HI Ron: neat pics, did you do this with the erbium?

You got pretty good hemostasis with this one too.

All the best. ….nice job.

glenn

Thought I’d add a fibroma case also.

5mm diameter
er,cr:YSGG 1.0 W EMLA 11/7

Preop

Postop

1 week

Ok, a few questions for you all.

Should I have been more invasive and gone deeper?
In this case after the piece was removed I went back and ‘resurfaced’

Biopsy?
Pt could pin point cause from trauma.
Any suggestions?

Actually, most of the cases I’ve seen posted,here and elsewhere, seem to look like they are more cratered afterward. I didn’t create a crater with this one and was wondering if there is any long term diffrence.

I’ve never had any bleeding to contend with on fibroma removals, just once in awhile on frenectomies.

Is this a WaterLase only topic?
If not stated differently I guess we are to assume WaterLase?
I though we were going to give out treatment parameters, tip size, duration, etc.
I never see Hertz posted in WaterLase posts, even if it is fixed, it would be helpful in treatment interpretation.
Ron,
What size tip did you use?
I would place tissue in biopsy bottle, evaluate healing and even then keep to see if insurance will pay w/o biopsy report, never know when you need that tissue.

Jeff

Ron,
Here is how it is done with a pulsed, FR, Nd:YAG, contact fiber, 3.0W 20 Hz 110usec, less than a minute.
3 point infiltration, 2% Carbocaine w/ 1/20,000 Levordefrin

Before treatment

Immediately after treatment

two weeks post-op

I look at the pictures and know this is great fun learning all these new methods. This is such a tremendous forum to share on.

I have found that the difference in wavelength (and therefore the tissue interaction) of the laser made a significant difference in the removal of a fibroma as you have presented. With regards to the depth of the cut you make – the fibroma should be the determining factor. With the erbium or the Diode you must decide where you will make your cut. Many times the tissue will feel the same and it is hard to differentiate what you’re removing from tissue you wish to keep. I also see this dilemma in the questions that are posed. With the FR Nd:YAG used in a selective ablation mode these tissues are recognizable and are able to be distinguished one from the other and separated. Thus you are able to remove the complete fibroma without sacrificing any additional tissue unnecessarily. Now that Bob has the camera and scope set up we will post the next one of these we remove – I hope he lets me use the camera!

Here is my first fibroma removal using the OpusDuoE.
10 Hz 350mJ using a 800micron tapered sapphire contact tip for less than 30 sec.
LA 2% Carbocaine w/ 1/20,000 Levordefren, tripod technique (3 drops in triangle surrounding lesion in mucosa)

Before

Immediately after

Next time I’ll use a 200 or 400micron tapered tip for more focused tissue response.

Jeff