USE OF THE ER-YAG LASER FOR IMPROVED PLATING IN MAXILLOFACIAL SURGERY- COMPARISON OF BONE HEALING IN LASER AND DRILL OSTEOTOMIES

Background and Objective: Surgical reconstruction of bony defects in t he maxillofacial region involves fixation of bony fragments with mini and micro plates. Bone stabilization during hole drilling is often cha llenging due to the need to apply pressure when using a conventional m echanical Hall drill. In addition, fragmentation of the fragile bones may occur and complicate the reconstruction. The pulsed Er:YAG laser o ffers an attractive alternative drilling modality because it does not require physical contact with the bone in order to drill holes, cuts b one with minimal thermal damage, and allows precise control of bone cu tting. The objective of this study was to investigate the pulsed Er:YA G laser as an alternative to the mechanical bur by comparing bone heal ing using both modalities. Study Design/Materials and Methods: Bone he aling in an inferior border defect of the rat mandible was examined us ing either an Er:YAG laser or a mechanical bur for drilling. The heali ng of osteotomies in facial bones and of screw holes for plate stabili zation of free bone fragments was studied. Results: All defects healed by 4 weeks postoperatively. Histologic evaluation demonstrated no dif ference in the amount of newly formed woven bone at the osteotomy site or screw holes made by either the laser or the drill. The extent of t hermal damage at the osteotomy sites was comparable in laser and mecha nically cut bone fragments. Conclusions: On the basis of this study we suggest that the Er:YAG laser can be used clinically in thin, fragile bones in the maxillofacial region. (C) 1996 Wiley-Liss, Inc.