ROLE OF CROSURGERY IN MAXILLO FACIAL SURGERY

Dr V.RAMKUMARCONSULTANT DENTAL&FACIOMAXILLARY

SURGEON REG NO:4118- TAMILNADU-INDIA(ASIA)

INTRODUCTION

• 1845 Dr James arnott used cryo surgery for palliative pain relief in cancer patients

• The temperature used was -24`c by employing brine solution with ice to administer cryo to his patients

Mechanism of heat exchange

• It depends on

• Water content

• Vascularity

• Rate of freeze

• Temperature coolant

Mechanism of cryo surgery

• Specific latent heat of fusion

It is a process by which heat geberated during cooling converts water into ice .

The extension of ice front and subsequent development of cryo lesion is governed by

• Thermal conductivity of tissue

• Specific heat of unfrozen tissue

• Tissue blood perfusion rates

Joule thompson effect

• The cryo probe are cooled by rapid expansion of compressed gas through a narrow orifice .

• The boiling point of nitrous oxide is 89.5`C

• The probe temperature is 70`C

• The higher the temperature is more effective destruction of the lesion. (196`C)

Equipment

• There are various models available in the market

• The common one used is cryo basco super deluxe model -004

Technique for cryo surgery

• Probe technique

• Spray technique

• Probes are of various size and shape

• Silicon metal end pieces are normally used

probe technique

• Probes of 1 cm in diameter are used in cryo therapy

• Increase contact by application of jelly

• Probe is placed firmly on tumor for malignant tissue for contact.

spray technique

• Cryo analgesic effect is more

• Spray must be used intermittently

• Pressure used is 8 to 12 psi

• Freezing cycle is short

precautions

• Cotton rolls for control of saliva

• High vaccum suction apparatus

Effects of thawing

• When freezing stops the tissue starts gets damaging.

• The intra cellular electrolytes has increase in permeability leading to swelling and rupture of cells

Vascular effects

• After a few hours of freezing there is increased permeability of small vessels leading to platelet plugging.

• Vascular stasis and micro thrombos occurs.

Advantages of cryo surgery

• Simple and painless

• No bleeding

• No scarring

• Less treatment time

Disavantages

• Delayed wound healing

• Least precise tissue destruction

• Non specific

• Mainly limited to surface lesions

Role in maxillofacial surgery

• Management of benign lesions

• Pre malignant lesions

• Mucocele

• Vascular malformations

• Hyperplastic conditions

• Cancer and neuralgic patients

Post operative sequale

• Duration of healing and scar formation

• Speech disturbance

• Alveolar bone exposure and osteoradionecrosis

• Pathological fracture and persistent lymphadenopathy.

FACIAL ACNE

CAPILLARY HEMANGIOMA

CAVERNOUS-HEMANGIOMA

BASAL CELL CARCINOMA

MUCOCELE

REFERENCES

• CRYOSURGERY BY SETRANG A ZACARIAN

• PETERWARDBOOTH

• PETERSON

• LASKIN

• POGREL et al COMPARISON OF CRYOSURGERY WOUND HEALING 000-1990