CO2 laser cryptolysis by coagulation for the treatment of halitosis

The aim of this study was to evaluate the impact of CO(2) laser cryptolysis by coagulation (LCC) treatment in the volatile sulphur compounds (VSC) halitometry in patients with chronic caseous tonsillitis (CCT).

Caseum retention and halitosis characterize CCT. Failure of clinical treatment indicated tonsillectomy. Recently, a conservative new treatment, CO(2 )LCC, has been introduced. It is painless and opens the crypt ostium, thus avoiding caseum retention. Halitometry is an objective new method for halitosis diagnosis. It measures VSC in parts per billion (ppb) in breathed air.

Thirty-eight patients with CCT and complaints of halitosis were selected, underwent physical examination and halitometry measurements, and then received four sessions of LCC. The laser technique consisted of 6-W applications, in scanned and unfocused mode, around crypts, following the shape of their openings (fluence 54.5 joules/cm(2)) and, afterwards, over the entire tonsillar surface (fluence 18 joules/cm(2)). Halitometries were done before each LCC session.

LCC was well tolerated by all patients, and all patients showed improvement in halitosis after LCC treatment. Eight patients (21%) had abnormal halitometry (>150 ppb) before treatment, but after LCC sessions their halitometry values became normal. These patients had caseum at examination. VSC measurement was reduced by 30.1%, and caseum retention was significantly decreased in this group.

Abnormal halitometry in this population is related to the presence of caseum. LCC is safe, well tolerated, and improves complaints of halitosis in patients with CCT. Improvement was related to a decrease in caseum retention. Patients with abnormal halitometry had VSC halitometry improvement of approximately 30%.