Background: Posttraumatic nerve repair and prevention of muscle atrophy represent a major challenge in restorative medicine. Considerable interest exists in the potential therapeutic value of laser phototherapy for restoring or temporary preventing denervated muscle atrophy as well as enhancing regeneration of severely injured peripheral nerve. Methods: I-Muscle and Peripheral Nerve Experimental Studies: low power laser irradiation (laser phototherapy) was applied for treatment of rat denervated muscle in order to estimate the biochemical transformation at cellular and tissue levels, as well as in a rat sciatic nerve model after crush injury, direct anastomosis and neurotube reconstruction. II- Intraoperative Clinical Study: following microsurgical release and neurolysis the nerve was subjected to direct laser irradiation using fiber optics. III- Clinical double-blind, placebo-controlled randomized study: based on the outcome of the animal trials, a clinical trial, which measured the effectiveness of 780-nm laser phototherapy on patients suffering from incomplete peripheral nerve injuries for 6 months up to several years, was designed. Results:Experimental model of denervated muscle: the animal study suggested that function of denervated muscles was partially preserved by temporary prevention of denervation-induced biochemical changes. The function of denervated muscles was restored, not completely but to a very substantial degree, by laser treatment, initiated at the earliest possible stage post-injury. Experimental peripheral nerve injury: laser phototherapy had an immediate protective effect, maintained functional activity of the injured nerve, decreased scar tissue formation at the injury site, decreased degeneration in corresponding motor neurons of the spinal cord and significantly increased axonal growth and myelinization. Intraoperative clinical study: direct laser irradiation was shown to improve functional activity of the surgically treated nerve. Clinical, double-blind, placebo-controlled randomized pilot study: in patients with incomplete long-term peripheral nerve injury, it was demonstrated that 780-nm laser irradiation progressively improved peripheral nerve function, which lead to significant functional recovery. Conclusions: Laser phototherapy temporarily preserves the function of a denervated muscle and accelerates and enhances axonal growth and regeneration after peripheral nerve injury or reconstructive procedures. Animal and clinical studies have both demonstrated the promoting action of phototherapy on peripheral nerve regeneration, which makes it possible to suggest that the time for broader clinical trials has come.
The effectiveness of low level laser therapy (LLLT) for pain relief and improved range of motion (ROM) in shoulder periarthritis was investigated, and serum prostaglandin E2 (PGE2) levels were measured to evaluate the underlying mechanism of LLLT action. This study included 40 women with a mean age of 62.7 years and mean symptom duration of 2.8 months. LLLT was effective in 32 patients (80%). In the “effective” treatment group, visual analog scale (VAS) pain scores, range of abduction, flexion, and internal rotation, and serum PGE2 levels improved significantly. A correlation was observed between improvement in each ROM and VAS scores, and both were useful as indices of symptom improvement and treatment efficacy. PGE2 also decreased significantly after laser therapy and played a role in pain symptoms, but there was no correlation with improvement in the ROM or VAS scores. Thus, serum PGE2 levels did not reflect the degree of shoulder function or pain. In the “ineffective” treatment group, no improvement, no correlation between ROM and VAS scores, and no change in serum PGE2 levels after laser therapy were observed. This seems to represent a special group.
Lymphangioma is a congenital malformation of the lymphatic system which usually occurs in children before the age of two years. Treatment options include surgical excision, radiation, aspiration, incision and drainage, and image-guided sclerotherapy, but the results have been unsatisfactory. Lymphangioma is histologically benign, but invades the surrounding structures so that local recurrence is common and the complication rate is high. Low reactive Level Laser Therapy (LLLT) is known for its beneficial effects such as pain attenuation, accelerated or enhanced wound healing, increased blood flow following LLLT and improvement of lymphatic flow. We report an unresectable lymphangioma patient who was treated with LLLT. Before LLLT, she had been suffering from lymphedema, cutaneous lymphorrhea, and pain. After LLLT, the lymphedema had improved and the cutaneous lymphorrhea and pain had completely resolved. We suggest that LLLT might become a successful treatment option in case of unresectable lymphangioma following lymphedema and cutaneous lymphorrhea.