Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
-
Otolaryngol Head Neck Surg · Mar 1997
Comparative StudyA comparison of mucosal incisions made by scalpel, CO2 laser, electrocautery, and constant-voltage electrocautery.
This study compares the histologic effects of scalpel, CO2 laser, electrosurgery, and constant-voltage electrosurgery incisions on the mucosal tissue of swine. Tissue studies comparing the CO2 laser with the scalpel and electrosurgery have been done. However, a gross and histologic comparison of the effects of all three techniques on oral mucosal tissue has not been reported. ⋯ The wounds created by all four instruments displayed intact epithelium by 4 weeks, and granulation tissue peaked at 4 weeks with all methods except constant-voltage electrosurgery, where granulation tissue was still prevalent at week 6. Constant-voltage electrosurgery and the CO2 laser provided the best combination of ease of use, hemostasis, and lack of tissue injury among the instruments compared. Incisions and excisions made with constant-voltage electrosurgery required less time than those made with the laser, but constant-voltage electrosurgery wounds also had significantly more granulation tissue in later weeks of the study, suggesting that wound healing may be delayed.
-
Otolaryngol Head Neck Surg · Mar 1997
Stretch-induced nerve injury as a cause of paralysis secondary to the anterior cervical approach.
The anterior approach to the cervical spine, first described 40 years ago, has become a popular and widely used procedure by spine surgeons to expose the anterior vertebral bodies from C3 to T1. A significant complication of this procedure is transient or permanent ipsilateral recurrent laryngeal nerve paralysis. In a previous review at our institution of patients with hoarseness after an anterior cervical approach, 15 of 16 patients demonstrated right-sided paralysis. ⋯ The right-sided approach to C7 resulted in an average in situ stretch on the ipsilateral recurrent laryngeal nerve of 12% and 24%, with 3 cm and 4 cm of Cloward retraction, respectively. The right-sided approach to C4 resulted in significant levels of stretch in 3 (30%) of 10 cadavers and no stretch in 7 (70%) of 10 cadavers. The relevance of these data is demonstrated by the review of numerous studies demonstrating the potential for significant neural damage with nerve stretch greater than 12%.