最新激光在耳鼻咽喉科(28)PPT课件.ppt

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1、激光在耳鼻咽喉科(28)PatientHistoryPatientisa18weekoldmalepresentingtopediatricswithatwoweekhistoryof“noisybreathing”thatisworsewithcrying.Thiswasnotedwhenthechildwaswithmotheratwork(sheworksatadaycarefacility).Thishasworsenedconsiderablyoverthelast5dayswithdifficultyinfeedingandhascreatedaconsiderable

2、amountofparentalconcern.Pediatricshasconsultedyouasmed-nebshavehadlittleeffectoverthelast4hours.PatientHistoryPMH:Uneventfulfulltermdelivery.Childhashadunremarkablehistoryuntilcurrentcondition.PSH:NoneMedications:NoneAllergies:NKDASH:Liveswithparents,immunizationsUTDFH:GrandparentswithDM,HTNSu

3、bglotticHemangiomaSieetal.with10yearexperiencewithCO2laserinSGHSerialproceduresand20%rateofpost-treatmentsubglotticstenosisMadgyetal.reviewedsixcasesofSGHmanagedwiththeKTPlaserSteroidsaftersurgeryEndpointwastoachieve60to70%airwaypatency3withmildpost-proceduralSGSBarlowetal.-spasticdiplegiain20

4、%of26childrenlessthan2yearsofagetreatedwithIFNLifethreateningHemangiomasrespondtosteroidsin30to60%ofcases–IFNadministeredinnon-respondersTreatmentIndicatorsforinterventionCompromisedairwayDeviationofvisualaxisOral/digestivetractobstructionBilateralauditoryobstructionRelative:bleeding,ulceratio

5、nandpotentialforsignificantfacialdisfigurementsLaserHistory1917:Einsteinfirstdiscussesstimulatedemissions1954:Townes&Gordon–maser1958:Townes&Schawlow(BellLaboratories)publishesfirsttheoreticcalculationsofthentitledlaser1960:Maimen(HughesAircraft)developsfirstlaser(rubywith694nmwavelength)1961:

6、Neodymium-doped(Nd):glasslaser1964:Nd:YAGandargonion(Ar)1965:CO2laser1968:PolanyidevelopsarticulatingarmforCO2laserLaterworkswithJakoontheablationofvocalfoldpapillomatosisTheLaserThreeessentialelementsLasingmediumExcitationsourceTwomirrorstoprovideopticalfeedbackTheLaserResonantCavitySpontaneo

7、usemissionStimulatedemissionPopulationinversionLaseroutputLaserPropertiesMonochromaticCoherentCollimatedHighenergydensity(Powerdensity)Irradiance=intensity/area=watts/cm2Fluence=(intensityXtime)/area=wattsXseconds/cm2=J/cm2LaserDelivery