laser on hard tissue
TRANSCRIPT
04/11/23 1
“Laser in
Orthopedic Surgery”(Part-4)
Interaction & effects of Laser (UV-IR) radiation on Biological Hard Tissues
and its application in Orthopedic Surgery.
“Laser in
Orthopedic Surgery”(Part-4)
Interaction & effects of Laser (UV-IR) radiation on Biological Hard Tissues
and its application in Orthopedic Surgery.
Presented by
Dr. Md Nazrul islam.Assistant Registrar, Orthopedic and Traumatology Dep't.Shaheed Suhrawardy Hospital, Sher-E-Bangla Nagor, Dhaka-1207. Bangladesh. [email protected].
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“ Progress in surgical medicine is often related to an improved technique of performing osteotomies, i.e.bone excisions.
Standard tools in orthopedics are saws, milling-machines and mechanical drills. All of them operate in contact mode and possibly induce severe mechanical vibrations and hemorrhage. It is thus straightforward to ask whether lasers might represent a considerable alternative in orthopedic surgery”.
• Markolf H. Niemz Laser-Tissue Interactions,Fundamentals and
Applications.
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Basics of Hard Tissue:
Hard tissueHard tissueBasics of Hard tissueBasics of Hard tissue
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Types of Hard Tissue:
Types of Hard Tissue:
• Compact bone or (Cortical bone): The hard outer layer of bones
is composed of compact bone tissue, This tissue gives bones their smooth, white, and solid appearance, and accounts for 80% of the total bone mass of an adult skeleton.
• cancellous (Trabecular bone): Filling the interior of the
organ is the trabecular bone tissue (an open cell porous network also called cancellous or spongy bone), Trabecular bone accounts for the remaining 20% of total bone mass but has nearly ten times the surface area of compact bone.
Tissue that has become mineralised, having a firm intercellular substance, e.g., cartilage and bone.
Basics of Hard tissue:Basics of Hard tissue:
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Mean composition of Human Bone:
Mean composition of Human Bone:
Matter Constituent Percentage• Anorganic Hydroxyapatite 0 – 60% Water 15 – 20% Carbonates 5% Phosphates 1%• Organic Collagen 20% Proteins 1–2%
Basics of Hard tissueBasics of Hard tissue
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Basics of Hard Tissue:
Basics of Hard Tissue:
Basics of Hard tissueBasics of Hard tissue
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Basics of Hard Tissue:Basics of
Hard Tissue:Basics of Hard tissueBasics of Hard tissue ::
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Radio Anatomy of Bone:
Radio Anatomy of Bone:Basics of Hard tissueBasics of Hard tissue
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•Laser: General View-
General General View-View-
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Types of laser act on
Hard Tissue:
Types of laser act on
Hard Tissue:
A. Cold Laser:
Cold Laser is the common term used for a Low Level Laser Therapy (LLLT) device. It is considered cold laser because it will not increase the thermal temperature of what it is contacting. Cold lasers deliver power from 1mW to 500mW.
A 100W Nd: YAG laser and A 100W Nd: YAG laser and optical fibre.optical fibre.
Laser:Laser: General View.General View.
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Types of laser act on Hard Tissue:
Types of laser act on Hard Tissue:
• B. Hard Laser. Most lasers used by medical professionals on the market are “HOT” lasers or high powered lasers. Hot lasers are lasers that have an output larger than one Watt (1000mW).
Laser:Laser: General View.General View.
..
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Types of laser act on Tissue:
Types of laser act on Tissue:
Laser:Laser: General View.General View.
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Laser theory:Laser theory:
• Biological field theory.
• Cellular oscillation theory.
• Bio luminescence theory.
Laser:Laser: General View.General View.
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Laser theory: Bio luminescence theory-
Laser theory: Bio luminescence theory-
• Bio luminescence theory - according to Russian researchers, DNA replication emits light at 630 nm. Since this is very close to the wavelength of the He Ne-laser light, it is postulated that laser may accelerate DNA replication via photic stimulation. Laser irradiation at this frequency is said to be non mutagenic since it is not in the range to alter the genetic program by affecting chromosomal ultra structure. The latter is more likely to occur at ultra-violet light irradiation at 300 to 400 nm.
Laser:Laser: General View.General View.
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Laser theory: Cellular oscillation
theory:
Laser theory: Cellular oscillation
theory: • Cellular oscillation theory - the laser beam carries electromagnetic oscillations of definite frequency. When it reaches the tissues the electromagnetic oscillations gradually "swing and excite" single cells. This is thought to eventually intensify the bionomical processes that ultimately regulate the performance of various vital organs. Soviet scientists go on to say that the cell itself begins to emit light similar to the rays of the laser, when the resonance sets in.
Laser:Laser:General View.General View.
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Laser theory:Biological field theory.
Laser theory:Biological field theory.
• Biological field theory - connections between tissues and organs in the intact organism are not limited to humeral effects and nervous control mechanisms alone. Rather, there exist unique around every cell, tissue and organ and higher structural levels (organism, organ) exerting a normalizing influence on lower levels (tissue cells). The resonance effect of the low power laser is thought to restore the normal energetic status of the organism, that is, restore its normal physiological state.
Laser:Laser:General View.General View.
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Tissue & Cellular Response:
Tissue & Cellular Response:
• Red light affects all cell:
absorbed by the mitochondria present in all cells
• Infrared light is more selective absorbed by specific proteins in the cell membrane & affects permeability directly.
Laser:Laser:HardHardTissueTissueView.View.
Laser:Laser:General View.General View.
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Tissue & Cellular Response:
Tissue & Cellular Response:
• Cytochromes (respiratory chain enzymes) within the mitochondria have been identified as the primary biostimulation chromophores (primary light-absorbing molecules).
• Cytochromes function to couple the release of energy from cellular metabolites to the formation of high energy phosphate bonds in adenosine triphosphate (ATP)
• Cytochromes also can absorb energy directly from illumination, it is possible that during LLLT light energy can be transferred to cell metabolism
via the synthesis of ATP.
Laser:Laser:General View.General View.
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Tissue & Cellular Response:
Tissue & Cellular Response:
• ATP is used to drive cell metabolism (maintain membrane potentials, synthesize proteins & power cell motility & replication).
• Since enzymes are catalysts with the capability of processing thousands of substrate molecules, they provide amplification of initiation of a biological response with light.
Laser:Laser:General View.General View.
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The Physiological Effects of Low Level Laser
Therapy:
The Physiological Effects of Low Level Laser
Therapy:• Improved blood circulation & vasodilation.-
Increases blood supply.• Increase collagen production:
– Develops collagen & muscle tissue
• Increase macrophage activity:– Stimulates immune system
• Alter nerve conduction velocity:– Stimulates nerve function.
• Increases ATP production• Biostimulation – Improved metabolism, increase of cell
metabolism- Increases speed, quality & tensile strength of tissue repair.
• Analgesic effect- Relieves acute/chronic pain.
• Anti-inflammatory & anti-edematous effects- Reduces inflammation.
• Stimulation of wound healing:– Promotes faster wound healing/clot formation– Helps generate new & healthy cells & tissue.
Laser:Laser:General View.General View.
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Laser:Short Term Effects-
Laser:Short Term Effects-
• * Production and release of beta-endorphins (these are morphine like substances produced by various cells in the body that inhibit the sensation of pain).
• * Cortisol production is increased (cortisol is the precursor of cortisone). This enables
the body to combat the stress associated with trauma or the disease process.
• * The short-term effect is significant in 5-10% of cases during or after the conclusion of the initial treatment, but is not as important as the long term or cumulative effect.
Laser:Laser:General View.General View.
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Laser:Long Term
Or Cumulative Effect-
Laser:Long Term
Or Cumulative Effect-
• * ATP (adenosine triphosphate) production is increased resulting in improved cellular Metabolism.
• * DNA (deoxyribonucleicacid) production; protein building block of tissue is substantially increased.
• * Neurotransmission is facilitated due to
elevated levels of serotonin and aceytylecholine.
• * Mitochondrial activity is stimulated resulting in cell replication etc. (i.e. replacement, regeneration and repair of abnormal cells).
• * Modulation of macrophages, fibroblasts and other cells .
• * Angiogenesis (formation of new blood vessels). • * Regulates cell membrane potential, essential
in Na, Cl and K ion transfer (electrolyte balance). • * Cytokines and other chemicals enhancing
cellular communications are released.
Laser:Laser:General View.General View.
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Laser:Other Effects:
Laser:Other Effects:
• * The immune response is stimulated.
• * Lymphatic drainage is improved.• * The histamine response is
positively altered.• * Production of growth hormone is
increased. • * The body’s natural healing
processes are enhanced.
Laser:Laser:General View.General View.
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Advantages of lasersurgery vs.
traditional surgery-
Advantages of lasersurgery vs.
traditional surgery-
1. Unique capabilities.2. No-touch technique.3. Dry surgical field.4. Reduced blood loss.5. Reduced edema.6. Limited fibrosis/stenosis.7. Potential reduction in spread
of metastasis.8. Fewer instrument in the
field.9. Sterilization of the impact
site.10. Reduced postoperative pain.11. Precision.
Laser:Laser:General View.General View.
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Advantages of laser surgery vs. traditional surgery-
Advantages of laser surgery vs. traditional surgery-
• Most laser surgeries can be performed on an outpatient basis.
• Very small / precise incision.
• No damage to surrounding areas.
• Less bleeding /"bloodless surgery," , and less swelling.
• Less time consuming procedure.
• Lower rate of local infections.
• Reduce post-operative pain.
• Reduce post operative recovery period.
Laser:Laser:General View.General View.
• * Non-invasive• * Non-toxic• * Easily applied• * Highly effective• * Cure rate > 95%• * No known negative side effects.
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Disadvantages of laser surgery vs. traditional
surgery?
Disadvantages of laser surgery vs. traditional
surgery?• Cost.• Eye hazards.• Imprecisely aimed lasers can burn or destroy healthy tissue.
• Needs special training/ arrangement.
• Cardiopulmonary resuscitation (CPR) arrangement is recommended to avoid/ manage electrical incidence.
Laser:Laser:General View.General View.
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CONTRAINDICATIONS:CONTRAINDICATIONS:• 1. Pregnancy. • 2. Patients with cancer. • 3. Patients with pacemakers. • 4. Directly looking into the light.5. Growth plates in children10.
• 6. Over cardiac region & Vagus nerve.
• 7. Over & around thyroid gland & endocrine glands.
• 8 .Patients who have been pre-treated with one or more photo- sensitizers.
• 9. Organ transplantation: There is a possibility that the laser's positive effects on immune systems could compromise the immune suppression, which is critical to successful transplantation.
Laser:Laser:General View.General View.
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Important parameters of laser of medical
interest:
Important parameters of laser of medical
interest:
Laser:Laser:General View.General View.
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Important parameters of laser
of medical interest:
Important parameters of laser
of medical interest:
• Ultraviolet: 100–400 nm • Visible Light: 400–700 nm • Near infrared: 700–2500 nm • Mid infrared: 2500 - 25000 nm
• Far infrared: 25–1000 µm
Laser:Laser:General View.General View.
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Important parameters
of laser of medical interest:
Important parameters
of laser of medical interest:
Laser:Laser:General View.General View.
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Different types of laser used in medical application:
Different types of laser used in medical application:
Laser:Laser:General View.General View.
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InteractionInteraction Laser interaction with Hard Tissue:
Laser interaction Laser interaction with Hard Tissue:with Hard Tissue:
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Laser and Hard tissue interaction:
Laser and Hard tissue interaction:
Laser Laser interaction interaction WithWithHard Tissue:Hard Tissue:
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Interaction of laser with Hard Tissue:
Interaction of laser with Hard Tissue:
Laser Laser interaction interaction WithWithHard Tissue:Hard Tissue:
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Laser-tissue interactions:Laser-tissue interactions:
Laser Laser interaction interaction WithWithHard Tissue:Hard Tissue:
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Laser-tissue interactions:Laser-tissue interactions:
Laser Laser interaction interaction WithWithHard Tissue:Hard Tissue:
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Interaction of laser with Hard Tissue:
Interaction of laser with Hard Tissue:
Laser Laser interaction interaction WithWithHard Tissue:Hard Tissue:
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Interaction of laser with Hard Tissue:Interaction of laser with Hard Tissue:
Laser interaction Laser interaction with Hard Tissue:with Hard Tissue:
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Interaction of laser with biologic tissues:
Interaction of laser with biologic tissues:
• Scattering• Penetration• Absorption
Electromagnetic radiation in the UV-IR spectral range propagates into biologic tissues until it is either scattered or absorbed.
Laser :Laser :InteractionInteraction with with Hard Tissue:Hard Tissue:
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Interaction of laser with biologic tissues:
Interaction of laser with biologic tissues:
Laser :Laser :interaction interaction with with Hard Tissue:Hard Tissue:
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Absorption of laser into biologic tissue-Absorption of laser into biologic tissue-
• Laser absorption in biological tissues
( In IR-UV region of medical interest) predominantly depends on wavelength.
• The absorption of laser is highest in water molecule.
• Protein, Pigments and Melanin has different absorption coefficient depending their molecular structure.
Laser :Laser :interaction interaction with with Hard Tissue:Hard Tissue:
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Mode of action of Laser on Hard Tissue:
Mode of Action:Mode of Action:
Mode of actionMode of actionof Laser on Hard Tissue:of Laser on Hard Tissue:
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Mode of action(Interaction) of laser with
Hard Tissue:
Mode of action(Interaction) of laser with
Hard Tissue:a. Photochemical/ Photo-
biological Bio-stimulation, anti-inflammatory, Analgesic effects.
b. Thermal effects of laser- Incision, Coagulation.
c. Mechanical effects- Tattoo removal.
d. Photo-ablative effects- Percutaneous discectomy.
Mode Mode of actionof actionof Laser with of Laser with Hard Tissue:Hard Tissue:
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Photomedicine:Photochemical
Effects-
Photomedicine:Photochemical
Effects-Laser light increases cell permeabilityLight is absorbed by mitochondria Leading to increased ATP production.Cascade of metabolic effects causes a number of physiological Improvement in Macrophage response and validity - Immune system boost/repair and increases in cellular proliferation.
Mode Mode of actionof actionof Laser with of Laser with Hard Tissue:Hard Tissue:
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Laser Effects: Photochemical/
Photobiological-
Laser Effects: Photochemical/
Photobiological-
• Anti-inflammatory effects of Laser.
• Analgesic effects of Laser.• Tissue healing/ regenerative effects of Laser.
• Biomodulative/ Biostimulative effects of Laser.
• Osseointegration effects of Laser on biomedical implant.
Mode Mode of actionof actionof Laser with of Laser with Hard Tissue:Hard Tissue:
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Schematic diagram of tissue healing
by laser:
Schematic diagram of tissue healing
by laser:
Mode Mode of actionof actionof Laser with of Laser with Hard Tissue:Hard Tissue:
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Laser:Biostimulative
effects.
Laser:Biostimulative
effects.Biostimulation is believed to occur at very low irradiances and to belong to the group of photochemical interactions.Wound healing and anti-inflammatory properties by red or near infrared lightTypical energy fluences lie in the range 1–10 J/cm2.
Mode Mode of actionof actionof Laser with of Laser with Hard Tissue:Hard Tissue:
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Laser:Reduces Healing Time
by-
Laser:Reduces Healing Time
by-
• Enhanced leukocyte infiltration.
• Increased macrophage activity.
• Increased neovascularization.
• Increased fibroblast proliferation.
• Keratinocyte proliferation.• Early epithelialization.• Growth factor increases.• Enhanced cell proliferation and differentiation.
• Greater healed wound tensile strength.
Mode Mode of actionof actionof Laser with of Laser with Hard Tissue:Hard Tissue:
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Laser:Thermal effects-
Laser:Thermal effects-
Mode Mode of actionof actionof Laser with of Laser with Hard Tissue:Hard Tissue:
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Laser:Thermal effects-
Laser:Thermal effects-
Mode Mode of actionof actionof Laser with of Laser with Hard Tissue:Hard Tissue:
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Laser:Thermal effects-
Laser:Thermal effects-
Temperature Biological effect• 37◦C Normal• 45◦C Hyperthermia• 50◦C Reduction in enzyme
activity, cell immobility• 60◦C Denaturation of proteins
and, collagen,coagulation• 80◦C Permeabilization of
membranes• 100◦C Vaporization thermal
decomposition (ablation)• > 100◦C Carbonization• > 300◦C Melting.
Mode Mode of actionof actionof Laser with of Laser with Hard Tissue:Hard Tissue:
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Summary of Thermal
Interaction:
Summary of Thermal
Interaction:• Main idea: achieving a certain temperature which leads to the desired thermal effect
• Observations: either coagulation, vaporization,carbonization or melting
• Special applications: coagulation, vaporization, melting,thermal decomposition,treatment of retinal detachment,laser-induced interstitial thermotherapy.
Mode Mode of actionof actionof Laser with of Laser with Hard Tissue:Hard Tissue:::
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Summary of Thermal
Interaction:
Summary of Thermal
Interaction:
• Typical lasers: CO2, Nd:YAG, Er:YAG, Ho:YAG, argon ion and diode lasers
• Typical pulse durations: 1 μs . . . 1min
• Typical power densities: 10 . . . 106 W/cm2.
Mode Mode of actionof actionof Laser with of Laser with Hard Tissue:Hard Tissue:::
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Application of laser on Hard Tissue: Thermal effects-
Application of laser on Hard Tissue: Thermal effects-
a. incision.b. Cutting of Hard Tissue
(Osteotomy).c. Cauterization.d. Bone Coagulation.e. Tissue Vaporization.f. Angiomas, known as port-
wine stains
g. Cutaneous condylomas.
Mode Mode of actionof actionof Laser with of Laser with Hard Tissue:Hard Tissue:
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Mode of action of laser act on Hard
Tissue: Mechanical effects-
Mode of action of laser act on Hard
Tissue: Mechanical effects-
• Nd:YAG lasers, a very high intensity of luminous flux over a small area (between 1010 and 1012 W/cm2) ionizes atoms and creates a plasma.
• At the boundary of the ionized region, there is a very high pressure gradient which causes the propagation of a shock wave. It is the expansion of this shock wave which causes the destructive effect.
Mode Mode of actionof actionof Laser with of Laser with Hard Tissue:Hard Tissue:
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Application:Mechanical effects of laser on Hard Tissue:
Application:Mechanical effects of laser on Hard Tissue:
Mode Mode of actionof actionof Laser with of Laser with Hard Tissue:Hard Tissue:
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Laser ablationLaser ablation
Laser
Micro
Nano
Ablation
Cutting
Dissection
Surgery
Scissors
Laser:Laser: Mode action on Mode action on Hard on Tissue:Hard on Tissue:
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Principles of photoablation:Principles of photoablation:
• Absorption of high-energy UV photons
• ⇓• Promotion to repulsive excited states
• ⇓• Dissociation• ⇓• Ejection of fragments (no necrosis)
• ⇓• Ablation.
Mode Mode of actionof actionof Laser with of Laser with Hard Tissue:Hard Tissue:
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Summary of Photoablation:Summary of
Photoablation:• Main idea: direct breaking of molecular bonds by highenergy UV photons
• Observations: very clean ablation, associated with audible report and visible fluorescence
• Typical lasers: excimer lasers, e.g. ArF, KrF, XeCl, XeF
• Typical pulse durations: 10 . . 100 ns
• Typical power densities:107 .1010 W/cm2
• Special applications: Prolapsed Disc decompression, refractive corneal surgery.
Mode Mode of actionof actionof Laser with of Laser with Hard Tissue:Hard Tissue:
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Ablation curves of fresh and dried bone obtained with a
CO2 laser.
Ablation curves of fresh and dried bone obtained with a
CO2 laser.
Ablation curves of fresh and dried bone obtained with a CO2 laser (pulse duration: 250 μs, wavelength: 10.6 μm). Due to its higher water content, freshbone is ablated more efficiently. Data according to Forrer et al. (1993).
Mode Mode of actionof actionof Laser with of Laser with Hard Tissue:Hard Tissue:
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Ablation curve of fresh bone obtained with an
Er:YAG laser-
Ablation curve of fresh bone obtained with an
Er:YAG laser-
(b) Ablation curve of bone obtained with an Er:YAG laser (pulse duration: 180 μs, wavelength:2.94 μm). Data according to Scholz and Grothves-Spork (1992).
Mode Mode of actionof actionof Laser with of Laser with Hard Tissue:Hard Tissue:
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Application: Photoablative
Effects-
Application: Photoablative
Effects-
a. Bone Tumor excision- Benign – bony exoxtosis/
osteoid osteoma. Malignant, no operation
induced metastasis.b. Bony tissue Biopsy.c. Herniated disc removal/ laser
decompression.d. Arthroscopy-meniscectomy.
Mode Mode of actionof actionof Laser with of Laser with Hard Tissue:Hard Tissue:
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Application
Application
Orthopedic Application of Laser.
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Modalities of Hard Tissue management:
Modalities of Hard Tissue management:
• Conservative management. General conservative procedure.
Laser conservative management.
• Surgical management. General operative management.
Laser operative management.
Orthopedic Orthopedic Application of Laser.Application of Laser.
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Orthopedic Application of
Laser:Nonoperative-
Orthopedic Application of
Laser:Nonoperative-
• Pain management.• Fractures: enhancement of union.• Burn healing• Wound care.• Healing Heel fissures.• Verrucae mnagement. • Plantar fascitis
mnagement.• Fungal nail correction. • Arthoscopy(all types)o
OrthopedicOrthopedic Application of Laser.Application of Laser.
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Orthopedic Application of
Laser:Nonoperative-
Orthopedic Application of
Laser:Nonoperative-
• Neurogenic Pain• Herpes Zoster (Shingles)
• Fibromyalgia • Post Traumatic Injury
• Diabetic Neuropathy • Trigeminal Neuralgia • Radiculitis • Sciatica • Management of gout.
OrthopedicOrthopedicApplication of Laser.Application of Laser.
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Orthopedic Application of
Laser:Non-operative
Orthopedic Application of
Laser:Non-operative
Acute & Chronic Joint Problems:– Osteoarthritis – Rheumatoid Arthritis – Ligament & Tendon
injuries – Chondromalacail
Patella.
Pain management-
Orthopedic Orthopedic Application of Laser.Application of Laser.
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Orthopedic Application of
Laser: Nonoperative:
Orthopedic Application of
Laser: Nonoperative: Chronic Back & Neck
Pain Reduction of Inflammation:
• Metatarsalgia • Trigeminal
Neuralgia • Brachial Neuralgia • Plantar Fascia • Frozen Shoulder • Carpal Tunnel
Pain management-
Orthopedic Orthopedic Application of Laser.Application of Laser.
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Orthopedic Application of
Laser: Nonoperative-
Orthopedic Application of
Laser: Nonoperative-
Researchers at Massachusetts General Hospital are developing a method to heal surgical incisions with laser light. Surgeons Ying Wang and Min Yao position a metal frame that directs a green surgical laser over the incision. The frame keeps the instrument steady and at a measured distance from the skin. They shine the light onto the cut to activate the dye, leaving it on for three minutes.Credit: Porter Gifford
Orthopedic Orthopedic Application of Laser.Application of Laser.
Laser healing:
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Open /Unhealthy wounds
o Pressure/Bed Sores o Post Surgical Healing o Burns.
Orthopedic Application of Laser: Nonoperative-
Orthopedic Orthopedic Application of Laser.Application of Laser.
WoundWoundManagementManagement
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Orthopedic Application of Laser:
Nonoperative:
Orthopedic Application of Laser:
Nonoperative:WoundWoundManagement: Management: Partial tear of Tendoachilis Partial tear of Tendoachilis (Approximately 50 percent)(Approximately 50 percent)
Orthopedic Orthopedic Application of Laser.Application of Laser.
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Orthopedic Application of Laser:
Nonoperative-
Orthopedic Application of Laser:
Nonoperative-
Laser application in burn is very promising and effective, It subsides burn pain, inflammation and promotes faster tissue healing without any scar.
Orthopedic Orthopedic Application of Laser.Application of Laser.
Burn Management:
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Orthopedic Application of
Laser: Operative General-
Orthopedic Application of
Laser: Operative General-
• Scar excision.• Excision of cysts, corns,
Callus.• Excision of Neuroma.• Excision of Heel Spurs.• Subungual heamotoma
management.• Heamangioma management. • Matrixectomy.• Removal of tattoo.
Orthopedic Orthopedic Application of Laser.Application of Laser.
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Orthopedic Application of
Laser: Operative-
Orthopedic Application of
Laser: Operative-
Limbs- Endoscopic nerve compression release- (carpal tunnel relese).
o PMMA vaporization(joint revisions).
o Enhancement of bone union/Regeneration.
Orthopedic Orthopedic Application of Laser.Application of Laser.
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Orthopedic Orthopedic Application of LaserApplication of Laser.. Orthopedic Orthopedic
Application of Laser:Application of Laser: Spine-Spine-
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Orthopedic Application of
Laser: Operative-
Spine-
Orthopedic Application of
Laser: Operative-
Spine-• Herniated Disc • Bulging Disc • Degenerative Disc
Disease • Arthritis of the Spine • Spinal Stenosis • Sciatica • Bone Spurs • Pinched Nerve • Scar Tissue • Foraminal Stenosis
Orthopedic Orthopedic Application of Laser.Application of Laser.
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Orthopedic Application of Laser:
Operative-
Orthopedic Application of Laser:
Operative-
Spine-
a.Cervical (Neck) Surgery: Cervical Endoscopic Discectomy (CED)
Anterior Cervical Discectomy (ACD) Anterior Cervical Fusion (ACF).
b.Lumbar (Back) Surgery Procedures: Lumbar Endoscopic Discectomy(LED/TA)
Disc prolapse/Disc degeneration- Percutaneous L. Disc Decompression.
Interspinous Process Decompression (X-STOP)
Micro discectomy (MD)Thermal Annuloplasty(TA).
Orthopedic Orthopedic Application of Laser.Application of Laser.
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See you next day with-
“Laser in Orthopedic Surgery”(Part-5)
“Double blind noninvasive application of Laser to Enhance Bone Union”.
Thankseveryone for patience,Bye.