Estetska in laserska kirurgija obraza
Estetska kirurgija je veja kirurgije, ki se ukvarja izključno z izboljšanjem pacientovega videza. V veliki večini gre za posege, ki se izvajajo na mehkih tkivih, čeprav sodijo sem tudi posegi, kjer se preoblikuje skelet, npr. preoblikovanje brade ali nosu (genioplastika in rinoplastika). Velik delež estetskih posegov se izvaja ambulantno, v lokalni anesteziji.
Injiciranje botulina za odpravo gub
Z injiciranjem botulina v določene skupine mimičnih mišic le-te za več mesecev oslabimo, posledica pa je, da določenih področij obraza ne moremo gubati in ostanejo gladki. Zelo pomembno je vedeti, kam in koliko bomo injicirali, da ne pride do nezaželenih stranskih učinkov (nenaraven, "zamrznjen" izgled, asimetrično gubanje, nezmožnost odpiranja očesa...). Učinek tipično traja 4 - 6 mesecev.
Injiciranje začasnih polnil (hialuronska kislina)
Z injiciranjem polnil zapolnimo oziroma odebelimo predele podkožnih mehkih tkiv, ki so upadli oz. atrofični. Tudi tu je zelo pomembno, da ne injiciramo preveč, saj je učinek lahko naravnost grotesken (dobro znana račja usta). S pravilno uporabo majhnih odmerkov polnila na pravihmestih pa obraz zapolnimo in tako pomladimo. Uporabljamo izključno začasna polnila, saj se trajna niso izkazala za varna - lahko namreč povzročajo vnetne reakcije tujkovega tipa. Injiciranja je treba ponavljati na 4 - 6 mesecev.
Kirurgija povešenih vek (zgornja blefaroplastika)
Zgornje veke se z leti povesijo in zmehčajo. Koža se naguba in visi navzdol, kar je estetsko moteče, včasih pa tudi ovira pri vidu. Z enostavnim posegom v lokalni anesteziji se odvečno kožo odstrani, rez pa se postavi v kožni pregib zgornje veke, da se brazgotine ne poznajo. Po operaciji je priporočeno hlajenje.
Laserska odstranitev motečih znamenj in starostnih peg
Starostne pege (senilna keratoza) in druge nenevarne spremembe je najlažje in najelegantneje odstraniti z laserjem. Učinek je podoben, kot če bi jih odbrusil z brusilnim papirjem. Ostane področje plitkih, drobnih ranic, ki ne zahtevajo šivanja in po zacelitvi ne puščajo brazgotin.
Znamenja, ki bi lahko bila nevarna, pa se izreže (ekscidira) in pošlje na histološki pregled, ranico pa zašije.
Laserska odstranitev hemangiomov in žilnih sprememb
Tovrstne spremembe, tako velike kot majhne, je najbolje odstraniti s posebnim žilnim laserjem. Najprej je treba izključiti morebitno arterijsko napajanje (kar je sicer redko), v tem primeru je najprej potrebno zapreti dovodno arterijo. Nizkopretočne lezije (velika večina) pa globinsko zakoaguliramo z laserjem. Po obdobju celjenja, ki traja 3 – 4 tedne, je estetski rezultat večinoma odličen.
Genioplastika - preoblikovanje brade
Genioplastika sodi v sklop kirurgije obraznih kosti. Izgled in velikost brade sta zelo pomembna dejavnika obrazne estetike in zato genioplastiko uvrščamo med estetske posege. Ta je lahko avgmentacijska, ko skušamo brado poudariti, ali pa redukcijska, ko skušamo brado zmanjšati, redkeje pa simetrizacijska, ko želimo brado postaviti v bolj sredinski položaj. Do kostnine brade lahko pristopimo skozi usta ali pa preko kože pod brado. Poseg naredimo v splošni anesteziji.
Strokovna literatura
Treatment of vascular lesions in the head and neck using Nd:YAG laser
Vascular lesions, including both haemangiomas and vascular malformations, are common pathological entities. More than 50% of these benign lesions are located in the head and neck region. The International Society for the Study of Vascular Anomalies adopted the classification of Mulliken and Glowacki (1982) for vascular lesions in 1996. This classification divides vascular lesions into tumours (haemangiomas, others) and malformations (capillary, venous, arteriovenous, lymphatic, combined).
Haemangiomas tend to develop after birth, and grow during the first year of life, and then slowly involute. They have a characteristic endothelial structure. More than 50% involute completely by theageof4or5years (Mulliken and Glowacki, 1982; Shapshay et al., 1987). That is why physicians tend to adopt a wait and see policy in the first years of life, rather than treating haemangiomas surgically. However, the process of involution is often accompanied by more or less visible scarring, especially in the facial region. Vascular malformations, on the other hand, are usually noted at birth, grow in concert with body growth and do not tend to regress (Mulliken and Glowacki, 1982). For the sake of simplicity, this paper refers to both (haemangiomas as well as vascular malformations) as vascular lesions. The distinction is only made when describing specific cases.
Many different modalities for treatment of vascular lesions have been used so far: surgery, embolisation, steroid therapy, cryosurgery, electrodessication, etc. (Shapshay et al., 1987) In the past decade, therapy with the neodymium:yttrium–aluminum–garnet (Nd:YAG) laser has emerged as new alternative. The laser’s beam is poorly absorbed in water and selectively absorbed by haemoglobin. Due to its poor absorption in water, the laser penetrates deeply into the tissue, down to a depth of 4 – 5 mm. As it passes through tissues, the laser beam emits heat and thus coagulates tissue down to the depth of about 7–10 mm, a process called photocoagulation. Its selective absorption by haemoglobin causes selective photocoagulation within blood vessels. The Nd:YAG laser beam can be delivered by a flexible optic fibre, which makes it very easy to handle. These properties are excellent for treating vascular lesions (Shapshay et al., 1987; Burkey and Garrett, 1996; Bradley, 1997; Werner et al., 1998).
In this study, a series of patients with vascular lesions (n 1⁄4 111) were treated with the Nd:YAG laser, and the results are presented.
Preberi celoten članek
Treatment of leukoplakias and vascular malformations of the oral cavity using laser
Both, leukoplakia and vascular malformations are common entities in oral pathology and there is still much debate about the appropriate treatment protocol. We have been successfully using Er - Yag laser for the treatment of leukoplakias and Nd - Yag laser for the treatment of vascular malformations over the last five years.
Leukoplakia is a clinical term used to describe a white plaque on the oral mucosa. It is certainly one of the most semantically abused terms in medical literature (1). WHO has given a definition of leukoplakia and later there have been several attempts to classify precancerous lesions more accurately (2, 3) . WHO later in 1983 suggested that the term should not be used in cases where etiology of white patches is known except in cases of tobacco use. The evidence for a relation between tobacco smoking and leukoplakia is quite strong but smokeless tobacco keratosis seems to be a different entity and carries a much smaller risk of malignant transformation than leukoplakia (4, 5).
Several other conditions as lichen planus, chronic cheek bite, frictional keratosis, tobacco pouch keratosis, nicotine palatinus, leukoedema, white sponge nevus, etc. also present as white plaques and must be ruled out before the term leukoplakia can be given. Histopathologic assessment of leukoplakia reveals hyperparakeratosis, which is variably associated with an underlying epithelial hyperplasia and / or dysplasia. Numerous follow-up studies gave different rates of malignant transformation, ranging from 3 - 20 % (6). Leukoplakias without underlying dysplastic changes are rarely associated with progression to malignancy - less than 5 % probability of malignant changes (7, 8). Some clinical features can be strong predictors of future risk (multiplicity, longer duration, irregularity, nodularity). Erythroleukoplakia or erythroplakia can be associated with carcinoma in situ or frank malignancy in nearly 40 % of lesions (9, 10, 11) Proliferative verrucous leukoplakia, as a distinct clinical form also has a higher potential to develop into verrucous carcinoma or well - differentiated squamous cell carcinoma (12). Because the rate of malignant transformation of leukoplakias is quite unpredictable and relatively low, some still argue that leukoplakia per se needs any treatment and suggest a good follow - up protocol. Also, it has been suggested that the term precancerous lesion should be replaced by the term potentially malignant lesion (1). On the other hand the incidence of oral cancer over the past years has been increasing and the majority of patients present with advanced stage of disease. It is important for the clinician to recognize changes of the oral mucosa and to perform a thorough oral examination regularly. Most oral carcinomas probably arise without any recognizable premalignant lesions (on the other hand, patients with oral cancers usually have one or more coexisting areas of leukoplakias adjacent to the cancer) but knowledge of such lesions can help clinicians to make the diagnosis of oral cancer early and could help patients to become aware of oral mucosa changes and nevertheless about treatment options.
Preberi celoten članek
