Outpatient Tonsillectomy in Children A Systematic Review在系统回顾门诊儿童扁桃体切除术.pptVIP

The 585-nm Pulsed Dye Laser for Recurrent Respiratory Papillomatosis: A Randomized Controlled Trial in Children Matthew T. Brigger, M.D. Massachusetts Eye and Ear Infirmary Harvard Medical School Overview: Current Trial A multicenter effort to assess the benefit of using the 585-nm pulsed dye laser (PDL) in children with RRP All children will be treated No children will receive placebo All will receive at least conventional treatment The safety of the PDL has been established Sites: Boston, San Diego, Birmingham, Cincinnati Background Surgical treatment of RRP The Goal: Remove papillomas to the fullest extent as is safely possible Balance the functions of the larynx Airway, swallowing and voice Preserve normal anatomy Primary methods – microlaryngeal dissection, microdebrider, CO2 laser The Problem Surgical therapies involve mucosal disruption Scarring potential “Good surgical technique” Do not disrupt opposing mucosal surfaces The Problem “Difficult to treat areas” Anterior commissure, inter-arytenoid space and laryngeal ventricle Often must leave gross papilloma Notoriously poor voice outcomes due to scarring Basic CO2 Laser Physics “Hemostatic Cutting Laser” Wavelength 10,600 nm in a continuous beam Primarily absorbed by water within tissue Water is heated to steam Steam expands and microscopically tears tissue Various ways to alter the degree of tissue damage defocusing, adjusting fluence (energy density) A Different Type of Laser Early 1980’s: Simon Parrish and R. Rox Anderson develop the 585 nm pulsed dye laser based on the concept of selective photothermolysis A novel treatment for cutaneous vascular lesion by atraumatically coagulating microvasculature of lesion while preserving the epithelium Destroys the vessels within the lesion Papilloma Histology Highly vascular fibrous core covered by nonkeratinizing squamous epithelium Why is the Histology Important? The vascular core of papillomas is a prime target for selective photothermolysis Destruction of pa