Although I don’t use radio surgery for every oral surgical procedure, there are certain indications where radio surgery is preferred over cold steel or laser. I’ve used the Delmarva 2000 HFR for mandibulectomies and maxillectomies where removal of skin, bone and mucosa was necessary and the unit has performed admirably.
Higher frequency units cause less collateral thermal damage than lower frequency units, and 4MHz is one of the highest, if not the highest, frequencies available in veterinary surgery. The hand pieces and cords are autoclavable. I like to use the bipolar forceps handpiece where pinpoint hemostasis is needed. With monopolar use, the current passes through the patient; with bipolar use, only the tissue grasped is within the electrical circuit.
Gingival enlargement is a common oral condition in dogs. It may result from formation of gingival tumors such as peripheral odontogenic fibromas, but when it is generalized throughout the mouth, it is commonly due to gingival hyperplasia. Left untreated, it may result in development of pseudopockets, which over time, leads to formation of true periodontal pockets and attachment loss of the tooth. The radio surgery unit with a wire loop or triangle attachment is my preferred instrument for removal of excess gingiva while maintaining a physiological bevel.
Some indications for radio surgery in dentistry/oral surgery
- Hemostasis- I avoid use directly at the edge of mucosal margins to minimize the likelihood of dehiscence, but I commonly use radio surgery in the submucosa, skin and subcutaneous tissues, which speeds surgical time and minimizes intraoperative and postoperative blood loss.
- Gingivoplasty- my preferred method of treatment in cases of generalized gingival hyperplasia.
- Oral tumor biopsy- loop or triangle attachment used to remove a pedunculated tumor at its base. Note that char artifact can make determination of pathologic margins difficult, so in cases where margin results are desired, cauterization after removal of mass with a scalpel may be desired, or use of a filtered setting during removal of the mass may minimize thermal damage to the histological sample.
- Tongue, palate and lip biopsies.
- Operculectomy- removal of the fibrous gingiva which sometimes prevents eruption of a tooth.
The Delmarva 2000 Veterinary HFR combines the benefits of a high frequency (4 MHz) radio surgery unit with ease of use and affordability.
John Lewis, VMD, FAVD, DAVDC