| Objective: Two parts that animal experiments and clinical cases will be used to compare the Er: YAG(Erbium: Yttrium-Aluminum-Garnet)laser with the traditional scalpel in the soft tissue incisions.The comparison will show characteristics of Er: YAG laser and the traditional scalpel in oral soft tissue surgery,which will be a reference for Er: YAG laser use in clinical application.Part I Comparative study on the process of Er:YAG laser and traditional scalpel healing in the rat palate incisionMaterials and Methods:1.Object of study: 50 healthy male SD rats were selected.The rats were randomly divided according to the random number to A,B groups,each 25.2.Surgical design and methods: In A group a 10 mm linear incision was made by scapel which was at a distance of 15 mm from front tooth parallel to the palatal midline.The incision line was on the left side of the midline palate.The distance of palatal midline was about 3mm and the depth to the bone surface.Er:YAG laser do the same way on the right side of the midline palate.In Group B,the scalpel and Er: YAG laser cutting position were swapt.Er: YAG laser incision was on the left of midline,at the same time the scalpel incision on the right.Rats with no postoperative suture.All the rats were no postoperative suture.3.Analysis: after 1 day,3 days,7 days,30 days the incision were sampled.1/2 front portion of each rat incision was fixed with paraformaldehyde,hematoxylin-eosin(HE)staining.then the amount of inflammatory cells kinds and infiltration were observed under the light microscope.1/2 rear the incision the expression of IL-1β,TGF-β1 was assaied by enzyme-linked immunosorbent assay.Each time point in the midline palate rat 10 mm distance of front tooth,3mm diameter hard palate tissue was taken as control.4.Statistical analysis: Spss17.0 was used to analyze data.The results were expressed as mean ± standard deviation(`x ± s),said multiple samples were compared using ANOVA,t-test was used to compare between groups.p <0.05 was considered statistically significant.Result:1.General performance: the immediate postoperative incision compared to the laser group was significantly bleeding.After 1 days of the two groups were compared with the depression,knife wound swelling,laser wound covering the surface of white pseudomembrane.30 days after operation,the wound healed completely,no obvious difference were found between the two groups.2.Morphological features: the loose and edema of dermal fibrous tissue was obvious under the scalpel incision.The infiltration of neutrophils and lymphocytes in the stroma of the scalpel incision was more than that of the laser group.After the operation,the skin and fibrous tissue of the laser group were obviously necrotic.30 days after the operation,the small blood vessels in the dermis and the interstitial tissue of laser group were obviously.3.The content changes of TGF-β1 at each time point : 1 day,3 days after operation TGF-β1 content of two group compared to the laser group were significantly increased(P <0.05).7 days after operation,the TGF-β1 content of two groups were decreased.TGF-β1 of control group was significantly increased(P <0.05).4.The content changes of IL-1β at each time point: 1 day,3 days,7 days after the incision the traditional scalpel amount of IL-1β expression was significantly higher than that of laser group(P < 0.05).Postoperative day 1 laser incision IL-1 expression and control groups had no significant difference(P > 0.05).3 days after operation,the expression of IL-1β laser incision was increased and the expression was significantly higher than that in control group(P < 0.05),but lower than the scalpel group(P <0.05).7 days after operation,two group expression of IL-1βhad no significant difference(P> 0.05),but the two groups were significantly higher than that of the control group(P <0.05).Conclusion:1.Er:YAG laser compared to traditional scalpel is more conducive to reducing the release of TGF-β in the incision,preventting excessive collagen deposition,reducing the generation of scar tissue.2.Er:YAG laser compared to traditional scalpel the expression of IL-1β less and slow.The incision of Er: YAG laser have smaller inflammation reaction and relatively faster healing.Part II A comparative study of Er:YAG laser and traditional scalpel in lingual frenectomy.Materials and Methods:1.Selection of cases: 28 patients(16 female,12 male)with tongue-mobility complaints who presented to the Oral-Maxillofacial Surgery of Yantai stomatological hospital participated in this study.Patients were randomly assigned to the laser treatment group(15)or traditional scalpel group(13)for treatment.2.Surgical design and methods: All patients were adopted epinephrine units of Articaine1.0ml local anesthesia.Different types of surgical procedures for different type Lingual frenulum.Er: YAG laser surgery were sutured.Scalpel group were given 4-0 absorbable suture postoperatively.3.Analysis methods:(1)Analysis of postoperative pain:Patients were followed up at day 3,7,and 30 after operation.The patient were provided with the degree of visual analogue pain scale(VAS)to score the degree of pain.(2)Immediately,3 hours,3 days,7 days,30 days after operation,according to Bates-Jensen Wound Assessment Tool to score the postoperative incision recovery.(3)Patients were followed up at day 3,7,and 30 after operation.Assessments of swelling,language and mental state were given on a five-point scale ranging from strongly agree to strongly disagree.4.Statistical analysis: Spss17.0 was used to data analysis,all data were collected comparison Mann-Whitney U test and Wilcoxon rank test.P <0.05,said the difference was statistically significant.Result:1.Postoperative pain scores at different time points: the VAS score of laser group 3 hours,3 days,7 days after operation higher than scalpel group(P <0.05).3h,3 days,7 days after surgery,two groups of patients at each time point of VAS pain score of the different(P <0.05).2.Postoperative wound score at different time points: after three hours the two groups showed no significant wound score difference(P> 0.05).3 days after operation,the score of two group patients have increased,and the scalpel patients wound score was significantly higher than the laser(P <0.05).Seven days after the surgery two groups wound score decreased,but the scalpel group still higher than the laser group(P <0.05).3.The satisfaction of parents at different time points: 3 days,7 days after surgery satisfaction scores of mental,eating and linguistic of two groups gradually increased(P <0.05).However,it did not show significant difference(P> 0.05)between the two groups.Conclusion: The healing of Er: YAG laser surgery wound is superior to the traditional scalpel,and Er: YAG laser can reduce the postoperative pain. |
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