Could the super-pulsed CO2 laser be used for oral excisional biopsies?

Abstract

Background. The main purpose of a biopsy is microscopic examination and diagnosis. Keeping the margins of specimens safe and readable is always fundamental to detecting marginal infiltrations or malignant transformation. Numerous options and tools have been introduced for biopsy procedures. Lasers are one of these options that provide many enhancements to clinical and surgical biopsy procedures in comparison to scalpels.Objectives. The aim of the present study is to quantify the thermal artefacts in histological specimens obtained using a CO 2 laser from different oral mucosal lesions and to evaluate if the resulting thermal effect hinders the histological examination. This aim is accomplished through quantitatively and qualitatively assessing the thermal effect in both the epithelium and connective tissue. Material and methods.A super-pulsed CO 2 laser (10,600 nm) was used to obtain 10 excision biopsy samples. The parameters were a power of 4.2 W in focused mode and a frequency of 80 Hz in super-pulse mode. The histological analysis was performed with an optical microscope. Computerized imaging software was utilized to quantitatively evaluate the thermal effect in both the epithelium and connective tissue expressed in microns. Results.The thermal effect of the CO 2 laser was limited to the surgical resection margins in all the specimens and did not hinder the histological analysis. Thermal artefacts were observed in 3 specimens. The range of thermal effects in the epithelial tissue was between 184 μm and 2,292 μm, while in the connective tissue it was between 133 μm and 2,958 μm. Conclusions.The resulting thermal effects of using a CO 2 laser did not hamper the histological evaluation. Utilizing a laser in biopsy procedures should be tailored. Not only should laser parameters and safety margins be taken into consideration but also the working time, clinical accessibility, and the nature and water content of the tissue.

Histological Effects of an Innovative 445 Nm Blue Laser During Oral Soft Tissue Biopsy

“…Compared to the CO 2 laser, the blue diode laser showed both lower epithelial and connective tissue average thermal effects [38].…”

<i>In vivo</i> clinical and histological thermal effect of a 445 nm diode laser on oral soft tissues during a biopsy

“…The device tested here also appears to be safer than a 10,600 nm superpulsed CO 2 laser, when evaluated "in vivo", at 4.2 W in pulsed wave (PW) [8]. The higher tissue alteration caused by the CO 2 laser is a result of the greater power needed to achieve beam cutting action, especially for vascularized tissues, as the wavelength of the CO 2 laser has water as a target.…”

Evaluation of the Effectiveness of the Carbon Dioxide (CO2) Laser in Minor Oral Surgery: A Systematic Review

“…53 Tenore et al found the thermal effect of the CO2 laser was visible in all specimens and stronger in attached gingiva than in other anatomical locations. 30 Another study found that when the excision of essentially normal marginal mucosa encircling the tumor is reduced, the recurrence of Oral Squamous Papillomas is markedly increased. 31 In a study, CO2 and Er,Cr:YSSG lasers improved the quality of scars after 4 weeks, had superior cosmetic results, and did not need a second treatment session compared to diode and Nd:YAG laser groups.…”