Palatal stiffening via transoral, retrograde interstitial laser coagulation

Current treatment modalities for snoring may include mucosal removal, coblation or radiofrequency palatoplasty, injection snoreplasty and placement of palatal implants with described disadvantages. We introduce a new laser assisted method avoiding intraoral injury. A pilot study treating 13 loud snorers having an RDI<8 was conducted. A diode laser coupled to a flexible fiberand a handle with curved needle was used. The fiber was introduced into the nasal surface of soft palate between palatoglossal and glossopharyngeal arches and advanced progressively anteriorly after pulling the uvula forward three times to create palatal scarring and stiffening. All responded to a phone survey. Six patients reported significant improvement, 4 had some improvement, 2 had mild improvement and one patient had no change. Pain score was moderate for 3 patients while the rest had mild pain. The laser harbors many advantages over other methods. Results with this technique are encouraging further studies

Laser disruption of biofilm

Objectives/hypothesis: to demonstrate the capability of a fiber-based Q-switched Nd:YAG laser (ARCLaser, Nuremberg, Germany and Valam, Orangeburg, NY) to disrupt biofilm. Study design: biofilms were grown in broth for 72 hours prior to the experiment. A clinical otorrhea isolate from Pseudomonas aeruginosa was used. Biofilms were placed in MatTek culture plates, on stainless steel screws, tympanostomy tubes, and polyethylene terephthalate (PET) sutures. Methods: culture plates, stainless steel screws, tympanostomy tubes, and PET sutures were used for the laser disruption of biofilm experiments. Q-switched Nd:YAG laser pulses were delivered on biofilms using shockwave probes originally designed for cataract surgery. The thin laser fiber tip was targeted against a titanium target, creating the production of plasma and resulting in a shockwave effect. Results: biofilm areas were imaged before, during, and after laser application using a confocal microscope. The biofilm was imaged growing on the glass/plastic step of the plates, in the grooves of the threads of the screws, over the tympanostomy tube, and on the PET suture. During laser treatment, a time-lapse function was used to capture the results. As a result of laser-generated shockwaves, the biofilm was initially seen to oscillate and eventually break off with individual pulses. Large and small pieces of biofilm were totally and instantly removed from the surface to which they were attached in a matter of a few seconds. Conclusions: we were able to effectively disrupt Pseudomonas aeruginosa biofilms in vitro using a miniature Q-switched Nd:YAG laser, thin fibers, and special probes that generated plasma formation and a resulting shockwave effect. This laser technology has the ability to generate a powerful stress wave sufficient to disrupt biofilm without any ill effect to the underlying host structure

Laser-Generated Shockwave for Clearing Medical Device Biofilms

Objective: This study aimed to evaluate a laser method of biofilm interruption from the surface of various common medical devices and from surgically removed sinus tissue with adherent biofilms in a timely manner. Background: Biofilm has emerged as a new threat not amenable to most antibiotic treatments. Biofilms, as opposed to planktonic bacteria, develop an extracellular polymeric slime matrix to facilitate adherence to host tissue or a prosthetic surface and to form a protective shield. A laser-induced biofilms disruption concept was previously described. Materials and Methods: Biofilms were grown in the laboratory on metallic and plastic medical device surfaces such as stents. Attempts to remove the biofilms with a laser were undertaken three times for each device. Q-switched Nd:YAG laser-generated shockwaves affecting Pseudomonas aeruginosa biofilms expressing yellow fluorescent protein (YFP) biofilm coating were applied with biologically safe parameters utilizing a fiber delivery system and a special probe. A confocal microscope was used to identify the biofilm structure prior to, during, and after laser application. The amount of biofilm removed from the medical devices in time was measured by quantifying green fluorescence. Results: The biofilm fluctuated and eventually broke off the surface as shock waves neared the target. The time to remove 97.9±0.4% (mean±1SD, n=3) the biofilm from the surface of a Nitinol (NiTi) stent ranged from 4 to 10s. The detached biofilm was observed floating in fluid media in various microscopic size particles. Conclusions: A new treatment modality using laser-generated shockwaves in the warfare against biofilms growing on surgical devices was demonstrated. Q-switched laser pulses stripped biofilm from the surface it adhered to, changing the bacteria to their planktonic form, making them amenable to conventional treatment. This therapeutic modality appears to be rapid, effective, and safe on metallic and plastic medical device surfaces

Laser disruption and killing of methicillin-resistant Staphylococcus aureus biofilms

OBJECTIVE: The aim of the study was to study the efficacy of 2 different lasers in vitro, in disrupting biofilm and killing planktonic pathogenic bacteria. MATERIALS AND METHODS: Biofilms of a stable bioluminescent of Staphylococcus aureus Xen 31 were grown in a 96-well microtiter plate for 3 days. The study included 7 arms: (a) control; (b) ciprofloxacin (3 mg/L, the established minimum inhibitory concentration [MIC]) alone; (c) shock wave (SW) laser alone; (d) near-infrared (NIR) laser alone; (e) SW laser and ciprofloxacin; (f) SW and NIR lasers; (g) SW, NIR lasers, and ciprofloxacin. The results were evaluated with an in vivo imaging system (IVIS) biophotonic system (for live bacteria) and optical density (OD) for total bacteria. RESULTS: Without antibiotics, there was a 43% reduction in OD (P < .05) caused by the combination of SW and NIR suggesting that biofilm had been disrupted. There was an 88% reduction (P < .05) in live biofilm. Ciprofloxacin alone resulted in a decrease of 28% of total live cells (biofilm remaining attached) and 58% of biofilm cells (both P > .05). Ciprofloxacin in combination with SW and SW + NIR lasers caused a decrease of more than 60% in total live biomass and more than 80% of biofilm cells, which was significantly greater than ciprofloxacin alone (P < .05). CONCLUSIONS: We have demonstrated an effective nonpharmacologic treatment method for methicillin-resistant Staphylococcus aureus (MRSA) biofilm disruption and killing using 2 different lasers. The preferred treatment sequence is a SW laser disruption of biofilm followed by NIR laser illumination. Treatment optimization of biofilm is possible with the addition of ciprofloxacin in concentrations consistent with planktonic MIC