The precision afforded by the CO₂ laser for incision, excision and ablation of soft -tissue in the oral cavity and oropharynx is second to no other surgical technology. The advanced laser systems and delivery devices from Lumenis are designed for work in these sometimes vascular and hard to reach tissue areas. Some accessories are designed to work with Lumenis free-beam CO₂ lasers, which have an articulated arm. The new FiberLase flexible CO₂ fiber with the AcuPulse™ 40WG laser system is also ideal for work in this area, particularly when the surgery is multi-level.

Leukoplakia, benign and malignant lesions

Leukoplakia is a pre-cancerous white-appearing lesion that can be local or diffuse in presentation. The CO₂ laser is ideally suited for excision and ablation of leukoplakia. Individual patches can be easily excised according to lesion geometry and depth.

Tissue samples are sent to the pathologist when leukoplakia, benign and malignant lesions are removed. The CO₂ laser works efficiently, while enabling tissue samples with good margins, good hemostasis and preservation of maximum healthy tissue.

Glossal hypertrophy

When enlarged size contributes to obstructive sleep disordered breathing, a partial glossectomy can be performed to reduce the size of the tongue. Visualization is enhanced because of microvascular hemostasis. Patient recovery may be easier and faster because of reduced trauma to remaining tissue.

Enlarged tonsils

Tonsils are units of lymphatic tissue, situated in the pharynx near the openings to the airway. When present, the palatine tonsils can be seen laterally in the oropharynx. The lingual tonsil is located at the base of the tongue near the epiglottis and is generally not visible without a mirror or endoscope. The pharyngeal tonsils (adenoids) are located in the nasopharynx above the soft palate and near the eustachian tubes. Enlarged tonsils can interfere with breathing, particularly while lying down at night. The condition associated with periodic episodes of apnea followed by snoring or episodic gasping for air is termed Obstructive Sleep Apnea (OSA). OSA interferes with quality of life because affected individuals may be tired, sleepy, cranky and even have problems concentrating.

In an outpatient setting, under local anesthesia, the CO₂ laser is sometimes used on adults to perform a partial palatine tonsillectomy (subtotal or capsular tonsillectomy). The same procedure may be performed under general anesthesia in the operating room. The Kamimi tonsil tip attached to the Oral Pharyngeal and Nasal Handpiece or FiberLase CO₂ fiber can be used for this application.

The free-beam Oral Pharyngeal and Nasal Handpiece with 90° angled-mirror tip can be used to reflect the laser beam onto the adenoids or the lingual tonsil. The flexible CO₂ fiber can also be used with various FiberLase handpieces, depending on the condition, patient anatomy and surgeon preference.

Enlarged palate, uvula

Laser-Assisted Uvulopalatoplasty (LAUP) may be performed in the office under local anesthesia for treatment of snoring or obstructive sleep apnea (OSA). Studies have shown that when the CO₂ laser is used, many patients experience reduced swelling and discomfort. The free-beam Oral Pharyngeal and Nasal Delivery System includes a Backstop tip designed especially for this procedure. Alternatively, the flexible CO₂ fiber can be used with a FiberLase rigid or malleable handpiece.

Multi-Level Obstructive Sleep Disorder

Chronic obstructive sleep apnea (OSA) adversely affects quality of life because lack of sleep saps energy, stamina and the ability to concentrate mentally. When left untreated, OSA can lead to other chronic cardiac and blood pressure conditions. The site of obstruction can be in a single or multiple locations. A variety of surgical procedures may be necessary, depending on the overall condition – some might involve the use of the CO₂ laser and others would require traditional reconstructive techniques. Only specially trained physicians can make this determination.

The CO₂ laser works well to reduce the size of overly large organs in OSA, nasal turbinates, tonsils, tongue, soft palate and uvula, etc. The AcuPulse 40WG CO₂ laser with the FiberLase flexible CO₂ laser fiber offers the greatest utility and ease-of-use for surgical treatment of multilevel obstructive sleep disease.

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