Effect of CO2-milliwatt laser on peripheral nerves: Part II. A histological and functional study

Menovsky, Thomas; Weerman, Marius van den Bergh; Beek, Hans van

doi:10.1002/(sici)1098-2752(2000)20:3<150::aid-micr10>3.0.co;2-h

Cited by 22 publications

(24 citation statements)

References 25 publications

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“…During the procedure, the surgeon irradiated the chitosan strips for longer than necessary because the adhesive activation lacked a visual end point. A reduction in fluence and temperatures are therefore needed to avoid or diminish nerve thermal damage; it also may prove beneficial to irradiate the adhesive with pulses rather than in continuous wave, as previously reported [20].…”

Section: Discussionmentioning

confidence: 95%

In vitro and in vivo tissue repair with laser‐activated chitosan adhesive

et al. 2006

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Background and Objectives: Sutures are currently the gold standard for wound closure but they are still unable to seal tissue and may induce scarring or inflammation. Biocompatible glues, based on polysaccharides such as chitosan, are a possible alternative to conventional wound closure. In this study, the adhesion of laser-activated chitosan films is investigated in vitro and in vivo. In particular we examine the effect of varying the laser power, as well as adding a natural cross-linker (genipin) to the adhesive composition. Study Design/Materials and Methods: Flexible and insoluble strips of chitosan films (surface area $34 mm 2 , thickness $20 mm) were bonded to sheep intestine using several laser powers (0, 80, 120, and 160 mW) at 808-nm wavelength. The strength of repaired tissue was tested by a calibrated tensiometer to select the best power. A natural cross-linker (genipin) was also added to the film and the tissue repair strength compared with the strength of plain films. The adhesive was also bonded in vivo to the sciatic nerve of rats and the thermal damage induced by the laser assessed 4 days post-operatively. Results: Chitosan adhesives successfully repaired intestine tissue, attaining a maximum repair strength of 14.7 AE 4.3 kPa (n ¼ 30) at the laser power of 120 mW. The chitosan-genipin films achieved lower repair strength (9.1 AE 2.9 kPa). The laser caused partial demyelination of axons at the site of operation, but the myelinated axons retained a normal morphology proximally and distally. Conclusions: The chitosan adhesive effectively bonded to tissue causing only localized thermal damage in vivo, when the appropriate laser parameters were selected.

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Section: Discussionmentioning

confidence: 95%

In vitro and in vivo tissue repair with laser‐activated chitosan adhesive

et al. 2006

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“…Laser light may destroy neural structures through direct ablation or overheating due to laser cutting of adjacent tissue. Both can lead to reduced or missing nerve function [4-6]. …”

Section: Discussionmentioning

confidence: 99%

“…However, these advantages come along with a lack of feedback: the surgeon does not receive sufficient information about the penetration depth of the laser cut or the type of tissue being ablated at the bottom of the laser cut. Hence, there is a risk of iatrogenic damage or the destruction of anatomical structures such as peripheral nerves [4-6]. …”

Section: Introductionmentioning

confidence: 99%

Optical Nerve Detection by Diffuse Reflectance Spectroscopy for Feedback Controlled Oral and Maxillofacial Laser Surgery

et al. 2011

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BackgroundLaser surgery lacks haptic feedback, which is accompanied by the risk of iatrogenic nerve damage. It was the aim of this study to investigate diffuse reflectance spectroscopy for tissue differentiation as the base of a feedback control system to enhance nerve preservation in oral and maxillofacial laser surgery.MethodsDiffuse reflectance spectra of nerve tissue, salivary gland and bone (8640 spectra) of the mid-facial region of ex vivo domestic pigs were acquired in the wavelength range of 350-650 nm. Tissue differentiation was performed using principal component (PC) analysis followed by linear discriminant analysis (LDA). Specificity and sensitivity were calculated using receiver operating characteristic (ROC) analysis and the area under curve (AUC).ResultsFive PCs were found to be adequate for tissue differentiation with diffuse reflectance spectra using LDA. Nerve tissue could be differed from bone as well as from salivary gland with AUC results of greater than 88%, sensitivity of greater than 83% and specificity in excess of 78%.ConclusionsDiffuse reflectance spectroscopy is an adequate technique for nerve identification in the vicinity of bone and salivary gland. The results set the basis for a feedback system to prevent iatrogenic nerve damage when performing oral and maxillofacial laser surgery.

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“…Following complete transection of cranial nerves in the head and neck, microsuture repair is conventionally performed . Laser nerve welding (LNW), which uses laser energy to repair the transected nerve endings, is an experimental alternative and does not require suture material . LNW has been described in animal models using CO 2 laser .…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] Laser nerve welding (LNW), which uses laser energy to repair the transected nerve endings, is an experimental alternative and does not require suture material. [4][5][6] LNW has been described in animal models using CO 2 laser. 4,7-9 LNW repair may improve functional recovery because it seals vital nerve growth factors and limits damaging intraneural axons with needle/ suture material.…”

Section: Introductionmentioning

confidence: 99%