1. BELARUSIAN МEDICAL POSTRGRADUETED AKADEMY
WELCOM TO BELARUS
Professor, Ph.D., Dr. Sc. Elena Merkulava
Dr. Aleksandre Kobakhidze
Minsk, Republic of Belarus
Good afternoon dear colleagues,
I am a professor in the Deparment of Otorhinolaryngology at Belarusian Medical Academy of Postgraduate Study. It is the first time we take part in such a respectable conference, therefore let me tell you a little bit about our country.

2. MINSK – THE CAPITAL OF BELARUS
Belarus is situated in the geographical centre of Europe.
The Belarusian medical postgradueted Akademy is in the city of Minsk, the capital of Belarus

4. PATHOLOGY OF UPPER RESPIRATORY WAYS IS A TOPICAL PROBLEM
Medical aid is free and financed by budget. Climatic peculiarities of our country such as high humidity and marsh-ridden soils also play a definite role in a frequent pathology of the respiratory tract.

5. PEOPLE LIVING ON MARSH – LAND
Belarusian people call themselves “people living on a marsh- land”.

6. CLIMATIC PECULARITIES – HIGH HUMIDITY
Thus, cases of sinusitis occur frequently in both adults and children.

7. Minimal Invasive Laser Surgery of the Nasal Septum
BELARUSIAN МEDICAL POSTRGRADUETED AKADEMY
Minimal Invasive Laser Surgery of the Nasal Septum
Professor Ph.D., Dr.Sc. Elena Merkulava
Dr. Aleksandre Kobakhidze
As professor Orlandi noted in their presentation during a World Congress in Paris this year, formation of chronic purulent sinusitis is caused by the action of the variety of factors. At the same time, literature presents contradictory research on the pathogenesis of the disease and the condition of the ostiomeatal complex and nasal septum deviation at etiology of sinusitis.
Now I am going to give the mikropone to Dr. Kobachidze, who made our research

8. Laser surgery
When we are talking about laser surgery of nasal septum, we moustly mean the surgery of nasal cartilage, but this is not so,

9. because we have to make into the consideration that, we have different tipes of nasal septal deviations and one of this is thickness of nasal septum, which we call also swell body, now I am going to talk about laser surgery of swell body, whereas according to the results, laser surgery for cartilage is not appropriate and better not to use laser

10. ?..
Nasal swell body(NSB)
what is the nasal swell body?

11. Anatomical characteristics
Histological evaluation
Functions
to answered the question We will mark (note) three main carascteristics

12. Nasal swell body(NSB) anatomical characteristics
Thickest and widest region of the nasal septum
Located at the level of the internal nasal valve
Anteriosuperior portion of the nasal septum
Overlying the cartilage and bone
The nasal swell body (NSB), is the thickest and widest region of the nasal septum, which is located superior to the inferior, and anterior to the middle turbinate. It consists of mucosa and a marked soft tissue overlying the cartilage and bone. Both cartilage and mucosa is thicker here compared to the other parts of the nasal septum
Nasal Septal Swell Body* (NSB) sagital CT image

13. Histological evaluation of the NSB
venous sinusoids, vascular structures
glandular and vaso erectile tissues
connective tissue
Copyright © 2010 American Medical Association. All rights reserved.
Hematoxylin-eosin–stained photomicrographs of the nasal septal swell body (NSB). The SB shows connective tissue (ct), glands (g), and thin-walled venous sinusoids (s) (original magnification ×40). (Arch Otolaryngol Head Neck Surg. 2010;136(11): doi: /archoto )

14. = Nasal swell body(NSB) Septal turbinate
Histological evaluation of the NSB is very simmilar to nasal turbinate and that’s why it is also called the septal turbinate/
Computed tomography evaluation of the NSB showed vasoactive properties but not as much as in the inferior turbinate

15. Nasal swell body(NSB) functions
Regulation of nasal airflow
Secretory function
one of the most Important role in regulation of nasal airflow, secretory function

16. Can produce a significant effect on nasal resistance.
Nasal obstruction
Nasal Septal Swell Body* (NSB) coronal CT image
Based on this carascteristics in the absence of the nasal septal deviation can produce a significant effect on nasal resistance,
And nasal obstruction
Nasal Septal Swell Body* (NSB) axial CT image

17. Treatment of nasal swell body
Medicinal treatment
Surgical correction (inadequacy of medicinal treatment)
management of anatomic nasal obstruction caused by swell body has become commonplace and has been shown to improve nasal airflow.
For this we have medicinal treatment and surgical

18. surgical correction Classical surgical treatment septal swell body
RadioFrequency Ablation of Septal Swell Body
are suggested different types of surgical treatment of nasal swell body, when after operation risk of mucosa and cartilage damage and septal perforation as a result are high

19. laser surgery of the nasal septal swell body
A surgical method with minimal damage of the cartilage and mucosa has not been developed yet, that allows us to offer experimental laser vaporization of the NSB

20. We We decided to try it out experiments on rabbits

21. The aim of our experiment
To work out length and frequency of laser wave
Suggest minimally invasive laser surgery of swell body.
Minimize risk of damage cartilage and mucosa
The aim of our experiment is to work out length and frequency of laser wave and suggest minimally invasive laser surgery of swell body

22. Experiment Rabbits (N=4)
Thulium laser (with different emitter parameters)
Different types of laser attachment
Histological research.
In the experiment participated 4 rabbits (N=4) to which were applied different frequency and wavelength laser surgery on a swell body by the “Mediola Compact”-Thulium laser. We carried out an acute experiment on two rabbits, for first rabbit emitter parameters was 1560 nm and 3wt, 5wt, 6wt, 9wt, and 970 nm and 3wt, 5wt, 6wt, 9wt. Based on visual effects for the next rabbit we have chosen 1560 nm and 6wt and 7wt, and for another two chronic experiment we also have used 1560 nm and 6wt and 7wt emitter parametres. materials were sent to pathohistological research.

23. Acute experiment wavelength 1560 nm 970 nm Power 3w, Power 3w,
In the experiment participated 4 rabbits (N=4) to which were applied different frequency and wavelength laser surgery on a swell body by the Thulium laser. We carried out an acute experiment on two rabbits, for first rabbit emitter parameters was 1560 nm and 3wt, 5wt, 6wt, 9wt, and 970 nm and 3wt, 5wt, 6wt, 9wt. Based on visual effects for the next rabbit we have chosen 1560 nm and 6wt and 7wt, and for another two chronic experiment we also have used 1560 nm and 6wt and 7wt emitter parametres..

24. materials were sent to pathohistological research

25. Results
Hematoxylin-eosin–stained photomicrographs of the rabbits nasal septal swell body (SB) After the laser impact 970 nm, power 3W. The SB shows connective tissue (ct), glands (g), and thin-walled venous sinusoids (s) (original magnification ×150).

26. Results
Hemorage zone
Histological research of rabbits nasal septum showed that, damage of the mucous membrane and cartilage, the lowest was when vaporization NSB have been done with laser, frequency 1560 nm and 7wt. and swell body decreased in size 4-5 times.
Hematoxylin-eosin–stained photomicrographs of the rabbits nasal septal swell body after the vaporisation . After the laser impact 1560 nm, power (I)7W. (II)9W The SB shows connective tissue (hemorrhage) (ct). Laser vaporization zone (lv), cartilage (c) Flat epithelium (fa) (original magnification 100).

27. according to experiment laser vaporisation of NSB with emitter parameters: wavelength-1560 nm and power-7W is a safe and effective treatment option for the correction of nasal obstruction, caused by nasal swell body.

28. If we do an operation with 7wats, there is high risk postoperative nasal septal perforation
The mucus membrane is much more resistant to laser radiation than connective tissue
An ideal parameter for swell body surgical treatment (laser vaporization) is 6-7 wat