Roman Smucler1,2,3, Zdeněk Ott,2
1Medical Faculty Plzen, Charles University, Plzen, Czech Republic
2Asklepion- Laser Centre Prague, Prague, Czech Republic
3Institute of Clinical and Experimental Dentistry, 1st Faculty of Medicine Charles University Prague, Czech Republic
Backgrounds and Objectives: Vascular malformations in head and neck region remains challenging pathology with significant morbidity. They are many treatment options but without single really effective modality. Laser coagulation with fiber inserted directly into tumor is one of them. But without navigation it seems to be adventurous surgery in complicated anatomy of face and it is very difficult to replicate. Some authors promote MRI or CT as perfect tools for planning and control but protocols are complicated not speaking about economy. Ultrasound with modern guiding seems to be more accessible for daily praxis. Majority of papers are written about Nd:YAG laser which we see as potentially dangerous because of large zone of irreversible thermal damage. Modern 1470 nm diode laser seems to be more precise, safe and technologically simple. Aim of this work is to validate effectiveness of this tool in one-year study.
Study Design/Materials and Method: 30 verified vascular malformations . We provided intravascular application of 1470 nm laser light into tumor under control of ultrasound in whole volume with power ranging from 5-10 W. Total dose was 750-2800 J according to tumor size. Patients were monitored every month; in case of recidive we indicated additional treatment. Blinded, independent evaluator, ultrasound controls.
Results: All tumors were eliminated or smaller under 25% of original size; with perfect control from sensitive anatomical structures (bone, nerves) in average 2,1 sessions. Complete tumor removal was achieved in only 21 cases after 3 treatments (70%).
Conclusion: Ultrasound guided intralesional coagulation of vascular malformations seems to be at least one of most effective methods with low level of complications, acceptable economy and little side-effects. Complete elimination of tumor is difficult to promise, because of coagulation near to sensitive structures like n. facialis, bones or facial muscles. Control of tumor, which is leading to stabilization of disease, is nearly guaranteed.