ULTRASOUND GUIDED INTRALESIONAL ND:YAG LASER TREATMENT OF DEEP VASCULAR LESIONS – TWO CASE REPORTS

Purpose: Vascular lesions in the head and neck region are a common pathological entity. Many different treatment modalities have been used for their removal. In the past decade, the Nd:YAG laser has emerged as a successful mode of treatment for vascular lesions. Its use in removal of deep vascular lesions, however, has not been reported often.

Methods and Materials: The Nd:YAG laser beam is poorly absorbed in water and selectively absorbed in haemoglobin, and causes tissue photocoagulation down to a depth of about 5–10mm. The laser beam is transmitted to the handpiece via a narrow, flexible fiberoptic cable. These properties make it an excellent tool for treatment of various vascular abnormalities.

Change of tissue structure upon coagulation can be monitored using ultrasound. At the same time, one can precisely determine the position of the laser emitting fiberoptic cable, which is introduced into the lesion using a wide-bore needle as a trocar.

Two patients with deep vascular lesions within the masseter muscle were treated with ultrasound guided Nd:YAG laser photocoagulation. Both lesions were well within the muscle, below the masseteric fascia, so there was no direct danger to the overlying facial nerve, which was our main concern. The lesions were treated on an outpatient basis in local anesthesia, in a step-by-step fashion, until complete coagulation. Both procedures lasted about 45 minutes.

Results: In both cases, the final result was gradual replacement of the coagulated intramuscular venous malformation with scar tissue. Function of the facial nerve remained undisturbed, and there are no external signs of the procedure.

Conclusions: Ultrasound guided laser photocoagulation of deep vascular malformations can be a safe, quick and cheap alternative to surgery and other modes of treatment.