Laser-assisted myringoplasty--technical aspects. 2000

I Pyykkö, and D Poe, and H Ishizaki
Department of Otolaryngology, Karolinska Institute, Stockholm, Sweden. iipo@ent.ks.se

At lower power, lasers fuse collagen fibres and weld tissues. Welded collagen fibres make a solid bond and allow tissue growth along the bonded edges. Our aim was to study applicability of lasers in myringoplasty. We used a KTP-532 laser in outpatient myringoplasty. The laser beam was delivered through a micromanipulator connected to a microscope or through a 200-400-micron silica fibre. The perichondrium was used for transplantant and harvested from the tragus. The margins of the perforation in the eardrum were evaporated, with the laser operating in a continuous mode at 2-4 W. The middle ear was filled with gelfilm to provide support for the transplant. The perichondrium was placed under the margins of the tympanic membrane and lazed at low power (0.2-1.5 W) in continuous mode. In pale tissues, venous blood, methylene blue or fluorescein was used to enhance the tissue admittance of laser energy. Surgical failures were linked to thermal tissue damage due to excessive energy during lazing. In two cases, visibility via microscope into the anterior edge was not complete and the transplantant did not adhere in the relatively limited area. One patient had epidermal growth under the tympanic membrane and developed local cholesteatoma. Laser-assisted myringoplasty provides several advantages over traditional myringoplasty: it is minimally invasive, no manipulation of the ossicles is needed and it is convenient in anterior perforations, where it can be done endoscopically. We prefer a fibre delivery system to a micromanipulator, as lazing with endoscopes is possible and thermal damage is easier to prevent.

UI MeSH Term Description Entries
D009225 Myringoplasty Surgical restoration of a perforated tympanic membrane by grafting. (Dorland, 28th ed.) Myringoplasties
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014432 Tympanic Membrane An oval semitransparent membrane separating the external EAR CANAL from the tympanic cavity (EAR, MIDDLE). It contains three layers: the skin of the external ear canal; the core of radially and circularly arranged collagen fibers; and the MUCOSA of the middle ear. Eardrum,Eardrums,Membrane, Tympanic,Membranes, Tympanic,Tympanic Membranes
D053685 Laser Therapy The use of photothermal effects of LASERS to coagulate, incise, vaporize, resect, dissect, or resurface tissue. Laser Knife,Laser Scalpel,Surgery, Laser,Vaporization, Laser,Laser Ablation,Laser Knives,Laser Photoablation of Tissue,Laser Surgery,Laser Tissue Ablation,Nonablative Laser Treatment,Pulsed Laser Tissue Ablation,Ablation, Laser,Ablation, Laser Tissue,Knife, Laser,Knifes, Laser,Knive, Laser,Knives, Laser,Laser Knifes,Laser Knive,Laser Scalpels,Laser Surgeries,Laser Therapies,Laser Treatment, Nonablative,Laser Treatments, Nonablative,Laser Vaporization,Nonablative Laser Treatments,Scalpel, Laser,Scalpels, Laser,Surgeries, Laser,Therapies, Laser,Therapy, Laser,Tissue Ablation, Laser
D018424 Cholesteatoma, Middle Ear A mass of KERATIN-producing squamous EPITHELIUM that resembles an inverted (suck-in) bag of skin in the MIDDLE EAR. It arises from the eardrum (TYMPANIC MEMBRANE) and grows into the MIDDLE EAR causing erosion of EAR OSSICLES and MASTOID that contains the INNER EAR. Middle Ear Cholesteatoma,Aural Cholesteatoma,Aural Cholesteatomas,Cholesteatoma, Aural,Cholesteatomas, Aural,Cholesteatomas, Middle Ear,Middle Ear Cholesteatomas
D019060 Minimally Invasive Surgical Procedures Procedures that avoid use of open, invasive surgery in favor of closed or local surgery. These generally involve use of laparoscopic devices and remote-controlled manipulation of instruments with indirect observation of the surgical field through an endoscope or similar device. Minimal Access Surgical Procedures,Minimal Surgical Procedures,Minimally Invasive Surgical Procedure,Surgical Procedures, Minimally Invasive,Minimal Surgical Procedure,Minimally Invasive Surgery,Procedure, Minimal Surgical,Procedures, Minimal Access Surgical,Procedures, Minimal Surgical,Procedures, Minimally Invasive Surgical,Surgical Procedure, Minimal,Surgical Procedures, Minimal,Surgical Procedures, Minimal Access,Minimally Invasive Surgeries,Surgeries, Minimally Invasive,Surgery, Minimally Invasive

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