Use of blue laser in a patient with postop restenosis of the choana after multiple surgical interventions for congenital choanal atresia

One of the most common complications following surgical interventions in nasal cavity is synechiae and scarring, which often leads to restenosis, particularly in cases of choanal atresia. Laser technologies, especially blue laser (wavelength 445 nm), represent a promising opportunity in rhinology for addressing these complications. Objective: to study the effectiveness and safety of blue laser for nasal synechiae and stenosis surgery in patients with congenital choanal atresia after multiple surgical interventions. In ENT department of Veltishev Institute 4 children have undergone choanal reconstruction following multiple attempts of choanoplasty. A clinical case of a 6-year-old girl diagnosed with bilateral complete choanal atresia, who underwent six surgical interventions within two years and was admitted with complete choanal restenosis is presented. The most common cause of restenosis after surgery for hoan atresia is the formation of synechiae in the surgical area. Traditional dissection of the synechiae in most cases leads to repeated stenosis. To reduce the recurrence rate in the patient, the authors used a blue laser. The blue laser demonstrated high effectiveness in the surgical treatment of postop restenosis, minimizing surgical trauma, preventing recurrences, and improving the patient’s quality of life. The results confirm the feasibility of using lasers in rhinology as a preferred method for treating restenosis and enhancing respiratory function.

1. Bansal M. Diseases of Ear, Nose and Throat. Head and Neck surgery. Jaypee Brothers Medical Publishers (P) Ltd.; 2013. 746 p.

2. Dhingra PL, Dhingra S. Diseases of Ear, Nose and Throat. 6th ed. Elsevier India; 2013. 490 p.

3. Hosemann W, Draf C. Danger points, complications and medico-legal aspects in endoscopic sinus surgery. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2013;12:Doc06. https://doi.org/10.3205/cto000098.

4. Stypinski MJ, Banaszewski J. Intranasal Synechiae as Complications of Rhinosurgical Treatment-A Review of Current Knowledge. J Clin Med. 2023;12(21):6831. https://doi.org/10.3390/jcm12216831.

5. Блоцкий АА, Блоцкий РА, Карпищенко СА. Способ лазерного иссечения синехий полости носа. Патент RU 2492835. 20.09.2013. Режим доступа: http://www.findpatent.ru/patent/249/2492835.html.

6. Sivabalaji K, Ali A, Bn A, Pv A, Tripathy R. Management of nasal synechiae with Kshara Sutra A case report. J Ayurveda Integr Med. 2021;12(3):540-543. https://doi.org/10.1016/j.jaim.2021.03.010.

7. Khatri H, Salati H, Wong E, Bradshaw K, Inthavong K, Sacks R, Singh N. Modelling the effects of post-FESS middle turbinate synechiae on sinonasal physiology: A computational fluid dynamics study. Auris Nasus Larynx. 2023;50(6):911-920. https://doi.org/10.1016/j.anl.2023.04.003.

8. Huseynov NM, Guliyev MD, Hashimli RM, Panakhian VM. Diode laser in the elimination of postoperative synechiae of the nasal cavity. Rossiiskaya Otorinolaringologiya. 2010;(6):18-20. (In Russ.) Available at: https://med-click.ru/uploads/files/docs/diodnyy-lazer-v-ustraneniiposleoperatsionnyh-sinehiy-polosti-nosa.pdf.

9. Lau K, Stavrakas M, Ray J. Lasers in Rhinology-An Update. Ear Nose Throat J. 2021;100(1 Suppl.):77S-82S. https://doi.org/10.1177/0145561320940115.

10. Karpishchenko S, Ulupov M, Gindryuk А, Kaplun D. Using thermal effect of 970 nm diode laser to reduce nasal swell body. Am J Otolaryngol. 2021;42(6):103165. https://doi.org/10.1016/j.amjoto.2021.103165.

11. Lenz H. 8 years’ laser surgery of the inferior turbinates in vasomotor rhinopathy in the form of laser strip carbonization. HNO. 1985;33(9):422-425. Available at: https://pubmed.ncbi.nlm.nih.gov/4077599/.

12. Lenz H, Eichler J, Schafer G, Salk J. Parameters for argon laser surgery of the lower human turbinates. In vitro experiments. Acta Otolaryngol. 1977;83(3-4):360-365. https://doi.org/10.3109/00016487709128857.

13. Komshian SR, Cohen MB, Brook C, Levi JR. Inferior Turbinate Hypertrophy: A Review of the Evolution of Management in Children. Am J Rhinol Allergy. 2019;33(2):212-219. https://doi.org/10.1177/1945892418815351.

14. Рябова МА, Улупов МЮ, Шумилова НА, Портнов ГВ, Тихомирова ЕК, Степанова ВА, Березкина ЕВ. Применение полупроводниковых и волоконных лазеров 0,53 мкм, 0,81 мкм, 0,97 мкм, 1,56 мкм и 1,94 мкм в хирургии хронических невоспалительных заболеваний полости носа. В: Петрищев НН (ред.). Актуальные проблемы лазерной медицины. СПб.: Ассоциация регенеративной эстетической медицины и Первого национального портала об эстетической медицине; 2022. С. 101-128. Режим доступа: https://www.elibrary.ru/blsvqq.

15. Рябова МА, Улупов МЮ, Шумилова НА, Портнов ГВ. Отработка практических навыков по лазерной хирургии в оториноларингологии. СПб.: Изд-во ПСПбГМУ, 2015. 37 с.

16. Doreyawar V, Gadag RP, Dandinarasaiah M, Javali SB, Maradi N, Shetty D. Inferior Turbinate Reduction: Diode LASER or Conventional Partial Turbinectomy? Ear Nose Throat J. 2021;100(2):NP125-NP130. https://doi.org/10.1177/0145561319839795.

17. Karpishchenko SA, Riabova MA, Ulupov MYu, Shumilova NA, Portnov GV. The choice of parameters for the laser application in ENT surgery. Vestnik OtoRinoLaringologii. 2016;81(4):14-18. (In Russ.) https://doi.org/10.17116/otorino201681414-18.

18. Gafurov SJu, Katahonov ShM, Holmonоv MM. Features of the application of lasers in medicine. European Science. 2019;3(45):92-95. (In Russ.) Available at: https://www.elibrary.ru/uxyokh.

19. Balouch B, Garabet R, Maxwell PJ, Sethi HK, Bress E, Ramadan O, Sataloff RT. The Safety and Efficacy of the 445-nm Blue Laser for Operative Management of Benign Nonvascular Laryngeal Lesions. J Voice. 2023:S08921997(23)00286-2. https://doi.org/10.1016/j.jvoice.2023.09.010.

20. Krivopalov AA, Korkmazov MYu, Shamkina PA, Glushchenko AI, Panchenko PI. Evaluation of the surgical effect of laser radiation on the biological model of the larynx. RMJ. 2024;(1):57-62. (In Russ.) Available at: https://www.rmj.ru/articles/otorinolaringologiya/Ocenka_hirurgicheskogo_vozdeystviya_lazernogo_izlucheniya_na_biologicheskuyu_modely_gortani/.