The greatest advantage of radiosurgery in veterinary dentistry and oral surgery is the ability to incise tissue with minimal tissue damage and accelerated healing. General practitioners have used antiquated electrocautery units for coagulation purposes and to remove minor dermal growths for decades. The newer 4.0 MHz radiowave surgery technology (I use Ellman International's) is a high-frequency, low-temperature technology that minimizes heat dissipation and thus reduces cellular alteration. This allows for greater patient comfort post surgery, enhanced healing and excellent tissue sample "readability" by the histopathologist. This new radiosurgery modality gives the surgeon the ability to cut with simultaneous coagulation. Cutting can even occur in juxtaposition to bone in the fully-filtered, fully-rectified mode at 4.0 MHz frequency without any danger of bone necrosis. A major advantage of this technology in oral usage is the production of "clean, blood free" surgical fields not noted with the scalpel as a cutting tool (see photo enclosures). There is also the elimination of surgeon-induced secondary infection that has been shown to be directly related to the scalpel. Ellman 4.0 MHz radiosurgery allows precise carving, sculpting and recontouring of oral soft tissues with a pressureless incision that is consistent with ergonomic standards of quality performance in the veterinary operatory. A variety of specialized inserts (i.e. active electrodes) are available for multiple surgical applications in all areas of dentistry. These electrodes bend for accessibility to difficult-to-reach areas in the oral cavity. Radiowave Technology The active electrode or cutting tip does not become heated in radiowave surgery. It is the tissue that provides the resistance. In other words, current is sent into the radiosurgery unit which is then converted to multiple waveforms. As the radiowave energy leaves the cutting tip, it causes intracellular water to boil and volatilize (i.e. intracellular volatilization). The energy that left the active electrode tip and has been transmitted to the tissue is then picked up by a neutral, passive electrode and returned to the radiosurgery unit. The Ellman ground plate is covered with Teflon which keeps bare metal from touching the patient or surgeon, prohibiting the potential of burn or shock. The ground plate or passive electrode functions like an antenna to attract the released energy and return it to the radiosurgery unit. The passive electrode does not have to contact the patient. It must be as close to the operatory field as possible to allow increased efficiency of operation. The active electrodes or inserts are bendable and fully autoclavable. In veterinary oral surgery and dentistry, the general practitioner has a large array of electrode choices. Listed in Table 1 are the Ellman inserts that are used most frequently at all Connecticut and New York Specialty Centers for Oral Care. Radiowave surgery is not just for the specialist. General practitioners can utilize this technology for many oral procedures, soft tissue surgeries, dermatologic biopsy, in exotic surgery and in the ER room. Table 2 lists common oral surgery usages for radiowave surgery for the general practitioner. Testimony from Specialists "Radiosurgery uses radiowaves of 4MHz to incise, ablate and coagulate without damaging surrounding tissue. In fact, in many ways, using radiowave surgery is much more like laser surgery than either electrocautery or conventional surgery, but without the expense, the char, or the photonic hazards. "Radiosurgery is excellent for removing a variety of cutaneous lesions such as sebaceous gland hyperplasia, skin tags, basal cell tumors, nevi and keratoses. Even deeper and larger lesions can be managed by utilizing the Vari-tip or scalpel blade electrodes to make more traditional elliptical incisons." Lowell Ackerman, DVM, Dipl. ACVD, American and Canadian Academies of Veterinary Dermatology "Four MHz radiofrequency has wide utility in small animal practice, especially for the practitioner wishing to do endodoscopic surgery or wanting to do Ôlaser' type of surgeries without the expense and hassle of lasers. "Radiofrequency surgery has many uses for reconstructive and plastic surgery especially for tumor resection and in vascular areas, such as around the head, distal limbs and rear areas." Clarence Alvin Rawlings, DVM, Ph.D., Dipl. ACVS "High frequency, low temperature radiosurgery has surged to the forefront in most surgical disciplines within the last five years. Why is this? Research has shown that 4.0 MHz frequency is ideal for cutting and obtaining biopsies. Minimal lateral heat is produced resulting in excellent healing with a good cosmetic appearance." Derrell Elkins, DVM, Dipl. ACVS --- Dr. DeForge is a fellow of the Academy of Veterinary Dentistry and adjunct instructor at Northwestern Connecticut Community College in oral radiology and periodontology. His website is www.vetdent.com.
