Histopathological Evaluation in Biopsies of Palatine Tonsils Submitted to Cryptolysis by Coagulation with CO 2 Laser for Treatment of Chronic Caseous Tonsillitis

Abstract

Objective: To perform histopathological evaluation in biopsies of palatine tonsils in a group of patients, with symptoms of chronic caseous tonsillitis, treated with an innovative and conservative method, using CO₂ laser. Background Data: In general, the treatment of chronic caseous tonsillitis with CO₂ laser, as described in the literature, refers to the clinical experience of the authors and, the technique used for criptolysis encourages tissue vaporization, which leads to the consequent reduction of the tonsillar parenchyma. Materials and Methods: The individuals were submitted to cryptolysis coagulation with only 6 W of CW, CO₂ laser power, in scanned and unfocused mode, over a mean area of 2.2 mm diameter, leading to energy doses from 18 to 54.5 joules/cm². Biopsies were performed at the beginning and end of each treatment. A comparative analysis was performed between the initial and final biopsies taking into consideration possible alterations in the following: germinal centers, lymphoid tissue, sub-epithelial fibrosis, and parenchyma fibrosis. Results: The histopathological analysis of these biopsies showed that the laser, used at a specific energy density, could relieve the symptoms of the disease causing neither increase of the fibrotic content nor decrease of the lymphoid structure. The action of the laser, following the proposed technique, is superficial, causing only epithelial coagulation, which enables a weakening of the tension forces in the crypt borders, causing them to open. This effect results in the reduction and even disappearance of caseous retention. Conclusion: We, therefore, conclude that the proposed method of treatment with CO₂ laser, called laser cryptolysis by coagulation (LCC) is an effective and conservative method, causing no significant morphological alterations to the tonsils.