Advantages Posted on 23 Jun 00:00

There are many advantages to the use of lasers in OMF surgery.

The advantages of laser surgery include: hemostasis and excellent field visibility, precision, enhanced infection control and elimination of bacteremia, lack of mechanical tissue trauma, reduced postoperative pain and edema, reduced scarring and tissue shrinkage, microsurgical capabilities, less instruments at the site of operation, asepsis due to non-contact tissue ablation and prevention of tumor seeding.

The hemostatic nature of the laser is of great value in OMF surgery. It allows surgery to be performed more precisely and accurately because of increased visibility of the surgical site.

This characteristic is particulary useful in cases of hemangioma or removal of inflamed epulis fissurata, or any procedure involving incision of the tongue, soft palate, or tonsillar pillars. Decreased postoperative swelling is characteristic of lasers and allows increased safety when performing surgery within the airway and increases the range of surgery that can be performed safely without fear of airway compromise.

This effect allows the surgeon to perform many procedures in an office or outpatient facility that previously would have required hospitalization for airway observation, postoperative nursing care, and parenteral pain management. The improvement of tissue healing and scarring is due to a combination of decreased collateral tissue damage, less traumatic surgery, more precise control of the depth of tissue damage, and fewer myofibroblasts in laser wounds.

When lasers are used intraorally, wounds generally heal with minimal scar formation and soft, pliable residual tissue. Because of this improved healing (along with the hemostasis), intraoral wounds can often be left unsutured (another distinct advantage). Decreased postoperative pain is often noted with the use of lasers for surgery. The physiology of this effect is still unknown but probably relates to decreased tissue trauma and an alteration of neural transmission.

This aspect has enabled surgeons to perform many procedures on an outpatient basis, with patients returning to work within 1 day or even immediately in many 344 A Textbook of Advanced Oral and Maxillofacial Surgery cases. Hollow wave-guide technology and fiberoptics make the laser accessible to almost any area in the oral cavity, even those that would be difficult or impossible to reach with other therapeutical modalities.

Despite many advantages, there are disadvantages that must be carefully weighed before choosing the laser for patient treatment. As mentioned previously, healing from laser surgery is usually excellent, with decreased scarring and increased function; however, the speed of healing is usually prolonged when compared with  other types of wounds.

This healing delay is undoubtedly due to the sealing of blood vessels and lymphatics. Typical intraoral healing takes 2 to 3 weeks for wounds that would normally take 7 to 10 days, and this must be taken into account when considering suture removal (when used) and obtaining informed patient consent .

None of the lasers can treat all tissue conditions (due to different wavelengths), but a variety of lasers can be useful for various conditions. Different wavelength lasers are used for various indications by taking advantage of their physical properties.