Diode laser thermal effect on the paranasal sinus osteoma

Studies of the effects of optical quantum generators’ beams on biological tissues and systems were started in 1960s. The biological effects of laser energy on the tissues depend on different things, and the biological effects of laser exposure are determined by the degree of tissue uptake. When a specific tissue is exposed we can choose a certain wavelength and predict an effect. Each laser contains an active medium that provides a specific wavelength depending on its chemical composition. From a retrospective analysis of the literature, we have found little information about the effects of diode lasers on bone tissue. The first serious attempts to use lasers for the purpose of osteotomy were extensively studied by Horch. It was found that excessively high temperature was the main source of tissue damage during bone osteotomy. Eriksson and Albrektsson described 47 C as the critical temperature for bone destruction. Data were found on the application of laser osteoperforation in ophthalmology for transcanalicular dacryocystorhinostomy. A group of authors, in a study using chilled lamb scapula, performed osteoperforation for assessment of various modes of both contact and distant exposure using a holmium laser with a wavelength of 2080 nm, and concluded that the optimal mode for creation of a 6-mm diameter perforation is as follows: contact influence at 10 W power with movement of the fiber through the specified hole diameter of the required size. When the bone is exposed to the lasers, where maximum absorption corresponds to the absorption by the water of biological tissues, surface damage takes place. The contact method of influence on the bone tissue helps to limit the damage area due to the combined action of the concentrated laser beam and the heated end of the fiber. Davidov and coauthors experimentally studied the effect of the laser with the wavelength 970 nm on bone tissue fragments of the bones of the human skull. The authors concluded that the distance influence is ineffective, and therefore, it was proposed to perform osteoperforation in a contact mode: power 12 W, in pulse mode, with a ratio of the pulse duration and the pause duration 4:1. Thermal relaxation, which lasts for a long time, is an important part of laser surgery. Limiting the time of laser exposure helps to minimize the temperature’s effect on surrounding tissues. In the experiment, Stein and coauthors, while studying thermal damage when the bone tissue of the facial skull and the sinuses of rabbits were exposed to an erbium laser, concluded that laser surgery can be an important addition to functional endoscopic sinus surgery. Osteoma is a benign bony tumor that is usually asymptomatic. The diagnostic method for finding a bony neoplasm is imaging. Only surgical treatment is indicated. The type of surgery depends on the size, anatomic localization, and dimension of the tumor, and includes different approaches. In the case of an osteoma growing on the agger nasi or frontal bulla, the frontal sinus cannot be opened endoscopically without osteoma mobilization. Mobilized tumor can be removed only after opening the sinus wide endoscopically, with the Draf III procedure or with an open approach. In both cases, all pathological bone tissue should be removed. Another possibility for successful resolution of this difficult situation is to destroy the mobile bone tumor inside the sinus. A diamond drill or punch forceps cannot be applied, because a neoplasm with a smooth surface can “run away” from the instrument. After translocation of the neoplasm to the sinus cavity, it is necessary to remove it transnasally through the formed expanded ostium. To reduce the dimensions of the osteoma down to the size required for its removal, we use a diode laser. In the literature we did not find any information on application of a laser to achieve this result.