The smaller anatomy and limited access to instrumentation pose a challenge to the pediatric airway surgeon. The enhanced precision and ability to photocoagulate tissue while operating with the laser enhances the surgeon’s ability to successfully treat unique pediatric conditions such subglottic hemangiomas, congenital cysts, respiratory papillomatosis, and laryngeal or tracheal stenosis. Due to its shallow tissue penetration and thermal effect, the carbon dioxide (CO2) laser is generally considered the laser of choice for pediatric airway applications. The potential for increased scarring and damage to underlying tissue caused by the greater penetration depth and thermal effect of the Nd:YAG and KTP lasers preclude their use in this population. In this review, we will describe the specific advantages of using lasers in airway surgery, the current technology and where the current technology is deficient.
In otolaryngology two novel RF instruments have been developed addressing the shortcomings associated with classic electrosurgery: controlled tissue ablation (Coblation) and temperature controlled radiofrequency total volume reduction (Somnoplasty). Coblation involves placing closely spaced bipolar electrodes in a conductive media in approximation with the tissue of interest. A plasma layer is produced disrupting molecular bonds in the tissue. Resultant debris is washed away during intraoperative irrigation. Since plasma forms in the conductive media, not on the tissue directly, surface temperatures are reduced (40-70°C compared to >400°C) resulting in decreased collateral tissue damage. In Somnoplasty, high frequency RF energy is delivered using a needle inserted into tissue. Resistive heating occurs in the tissue surrounding the electrode leading to heat generation and temperature rise. Temperature change is monitored using integrated thermocouples providing a control signal to a microprocessor permitting modulation of energy delivery rate. Irreversible tissue damage occurs at a threshold temperature. The tissue itself generates heat and not the probe. This presentation will introduce the principles underlying Coblation and Somnoplasty, focusing on their utility in head and neck surgery and addressing how these technologies are used to treat disorders of the head and neck while reducing thermal injury and carbonization.