[Revision of the stapes foot plate with various laser systems. 1: Continuous laser irradiation]

During stapedotomy, the small dimensions and highly sensitive anatomic structures present require the highest degree of precision and safety. The risk of damage to middle and inner ear structures through manipulation with conventional instruments can be reduced by non-contact perforation of the footplate with the laser beam. The present study was devised to clarify which of the presently available laser systems was best suited for use in stapes surgery and thus represent a significant alternative to conventional stapedotomy. Isolated human stapes and bovine compact-bone platelets were used to investigate the connections between the parameters of various laser systems and their effects on bone tissue. The aim was to optimize the laser parameters required to achieve a perforation of 500 microns to 600 microns in diameter. In addition, the thermal effects of laser irradiation were assessed. Three different systems were employed: the argon and CO2 lasers in continuous wave (cw) modes and the CO2 laser in superpulse mode. The lasers investigated offered the advantage of achieving an adequately large perforation with one or a few juxtaposed applications but caused in part extensive thermal side effects at the stapes footplate. To reduce thermal effects, footplate perforation was best performed by several juxtaposed single shots at low power, short pulse duration and small beam diameter. The suitability of the argon laser for stapedotomy was rendered doubtful in view of the lower absorption coefficient of the stapes for the argon laser beam and the considerable influence exerted by the degree of pigmentation of the irradiated tissue sites with a resultant poor reproducibility of the perforation diameter.(ABSTRACT TRUNCATED AT 250 WORDS)