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Biomedical subjects

S M Shapshay

Publications and source records attributed to S M Shapshay.

At least 73 records · Page 4Linked to original sources
PubMed1990

Endoscopic laser arytenoidectomy revisited.

Arytenoidectomy is currently the most reliable method of treating patients with bilateral vocal cord paralysis. Although both endoscopic and external approaches have been described, the endoscopic laser technique is more desirable because it requires no incision and allows for the immediate assessment of airway size. Eleven patients with bilateral vocal cord paralysis treated by endoscopic laser arytenoidectomy were presented in 1984. At that time, 10 of the 11 patients had been successfully decannulated. Follow-up on that group of patients revealed that 7 of the 10 successfully treated patients remain decannulated with a good airway, although 2 of these patients required a revision procedure to excise a granuloma. One patient failed at 15 months and has failed two subsequent revision operations, and 2 patients have been lost to follow-up. Since 1984, 17 additional patients with bilateral vocal cord paralysis have been treated by the authors using the same endoscopic laser arytenoidectomy technique; all have been successfully managed, with a minimum follow-up of 3 years. The technique of this operation will be reviewed. This study demonstrates the clinical usefulness of endoscopic laser arytenoidectomy in the treatment of bilateral vocal cord paralysis.

Arytenoid Cartilage↗
PubMed1990

Soft tissue effects of the holmium-YSGG laser in the canine trachea.

A holmium-yttrium scandium gallium garnet laser is a pulsed mid-infrared crystalline laser (wavelength, 2.1 microns), which is easily transmissible through flexible quartz fibers. With use of a 300-microns fiber delivery system, this laser was applied in the canine trachea to create a standard 5-mm diameter lesion through mucosa and submucosa. Power settings of 400 mJ and 600 mJ per pulse at 2 pulses per second were used, and wound healing was studied over a 2-week period. Excellent control of depth of tissue ablation was noted, with uncomplicated wound repair. Although healing was somewhat slower compared with healing when the CO2 laser was used, less granulation and fewer inflammatory changes were noted. Further studies need to be performed to determine ideal laser dosimetry before this laser is applied clinically.

Animals↗
PubMed1990

Benign lesions of the larynx: should the laser be used?

The use of the carbon dioxide (CO2) laser in the treatment of patients with benign laryngeal lesions, excluding respiratory papillomatosis, has been questioned because of potential adverse thermal effects on surrounding tissue. We question whether wound healing and subsequent quality of voice would be better if the surgeon used the "cold technique" with microlaryngeal instruments. Since the advent, in 1987, of a small-spot (0.3 mm) CO2 laser micromanipulator and more precise microlaryngeal instruments, we have redefined our use of the CO2 laser for benign laryngeal lesions. Over the past 4 years, in a series of 68 consecutive patients with vocal cord nodules, polyps, polypoid changes, or granulomas, the CO2 laser was useful for mucosal micro-flap dissection techniques and for vascular lesions. Smaller pedunculated lesions, such as vocal cord nodules, were more efficiently removed with the new microlaryngeal instrumentation. The combined selective use of a microspot CO2 laser at low-power settings (1 to 3 W), with 0.1-second pulses, and with precise microlaryngeal instruments will give the best results.

Adolescent↗
PubMed1989

Laser technology in the diagnosis and treatment of head and neck cancer.

The carbon dioxide (CO2) laser has been used with microsurgical precision as an excisional biopsy tool in the diagnosis, staging, and treatment of laryngeal, oral, and oropharyngeal cancer. Selected early cancers of the larynx and oral cavity have been treated for cure, and more advanced and recurrent tumors have been treated for palliation. Other laser wavelengths, such as the neodymium-yttrium aluminum garnet laser (Nd-YAG) and the argon dye laser employed in tumor photosensitization, have shown promise in the diagnosis and treatment of head and neck cancer. Laser technology is most useful when used in conjunction with the standard cancer therapies, such as radiotherapy, surgery, and chemotherapy.

Combined Modality Therapy↗
PubMed1989

New microlaryngeal instruments for phonatory surgery and pediatric applications.

A new microlaryngeal instrument set has been developed for phonatory surgery in adults and for pediatric laryngology. This 20-instrument set consists of forceps (cupped and alligator type) and scissors with 1-mm distal grasping and cutting tips. Open tip and whistle tip variety suction instruments with tip diameters of 1.0, 1.5, and 2 mm are also available. Included as well are fine (1.0-mm) probes for palpation and laser welding and smoke evacuation double-action grasping forceps. This microlaryngeal instrument set has been extremely useful in more than 80 clinical applications.

Adult↗
PubMed1989

Total cervical tracheal stenosis: treatment by laser, dilation, and stenting.

Twelve patients with total cervical tracheal stenosis were treated by endoscopic laser excision (neodymium:yttrium aluminum garnet or carbon dioxide laser), bronchoscopic dilation, and prolonged stenting with a silicone T-tube. All patients had previous traumatic or prolonged endotracheal intubation requiring a tracheotomy and presented with aphonia as the major complaint. Multiple laser and dilation treatments were necessary in ten patients. Average duration of T-tube placement was 6 months. Excellent results (decannulation and good voice) were achieved in eight patients with a follow-up of 9 months to 6 years. Persistent granulation tissue and some degree of fibrosis were the most common complications (eight of 12 patients). Two patients died of medical complications. A high success rate with this endoscopic technique justifies this approach as our initial therapy, with open surgical techniques reserved for failure.

Adult↗
PubMed1989

Teaching models for Nd:YAG laser bronchoscopy.

A number of groups have demonstrated the efficacy of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser bronchoscopy for treatment of patients with selected tracheobronchial disorders. This therapy involves a new technology, the laser, and new adaptations of conventional rigid and flexible bronchoscopy that are unfamiliar to many bronchoscopists. We describe two teaching models for laser bronchoscopy that have been employed successfully in our laser courses. Using these models, bronchoscopists can become familiar with laser bronchoscopic equipment and appreciate the interaction of laser and soft tissue in a controlled setting in the laboratory before applying this therapy to patients.

Animals↗
PubMed1988

New microspot micromanipulator for carbon dioxide laser surgery in otolaryngology. Early clinical results.

A new micromanipulator with microspot capability has been developed for carbon dioxide laser surgery in otolaryngology. The instrument features new infrared optics, which provide smaller laser spot sizes than those achievable with conventional micromanipulators (300 micron using a 400-mm operating microscope lens). The conventional red helium-neon aiming laser is replaced with a nonlaser fiberoptic image, and a power defocus control on the joystick manipulator eliminates external defocus controls. Less surrounding tissue trauma occurs with this new instrument by using a higher power density with average power settings of 1 to 2 W for cutting and ablation of tissue. Eight patients with benign laryngeal disease and one patient with dysplastic changes of the vocal cord were treated successfully without complications.

Animals↗
PubMed1988

Management of rhinophyma with carbon dioxide laser: Lahey Clinic experience.

The carbon dioxide (CO2) laser as a surgical tool for the difficult cosmetic problem of rhinophyma permits unprecedented refinement in treatment. Previously described conventional techniques have included the cold knife and the dermabrader. With these methods, hemostasis must be obtained with electrocautery, which if used extensively makes fine sculpting difficult. Seven patients with rhinophyma were treated with the CO2 laser at the Lahey Clinic from 1982 to 1987. We used a laser handpiece with a variable spot size. With this technique, we found the laser to be an excellent cutting tool while simultaneously providing superior hemostasis. In the followup period of up to 4.5 years, the cosmetic results have been excellent. Thus, the CO2 laser has become our treatment of choice for the management of patients with rhinophyma.

Hemostasis, Surgical↗
PubMed1988

Gastric mucosal dissection using the Nd-YAG laser synthetic sapphire crystal contact probe. Development of an endoscopic method for the treatment of pancreatic pseudocysts.

A canine gastric-ulcer model was developed to evaluate the safety and effectiveness of the neodymium yttrium-aluminum-garnet (Nd-YAG) laser synthetic sapphire crystal contact probe in intraluminal gastric dissection. The purpose of the study was to assess the potential endoscopic application of the Nd-YAG contact probe in cystogastrostomy for the treatment of selected patients with pancreatic pseudocyst. Seven dogs were used in the study. In the first two dogs, full-thickness linear incisions through the gastric wall demonstrated the Nd-YAG contact probe could be used for a full-thickness gastrostomy dissection. In the other five dogs, gastric ulcers were created by injection of morrhuate sodium (5%). Gastric mucosal dissection with the Nd-YAG contact probe was performed without difficulty. Hemostasis was obtained with either the Nd-YAG contact probe or noncontact fiber, and all areas of dissection and ulcer beds healed within 35 days. The Nd-YAG laser contact endoscopic delivery system appears to be a promising technique for intraluminal dissection.

Animals↗
PubMed1987

Carbon dioxide laser in removal of polytef paste.

Teflon injection is the most popular surgical technique for improvement of voice in patients with a unilaterally paralyzed larynx. The results with this method usually are good, but cases of overinjection with resultant poor voice, airway compromise, or both, do occur. The carbon dioxide laser has become a standard instrument for laryngeal surgery, and it might reasonably be used in attempts to correct the overinjected vocal cord. Realizing that Teflon could share flammable characteristics with other polymers, such as rubber and polyvinylchloride, we investigated the effect of the carbon dioxide laser on fresh polytef paste (Mentor O & O Inc, Hingham, Mass) before using it in a patient with an overinjected hemilarynx. Fresh paste was found to ignite after exposure to standard laser power at normal time settings, both in room air and in an oxygen-enriched atmosphere. To determine the effect of the laser on Teflon in situ, the paste was injected subcutaneously and intramuscularly into a rat. After a suitable interval of time, the Teflon was found to glow but not ignite when exposed to the laser under standard operating conditions. Only under high power in an oxygen-enriched environment did ignition occur. In our patient, the laser was used to incise the mucosa over the polytef granuloma, and standard microsurgical (nonlaser) techniques were used to complete the removal with good results. Laryngologists should be aware of the dangers of using the carbon dioxide laser on or near Teflon, especially in freshly injected vocal cords.

Carbon Dioxide↗
PubMed1987

A new rigid bronchoscope for laser fiber application.

A new fiberoptic rigid bronchoscope system, designed especially for laser fiber delivery, provides the endoscopist with an excellent conduit for application of the flexible fiberoptic bronchoscope, while still allowing maintenance of adequate ventilation. This system is designed for treatment of benign and malignant obstructing tumors in the trachea and mainstem bronchi. The bronchoscope will be available in sizes ranging from 6 mm to 10 mm in diameter.

Bronchial Neoplasms↗
PubMed1987

Laser applications in the trachea and bronchi: a comparative study of the soft tissue effects using contact and noncontact delivery systems.

A comparative study of laser soft tissue effects using carbon dioxide (CO2) and neodymium-yttrium aluminum garnet (Nd-YAG) lasers in contact and noncontact endoscopic delivery systems was done in the canine tracheobronchial tree to determine the best laser system for the specific disease. The CO2 laser bronchoscopic coupler, CO2 laser waveguide, Nd-YAG laser fiber, and Nd-YAG laser contact probe were used. A 5 mm diameter soft tissue injury exposing tracheal cartilage was made, and the power density for each laser modality was measured. Soft tissue effects were documented histologically using routine techniques and scanning electron microscopy acutely and at 1 week and 2 weeks after injury. The effects were similar with the CO2 laser coupler and the CO2 laser waveguide with comparable power densities. Compared with the CO2 laser, the Nd-YAG laser fiber caused more extensive and more difficult to control thermal damage in tissue. The Nd-YAG laser contact probe was capable of precise soft tissue ablation with minimal surrounding tissue damage and was associated with the most rapid healing. This study concluded that high power density with short exposures is desirable when treating benign disorders, such as tracheal stenosis, making the CO2 laser or Nd-YAG laser contact probe application a good choice. On the other hand, malignant tumors with a potential for hemorrhage are best treated with the Nd-YAG laser noncontact fiber system because of its superior coagulative effects.

Animals↗
PubMed1987

Neodymium-YAG laser intranasal photocoagulation in hereditary hemorrhagic telangiectasia: an update report.

Hereditary hemorrhagic telangiectasia is a challenging problem for the otolaryngologist since frequent, often severe epistaxis is the major symptom. Options for therapy in the past have included nasal packing, electrocautery, systemic estrogens, septal dermatoplasty, arterial embolization, and arterial ligation. Although successful treatment has been achieved with some of these methods, particularly septal dermatoplasty, other forms of therapy are needed prompting the use of laser photocoagulation. The neodymium yttrium-aluminum-garnet (Nd-YAG) laser was used to treat a group of 19 patients with hereditary hemorrhagic telangiectasia over a 4-year period without complications. Endonasal laser photocoagulation was effective in decreasing epistaxis in patients not requiring frequent transfusions prior to laser therapy. Three patients with the most severe epistaxis received minimal or no benefit from Nd-YAG laser photocoagulation. In most patients Nd-YAG photocoagulation is successful in treating epistaxis associated with hereditary hemorrhagic telangiectasia and should be a therapeutic option for this chronic disease having no available cure.

Epistaxis↗
PubMed1987

Neodymium-YAG laser photocoagulation of hemangiomas of the head and neck.

Hemangiomas of the head and neck region can be a therapeutic challenge depending on their size, flow rate, and location. The neodymium-yttrium aluminum garnet (Nd-YAG) laser was used to treat 16 pediatric and adult patients with cavernous, capillary, and mixed hemangiomas as well as hypertrophic port-wine stains of the head and neck. Low-power energy and intermittent short exposure accomplished photocoagulation with minimal damage to surrounding tissue. Follow-up study in these patients has ranged from 1 to 3 years with excellent results in 14 of 16 patients. Few complications and no major morbidity or mortality occurred. Photocoagulation of hemangiomas of the head and neck using the Nd-YAG laser appears to be an exciting new therapeutic option for this difficult problem. Further clinical study and follow-up appear to be warranted.

Adult↗
PubMed1986

Flammability of endotracheal tubes during Nd-YAG laser application in the airway.

The effects of the neodymium-yttrium aluminum garnet (Nd-YAG) laser on several commonly used endotracheal tubes were examined. Six different types of tubes were tested for flammability. Three tubes were clear, transparent polyvinylchloride with black lettering on the surface. One was yellow-green silicone rubber with green lettering on the surface. One, which was opaque gray with no printing or marks on it, was designed specifically for use with the carbon dioxide (CO2) laser, and one was opaque red rubber with black letters printed on the surface. The latter was tested with and without a wrapping of reflective aluminum tape. On each tube a clear, unmarked area and an area with printing were tested. In each area the tube was impacted by the laser at three to five points. Pulsed and continuous patterns of laser impact were used. Power ranged from 20 to 50 W. The clear polyvinylchloride tubes were not damaged by a pulsed pattern of exposure in unmarked areas. Segments with black printing or marks were consistently damaged. Continuous laser exposure consistently damaged clear portions of the tube. In clear unmarked areas, silicone rubber tubes were damaged with the pulsed pattern when exposure reached 50 W for 1 s. Areas with green lettering were damaged at the lowest level of exposure. Continuous laser exposure at 30 W damaged clear portions of these tubes after 7 s. Opaque red rubber and opaque gray tubes were damaged at the lowest levels of exposure in both clear and marked areas with pulsed and continuous laser emission. A wrapping of reflective aluminum tape offered no protection.(ABSTRACT TRUNCATED AT 250 WORDS)

Color↗