Nerve coblation for treatment of trigeminal neuralgia: A case report

BACKGROUND Trigeminal neuralgia(TN) is a severe type of neuropathic pain which is often inadequately managed using conventional therapies. In this report, we present the first case of TN treated with gasserian ganglion nerve coblation(NC).CASE SUMMARY A 58-year-old man presented with right facial pain, mostly localized in the right zygomatic zone, alveolar region, and jaws. Similar to acupuncture and shock pain, the pain lasted about five seconds after each attack before resolving unaided. A diagnosis of TN was made, after which treatment with acupuncture therapy and oral carbamazepine was given. However, the pain was not satisfactorily controlled. Subsequently, gasserian ganglion NC of the right trigeminal nerve guided by computed tomography(CT) was performed on the patient. Following this procedure, the right zygomatic, alveolar, submandibular,and cheek pain disappeared completely. The right zygomatic and alveolar areas experienced mild numbness(level II). At 1-, 2-, 3-, and 6-mo follow-ups after surgery, the patient was painless and the numbness score was level I.CONCLUSION CT-guided gasserian ganglion(NC) is an effective treatment for TN and is associated with less or no postoperative numbness or hypoesthesia in comparison with current standard-of-care approaches.

Comparison of Coblation Tonsillectomy vs Dissection Tonsillectomy

Background: Tonsillectomy is one of the most commonly performed surgical operations in the recent years. It is mainly done for chronic tonsillitis and obstructive symptoms. Aims & Objectives: To compare the operating time, intraoperative blood loss, postoperative pain, time needed to return to normal diet and activity in coblation and dissection tonsillectomy. Methods: This is a prospective study done at Pushpagiri Medical College for a period of one and a half years from March 2015 to September 2016. Out of the 50 patients, 25 underwent coblation tonsillectomy and 25 underwent conventional dissection tonsillectomy. Method of surgery depended on patients’ or parents’ choice. Intra operative measures like operating time, blood loss and post-operative morbidity were measured and compared. Results: In this study, there was significant difference in intraoperative time in coblation tonsillectomy compared to cold dissection tonsillectomy (mean operative time—13.4 minutes for coblation and 20.4 minutes for cold dissection with p value less than 0.05). Intraoperative blood loss was significantly less for coblation (18.9 ml) compared to traditional (43.0 ml) with p value 0.002. Average postoperative pain score 6 hours after operation was 7.6 for coblation and 8.5 for cold dissection with a significant p value of 0.002. Average time taken to return to normal diet among coblation was 6.4 days and dissection was 7.0 days with p value of 0.078 which is not statistically significant. However, average time taken to return to normal activity among coblation was 6.3 days and dissection was 7.1 days with a significant p value of 0.024. Conclusion: Coblation tonsillectomy significantly reduces the operation time, intraoperative blood loss, immediate postoperative pain, and patient returns early to regular routine, but with a higher cost.

Coblation Intracapsular Tonsillectomy and Coblation Complete Tonsillectomy for Obstructive Sleep Apnea

Objective: Total tonsillectomy and intracapsular tonsillectomy are common procedures for the treatment of obstructive sleep apnea (OSA) in children. The objective of this study was to compare the effectiveness of coblation intracapsular tonsillectomy (ICT) and coblation complete tonsillectomy (CT) as treatments for OSA. Study design: A retrospective study of all the children ages 2 - 18 years with OSA who underwent coblation intracapsular tonsillectomy (ICT) or coblation complete tonsillectomy (CT) from January 2007 to August 2010 by the same surgeons at one institution. Methods: Data were retrieved from children’s charts and from telephone interviews with children’s parents, regarding pre and postoperative OSA-18 scores, postoperative pain, postoperative complications, use of analgesic drugs, and time to return to a solid food diet. Results: All 43 children who underwent ICT and 37 children who underwent CT suffered from OSA before surgery, and none did postoperatively. There were no minor complications in the ICT group, compared to 13.5% in the CT group (p = 0.01). According to parental report, 72% and 21% suffered a low level of postoperative pain, and 9% and 33% severe pain in the ICT and CT groups, respectively. For these respective groups, 49% and 73% needed analgesic drugs (p < 0.05);and 65% and 35% ate solid food during the first 3 days post surgery. Conclusions: Both ICT and CT were safe, with few complications;however recovery was faster in the ICT group, as demonstrated by less pain, and more rapid return to a solid food diet.

Microscopic Surgery with Coblation for the Treatment of Benign Laryngeal Lesions: A Case Report

Background: Coblation based bipolar plasma devices are designed to operate at a relatively low temperature to gently dissolve and/or shrink target tissue with minimal thermal damage to surrounding healthy tissue. Coblation technology provides ablation, resection, coagulation of soft tissue and hemostasis of blood vessels in one convenient surgical device. Coblation technology can be used in the larynx and trachea for removing or debulking sessile polyps, lesions or tumors. Minimally invasive coblation technology can offer less invasive treatment with quicker recovery and shorter hospitalization. Aim: This case study aims to explore the advantages of coblation combined with microscopy to treat benign laryngeal lesions. Case report: We report the case of laryngeal papilloma treated with minimally invasive coblation resection. Fiberoptic laryngoscopy was done pre-operatively and that showed papillomatous mass at anterior half of right vocal cord involving inferior surface and also extending upto anterior commissure. Mobility of both vocal cords was normal. On the basis of the above findings with normal vocal cords mobility, the microlaryngeal surgery with coblation was planned. After complete pre-op work up, the patient underwent trans-oral microscopic coblation excision of mass under general anaesthesia. Power level was set to 7 for ablation and 3 for coagulation. The PROciseTM LW Plasma Wand system was chosen such that it was malleable to reach the papillomatous mass without obstructing the vision. It was totally excised and sent for histopathology examination. Post-operatively after four hours, he was able to take normal diet comfortably. He was followed up after 10 days. Histopathological report confirmed the diagnosis of papilloma. Check laryngoscopy was performed after 3 weeks. Laryngeal examination was absolutely normal with almost normal vocal cords and normal voice post-operatively. Conclusion: Microscopic surgery with coblation has the advantages of less bleeding, short procedure duration, increased completion rate and few complications.

Coblation: An Alternative to CO2 Laser and Microdebrider for Laryngeal Papillomatosis

Objective: To assess the efficacy of coblation in treating laryngeal papillomatosis and its effect on post operative voice outcome. Study Design: This is a retrospective study. Setting: Tertiary referral centre. Subjects and Methods: All the patients diagnosed with laryngeal papillomatosis between January 2013 to December 2016 were included in this study. Preoperative assessment was done with rigid and flexible laryngoscopy. PRAAT software was used for voice analysis. All patients underwent coblation assisted microlaryngeal surgery. Post operatively patients were followed up at 1 week, 15 days, 1 month, 3 months and 6 months with rigid laryngoscopy. Voice analysis was repeated after 3 months to assess the improvement in voice. Results: Coblation was found to be effective in treating laryngeal papillomatosis. In our series of seven patients, three patients underwent repeat procedure with coblation for recurrence. But longterm follow up these patients did not reveal any recurrence of laryngeal papillomatosis. Voice analysis revealed a significant improvement in measures of perturbation and maximum phonation time. Conclusion: Coblation is a promising alternative to the conventional methods for the treatment of laryngeal papillomas as it can achieve satisfactory disease clearance with good voice quality.

Postoperative Outcomes in Coblation versus Electrocautery Tonsillectomies

Purpose: To investigate whether children undergoing a tonsillectomy or adenotonsillectomy (AT) with Coblation? will experience less postoperative pain and return to a normal diet and a regular activity level sooner compared to the same procedure using electrocautery dissection. This may manifest less school and work missed by the child and caregiver, respectively. Materials and Methods: Seventy-four children between the ages 2-13 years with either obstructive sleep apnea or chronic tonsillitis were recruited at a single tertiary-care center from January 2011 to November 2012 and underwent an AT via electrocautery or Coblation?. Caregivers were given a ten-point Wong-Baker FACES pain scale and questions inquiring the degree of oral intake, activity level, and impact on both the child and caregiver in regards to missing work or school on postoperative days (POD) 0, 1, 2, 3, 5, 7, and 14. Results: Children in the Coblation? arm required less pain medications (p 0.0049) on POD 0. Subsequent results were not significantly different for any other day. Age- and gendered-controlled multivariate analysis revealed a statistically significant difference in pain medications administered (p 0.0001) but not pain scores (p 0.2115) between the two techniques, although this difference in medications is likely related to the results observed on POD 0. There was no incidence of postoperative hemorrhage in either group. Conclusions: While there was less pain medication administered and slightly improved oral intake of liquids on POD 0 for children in the Coblation? arm, there was no difference in subsequent postoperative outcome or hemorrhage rates.

A New Modality of Treatment for Adult Laryngeal Haemangioma by Coblation: A Case Report

Few adult haemangiomas of larynx have been reported. Most common presentations are in infants where the incidence is about 4% - 5% [1]. In children they resolve by age of five whereas in adults they do not regress. In children the most common modality of treatment is by propranolol. In adults, there are various modalities of surgical excision by laser excision with Co2 or KTP and electrocautery assisted excision. We are presenting a case of adult laryngeal haemangioma that presented with blood-tinged sputum on coughing since 8 months and we managed with micro laryngeal surgical excision by coblation without any complications.

Examining the life-cycle of the Coblator II device:Increases in paediatric post-tonsillectomy haemorrhage after six years of use

All paediatric tonsillectomies were examined from 2012–2019 at a single tertiaryreferral institution,and all were performed by one of two paediatric otolaryngologists.One exclusively used the diathermy,the other exclusively used the Coblator II.Two Coblator units were purchased simultaneously in 2012 and not replaced.There was no significant difference in number of tonsillectomies performed(1298 via diathermy,1221 via Coblator),nor in postoperative day of bleed,patient age,indication for procedure,and no patient had an underlying coagulopathy.The most common indication for tonsillectomy in both groups was sleep-disordered breathing.There was no significant difference in postoperative haemorrhage rates between groups for the first six years of the study(0%-1.4%/year).Years 7 and 8 saw the Coblator group haemorrhage rate significantly increase(0%-0.6%diathermy group vs 2%-3%Coblator group),though still fell within accepted rate of postoperative haemorrhage.The devices were then replaced,and the differences in haemorrhage disappeared.There appears to be a significant increase in paediatric post-tonsillectomy haemorrhage when using a Coblator device greater than six years old.This may suggest a useful lifespan for the Coblator II device.

鼻内镜对减少低温等离子扁桃体切除术后出血的疗效观察

目的研究手术结束前应用70°鼻内镜检查扁桃体术腔与常规检查扁桃体术腔两种方法对低温等离子扁桃体切除术后出血的影响。方法我院2008年1月～2018年1月行全麻下低温等离子扁桃体切除术的患者1249例,采用回顾性临床病例对照研究方法,分为手术结束前应用70°鼻内镜检查扁桃体术腔组635例(治疗组)与常规检查扁桃体术腔组614例(对照组),比较两组的术后出血发生率和术后出血量等。结果手术结束前应用70°鼻内镜检查扁桃体术腔,可减少低温等离子扁桃体切除术后原发性出血概率,而与术后继发性出血无明显相关。结论手术结束前应用70°鼻内镜检查扁桃体术腔能有效减少低温等离子扁桃体切除术后原发性出血发生概率。

低温等离子消融术在儿童阻塞性睡眠呼吸暂停低通气综合征中的应用

腺样体和（或）扁桃体肥大导致的上呼吸道阻塞是引起儿童阻塞性睡眠呼吸暂停低通气综合征（OSAHS）最常见的原因,腺样体和（或）扁桃体切除术是治疗儿童OSAHS最有效的方法。我科自2008年12月～2011年12月对38例OSAHS患儿进行低温等离子消融术辅助内镜下切除儿童扁桃体和腺样体,取得了较为满意的效果。现报道如下。

鼻内镜下低温等离子射频治疗鼻出血

低温等离子射频与传统烧灼法治疗鼻出血的机制一样：破坏出血点组织,使血管封闭或凝血而达到止血目的.我科自2003年9月至2005年3月在鼻内镜下采用低温等离子射频双极电凝治疗鼻出血,取得良好的效果,报道如下.

低温等离子扁桃体消融术临床分析

扁桃体切除术后出血率为0.98%～5.50%[1]。部分患者术后止血相当困难,引起失血过多,甚至危及生命。疼痛影响患者进食、饮水,约2周才能完全恢复。因此,临床上为了减少术中术后出血、减轻患者术后的疼痛,已采用扁桃体挤切术、电刀切除术、激光切除术、超声刀切除术等希望能改良扁桃体剥离术。目前,低温等离子刀已广泛应用于外科手术,本研究自2009年末开始观察低温等离子扁桃体消融术[2]对患者术中、术后的影响,并与扁桃体剥离术进行比较。

低温等离子射频技术治疗杓会厌皱襞血管瘤

杓会厌皱襞位于喉咽部与喉交界处,构成喉入口的两侧缘。原发于此处的血管瘤很少见,因病变位置深在隐蔽,涉及重要部位功能,治疗颇为棘手,合理选择手术入路,正确掌握手术方法和技巧是治疗成功的关键。2012年10月～2012年11月我科应用低温等离子射频技术治疗杓会厌皱襞血管瘤附2例,疗效满意,现报道如下。

胸椎前路松解术

胸椎前路松解手术应用于脊柱侧凸的治疗已有近半个世纪，对于先天性侧凸、特发性侧凸年龄过小，为防止曲轴现象所作的前路松解目的明确，且效果肯定。而对于重度、僵硬性脊柱侧凸，通过一期前路松解，同期或者二期联合后路松解内固定融合术明显增加了手术的矫正率，并减少了并发症的发生。脊柱侧凸的主弯以胸弯最为多见，所以胸椎前路松解术在脊柱畸形，尤其是严重、僵硬脊柱畸形的矫形术中的作用突显重要。故了解胸椎前路松解术的发展、适应证、手术方法、生物力学以及并发症的防治也具有重要意义。

Assessment of Radiofrequency in Otorhinolaryngology at the Military Hospital of Ouakam (MHO)

Introduction: Coblation® is a low temperature-controlled tissue ablation technique widely used in human surgery. Its development in otorhinolaryngology has allowed a spectacular advance in the management of diseases of the nasal and oral cavities. The objective of our work was to study the indications for radiofrequency in ENT, to describe the technical aspects and to evaluate the results of his practice at the HMO. Patients and Methods: This is a retrospective study carried out in the ENT and Head and Neck Surgery department of the Ouakam Military Hospital (MHO) over a period of 3 years (from January 2015 to the end of December 2017), involving 37 patients who received radiofrequency treatment in the ENT sphere. Results: The study was carried out on 37 patients. The sex ratio of 0.19. The mean age of the patients was 33.3 years. The indications were dominated by chronic caseous cryptic tonsillitis with or without halitosis with 24 cases (64.9%) followed by recurrent tonsillitis in 5 cases (13.5%) then we have obstructive hypertrophy of the palatal tonsils with syndrome sleep apnea (OSAS) in 4 cases (10.8%) followed by nasal obstruction (hypertrophy of the inferior turbinates) and hypertrophy of the soft palate and uvula in 2 cases (5.4%). The complication rate was 8.1% and dominated by transient dysgeusia in 1 case or 2.7%, uvula edema in 1 case or 2.7% and bleeding in 1 case or 2.7%. The postoperative follow-up was done one week, 1 month, 3 months, 6 months and 12 months after radiofrequency. Volumetric reduction begins to set in from 1 month (62.5%) and becomes maximum in 3 months (74.3%). Conclusion: Coblation® is a controlled tissue ablation technique at low temperature, patented by ArthroCare® Corporation in 1997. Very widespread in human surgery. Its development in otorhinolaryngology was later, but allowed a spectacular advance in the management of diseases of the nasal and oral cavities.

Surgical Excision of Clivus Chordoma with the Use of Coblator—A Case Report

Chordomas are dysembryogenic tumors originating from the notochordal process [1] [2]. They are aggressive tumours with unique diagnostic and management challenges. Primary therapy is complete surgical removal of the tumour as much as possible. The likelihood of recurrence is high in spite of complete surgical resection. A 52-year-old female patient presented with complaints of decreased vision in right eye, nasal bleeding, nasal blockage and difficulties in swallowing. CT scan and nasal biopsy were performed which confirmed the diagnosis of clivus chordoma. The CT scan showed extension into nasopharynx, nasal cavity and oropharynx pushing onto the soft palate. Surgical excision of the mass was performed with coblator by both intraoral and intra nasal approach [3]. On follow-up, nasal endoscopy and CT were done;the patient was relieved of the symptoms and was clinically better.