences, Budapest, Hungary

Abstract

In their patient population, the authors summarise experience with 4032 laser operations of oral lesions, the manifestation of the advantages and disadvantages of this technique. The haemostatic effect of the laser is of special significance, which became evident in the surgery of vascular lesions and patients with clotting disturbance. For protection of the healthy tissues, various laser surgical methods were used-coagulation, vaporisation, excision- the postoperative oedema, pain, inflammation, wound healing disturbances, and scarring were minimal. By the use of this method, the oral cavity functions can be well maintained. Following the CO2, Nd Yag, Argon, Combi (CO2+NdYAG) laser treatment, the number of complications (oedema, pain, scar formation) was low. The laser treatment is economically favourable, since the absence of patients from work is minimal. Methods have been elaborated to overcome the disadvantages of laser treatment. The advantages of four type surgical laser treatments in oral surgery manifest themselves very markedly.

Key words: Laser surgery, oral surgery, advantages,

Address reprint requests to Lajos Gáspár, DDS, PhD, Budapest, 1029, Zsiroshegyi ut 118. Hungary.

Introduction

The laser, a recent thermotherapy tool, is used in various fields of medicine. Its application in oral surgery is becoming more and more widespread, and favourable experience has been accumulated especially in surgery of vascular lesions and precancerous conditions. The timely and successful treatment of the latter is of special significance because of the dramatically increasing incidence and the resultant mortality of oral cancers.

In the past 20 years, during which laser surgery has come into focus, various pros and cons have arisen. 1-7 Although the data are occasionally contradictory, the definite advantages of laser therapy are becoming overwhelming. Our own experience concerning the advantages and disadvantages of using the CO 2, Nd YAG, Argon, Combi (CO2+Nd YAG) lasers in oral surgery is described.

The fact that the focused CO2 laser beam is useful for cutting the tissues was revealed as early as 1966, when it was proved that in view of the homeostatic effect, an almost bloodless incision could be made on hepatic tissue. First in cadaver investigations and later in clinical practice, it was shown by Jako 17 that a region of predetermined size could be removed from the larynx with saving of the surrounding tissues (function-preservative operations).Kaplan, 18-19 experiencing minimal scarring, widely applied the CO 2 laser in plastic surgery. Oosterhuis 2o confirmed the advantages of using the laser in tumour surgery. Hall, 15 in 1971, reported that the laser-incised wound has a sharp border and healing is almost scar-free. Sowislo et al. 25 proved in their study of wounds cut by surgical knife, electrocautery and CO2 laser, the advantages of the laser:sharp wound edges, minimal blood loss, lack of oedema, and minimal scar tissue. The laser beam can be applied in a no-touch manner: thus, the instrument does not pass tumour cells to the surroundings (ablastic instrument). 13,14,16,21,22,23,24,26,

In comparison with other instruments, the relapse rate is minor following laser application, and it can be repeated several times, with a broad spectrum of indications. The number of postoperative oedema, pain, scar formation is minimal. It has become evident that the use of the surgical laser results in considerable financial savings for the health service. 8-12

The most significant disadvantages to laser application derive from the fact that it is troublesome to direct the laser beam to the target area in deep tissues, and sterile conditions must be ensured. Safety precautions must be observed, and the resulting vapour must be drawn off. The instruments are still extremely expensive. These advantages and disadvantages in oral surgery are unelucidated in numerous aspects, although they must be clarified for the routine use of the laser beam.