Ablation of Diffuse Keratosis and Resection of Thick Ulcerated Lesion on Lateral and Posterior Portion of Tongue Using AcuPulse™ 40WG CO2 Laser System with FiberLase™ CO2 Fiber Case by Marc Remacle, M.D. | CHU Mont-Godinne, University of Louvain, Belgium

1. Ablation of Diffuse Keratosis and Resection of Thick Ulcerated
Lesion on Lateral and Posterior Portion of Tongue Using
AcuPulse™ 40WG CO2 Laser System with FiberLase™ CO2 Fiber
Case by Marc Remacle, M.D. | CHU Mont-Godinne, University of Louvain, Belgium
ENT Technique Guide Series Volume 12, No. 3, April 2012 PB-1125170_A
The CO2 laser permitted decreased local thermal effects with no oozing or bleeding. Compared to free-beam
handpieces in this tight space, the FiberLase handpiece is much smaller and ergonomic. The malleable handpiece can
be shaped/angled according to the needs at the treatment site. The microvascular hemostasis afforded by the carbon
dioxide laser wavelength improved visualization and treatment speed.
Preoperative
Past Medical
History and
Presenting
Complaint
 57 year-old male, chain-smoker and occasional drinker, poor dental hygiene
 Burning sensation along left lateral side of tongue
 Pain when eating spicy or salty food and following some movements of the tongue
Relevant Physical
Findings and
Diagnostics
 Diffuse hypertrophy of epithelium (kyperkeratosis) mainly developed on left side of
tongue. Thickness and small ulceration on lateral and posterior side of tongue
 Biopsy performed at level of ulceration
Diagnosis  Severe dysplasia (grade 3) or in situ carcinoma (Cis)
Operative
Surgical
Procedure
 Ablation of diffuse keratosis and resection of thick keratosis and ulceration of
lateral and posterior part of tongue under local anesthesia
 Procedure performed in Ambulatory Surgery operating room
Anesthesia  Local infiltration with lidocaine 2% and epinephrine 1:10,000 (10 m)
Laser
Accessories
 FiberLase flexible CO2 laser fiber
 FiberLase M-Handpiece (malleable). Tip curved according to procedure location.
 Because the M-handpiece was used, higher pressure compressed air used from
wall source.

2. CO2 Laser-Assisted Ablation and Resection of Lateral/Posterior Portion of Tongue
Using AcuPulse™ 40WG CO2 Laser and FiberLase™ CO2 Fiber
Marc Remacle, M.D.
2
Smoke
Evacuation
 Smoke evacuation was not required
 It was not necessary to instruct the patient to hold his breath, because the constant
purge air through the fiber cleared the smoke
Laser and
Parameters
 Laser System: AcuPulse 40WG with FiberLase Flexible CO2 Laser Fiber and
malleable handpiece
 Laser Operation Mode and Power: SuperPulse at 15 Watts
 Exposure Mode and Time: Repeat, Time ON 0.1 sec., Time OFF 0.1 sec.
 External purge air system using compressed air from wall source
Laser
Technique
 Tip distance from tissue: 2-3 mm
 Diffuse keratosis was vaporized until muscle fibers of tongue were reached
 A section of the thick lesion with ulceration was obtained with a margin of
3–4 mm
Hemostasis  Bipolar coagulation was available in case of bleeding, but was not used
 Although the laser energy delivery was used for cutting, it provided adequate
hemostasis – there was only a small amount of oozing
Technique Tips
Minimize Thermal
Effects
 Use of SuperPulse mode vs CW mode decreases local thermal effects and enables
tissue sample for good histologic examination
 Pause at intervals to clean carbonized tissue with a saline-soaked sponge.
Removing the carbon, decreases heat buildup in tissue.

3. CO2 Laser-Assisted Ablation and Resection of Lateral/Posterior Portion of Tongue
Using AcuPulse 40WG CO2 Laser and FiberLase CO2 Fiber
Marc Remacle, M.D.
3
Operative Photos
Fig. 1 Keratosis of tongue Fig. 2 Ablation of diffuse keratosis
Fig. 3 Section of thick lesion with ulceration in center Fig. 4 Section is completed
Post Operative
Discharge and
Postoperative
Instructions
 Procedure length was approximately 30 minutes, including anesthesia
 Patient immediately discharged
 Advised to wash mouth with alkaline solution, avoid spicy and salty food, eat
pureed food and take painkiller (paracetamol with codeine) for 5-10 days
 Cold drinks and ice cubes for cooling and refreshing the mouth
Recovery
and Outcome
 Patient seen after 10 days; surgical site was inflammatory. Patient reported not
much pain and that he did avoid hot, salty and spicy foods.
 Healing was complete after two weeks
Discussion
The flexible hollow fiber allowed a more comfortable procedure compared to cold steel, electrocautery
or conventional laser treatment with the Kamami handpiece.
The low thermal damages in the specimen, in comparison to electrocautery or some other wavelengths
(KTP, diode, etc.), allowed a good histological examination of the margins.