In-Office Laser Treatment of Recurrent Respiratory Papilloma S. Carter Wright, Jr. MD Center for Voice and Swallowing Disorders Wake Forest University Health Sciences Winston Salem, NC 27127

Light Absorption in Tissue 100,000 10,000 1,000 100 10 1.0 0.1 0.01 0.001 0.0001 PDL Er:YAG Melanin Water CO2 Hemoglobin Absorption Coefficient (per centimeter) Oxyhemoglobin 0.2 1.0 3.0 10 20 Wavelength (Microns) Source: Brown, Dale : Nd:YAG Laser, Laryngoscope 110: May 2000 p.855

Absorption Length Absorption Length (millimeters) Wavelength (Microns) Argon KTP Excimer Nd:YAG Ho Er CO2 0.0 1.0 Absorption Length (millimeters) Pigmented tissue 2.0 CO2 0.00 3.0 0.01 0.02 4.0 0.2 1.0 3.0 10 20 Wavelength (Microns) Source: Brown, Dale : Nd:YAG Laser, Laryngoscope 110: May 2000 p.855

Advantages of CO2 laser Minimal depth of penetration Highly absorbed in water Precise tissue handling Variable spot size makes for an excellent cutting and ablation tool Limited collateral damage “What you see is what you get”

Glass Core Limits Transmission A new surgical tool OmniGuide Fiber Glass core Glass Core Limits Transmission Cladding Conventional Fiber CO2 light propagates through hollow core Outer Cladding Fiber Technology Carefully selected materials Unique design and manufacturing capability MIT Patents (16 issued, >12 pending) Current fiber OD ~1.5mm, spot size ~450 um to 1mm Hollow Core Photonic Bandgap Reflector Ref: B.Temelkuran, S.D.Hart, G.Benoit, J.D.Joannopoulos, and Y.Fink, Nature 420, 650 (2002).

In-Office CO2 Laser at WFU

Tracheal Papilloma

Laryngeal Papilloma