Dr.JYOTHISH.

K
 It is the process of rapidly freezing tissue by exposing
it to intensly low tempratures.

 Cryosurgery works by taking advantage of the

destructive force of freezing temperatures on cells.

 At low temperatures, ice crystals form inside the cells,

which can tear them apart.

 More damage occurs when blood vessels supplying the

diseased tissue freeze

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 Ice towels
Ice packs
Immersion
Ice cube massage
Ice spray
TECHNIQUES
OF Cold gel
APPLICATION
OF
CRYOTHERAPY

3
 Reduces pain.

Reduces muscle spasm.

Reduces swelling.
USES OF
ICE THERAPY
Promote repair of the damaged tissues.

Provide excitatory stimulus to inhibited muscles.

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 Greek word“kryos” means frost
 Local application of low temperature was first used by egyptians for
pain relief, then during franco-american war for amputated limbs
 James Arnott, in 19th century, stated that a very low temperature will
arrest every inflammation which is near enough to the surface.
 The first cryogens were liquid air and compressed carbon dioxide
snow. Liquid nitrogen became available in the 1940s and currently is
the most widely used cryogen.
 In 1961, Cooper and Lee developed the first cryotherapy probe system,
involving the circulation of liquid nitrogen through a closed metal tube
placed in direct contact with the target tissue.
 Liquid nitrogen (most commonly used) : -196°C
 Nitrous oxide : - 89°C
 Solidified CO 2 (dry ice, CO 2 snow) : -78°C
 Chlorodifluoromethane : -41°C
 Dimethyl ether and propane : -24°C (42°f)
 Argon
Liquid nitrogen
 Common method, The super-cooled liquid may be sprayed
using cryogun on the diseased tissue, cryoprobe, or simply
dabbed on with a cotton or foam swab.

Carbon dioxide
 Less frequently, doctors use “carbon dioxide snow" formed into
a cylinder or mixed with acetone to form a slush that is applied
directly to the tissue.
Argon
 Recent advances in technology have allowed for the use of argon
gas to drive ice formation using a principle known as the Joule-
Thomson effect. This gives physicians excellent control of the
ice, and minimizing complications using ultra-thin 17 gauge
cryoneedles.

Dimethyl ether – propane

 A mixture of dimethyl ether and propane is used in some
preparations such as Dr. Scholl's Freeze Away. The mixture is
stored in an aerosol spray type container at room temperature
and drops to −41 °C when dispensed. The mixture is often
dispensed into a straw with a cotton-tipped swab.
 The apparatus consists of a container in which the pressurised
refrigerant media (gases) are stored as liquid gases.

 It generates liquid nitrogen at temporature of -196*c

 Other refrigerants are carbon dioxide, nitrous oxide, & freon which
may reach temprature of -20* to –90*
 A probe is connected to the content to the tube

 This probe is applied on the region of the abnornal tissue

 Time depends on temprature, size of lesion & type of tissue

 Freezing & thawning are done alternatively as many times as

necessary for the lesion

 This process destroyes the tissue

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 There are two systems and both require a
cryogen.

 1. Open system: It involves direct application by

cotton pellets or as spray, the heat is released
by vaporization due to drop in temperature.
Used when no control over depth is required

 2. Closed system: This is based on three

principle thermoelectric, evaporative and Joule
Thomson effect. Used when depth orientation is
required.
 SPRAY

 PROBE

 FORCEPS

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 Probe freezing: It is done by direct application of a probe tip
to the lesion. The cryogen circulates through the probe tip
and super cools it, when allowed to contact the target tissue.

 In contact freezing, firm contact is made between the cryoprobe and the target
tissue.

 While in penetration freezing probe penetrates the target tissue, providing

a large area of direct contact.

 Spray freezing: It is done by direct application of the liquid

nitrogen to the tissue and is the most destructive method.
Liquid nitrogen is delivered to the target tissue at such a
volume and velocity that it evaporates at the edge of the
lesion.
• The application of liquefied N₂0 sprayed directly
on the skin will bring temperature fully under
control (nitrous oxide always evaporates at (-
)127⁰

• Sophisticated micro-applicator technology enables

an unprecedented level of accuracy of treatment
from 1mm. The prevention of trauma to
surrounding tissue will assure patient’s comfort

• The pressure of the spray at 721 psi will give

maximum control over depth of freezing and will
guarantee the results of the treatment.
• The penetration of the ice crystal into the lesion as a result of cryosurgery with the CryoProbe will go
faster and deeper with minimal surface trauma.

• The freezing rate of CryoProbe is 1mm

per 5 seconds

• Depth of treatment: the CryoProbe freezes up to a maximum 5 mm cell structure

Very cold gases are then passed through the needles, creating ice balls that destroy
the gland(tumor).
18
The destructive effect of freezing tissue has been categorized into
two major mechanisms

 Immediate cell destruction  Direct effects

 Delayed cell destruction  Indirect effects

1. Ice crystal formation:
Rapid cooling causes formation of ice crystals from
intracellular and extracellular fluid resulting in physical
disruption of cell

2. Thermal shock:
Damage of cell membrane due to freezing occurs and this
alters cell permeability leading to cell death.

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3. Cellular dehydration and electrolyte disruption:

 Initially during freezing the extracellular fluid alone forms ice which is

limited by intracellular fluid and there is increase concentration of

electrolyte in the extracellular fluid this causes movement of intracellular

fluid to extracellular spaces where they again form ice crystals.

 This results in dehydration of cell, cell shrinkage, intracellular increase in

electrolyte which is toxic to the cell and all together causes’ cell death.

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4. Enzyme inhibition:
 Each enzyme requires particular temperature for their
functioning which when altered prevents their function.

5. Effect on proteins:
 During the phase after cooling when the cells return to normal
temperature imbibes more water as it has high concentration
of electrolyte which result in swelling and rupture

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1. Vascular effect:

 Ischemic necrosis results due to vascular thrombus and

micro-thrombus formation.

2. Immunological effect:

 Massive release of pathological cell antigen occurs making

them susceptible for host surveillance mechanism.

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o Temperature

o cooling rate

o Thawing rate

o Freeze duration

o Repetitive freeze- thaw cycle

 Cooling rate

• In cryosurgery, rapid cooling rate i.e. more than

500C/min produces intracellular ice- crystals which is
more destructive
• Such higher rates of cooling can only be achieved close to
the cryoprobe
Temperature

• Mazur stated that the lethal temperature range is between

-50C to -500C.
• The treatment of tumor requires a tissue temperature at
which all the abnormal cells are certainly dead.
Thawing rate

• Thawing rate should be slow and continued for longer time

period; rapid thaw rates allow cell survival.

Repetitive freeze- thaw cycle

• Rapid freezing and slow thawing do not guarantee effective

cell destruction.
• Use of repeated freeze-thaw cycle is also beneficial in
treatment of cancerous tumor
Benefits of Cyrosurgery in Veterinary Medicin
 Minimal/Painless

 No open wounds – No Bleeding

 No suturing

 No general anthesia – safe for older

 Rapid treatment time – only seconds

 Pinpoint Accuracy

 Less discomfort ,no hospitalization/minimal post op care.

 Predictable, low tissue damage.

 Minimal or no scarring.

 Can be an adjunctive therapy with surgery or radiation therapy in

malignancy.

 Safe, easy to perform, inexpensive.

 1.Healing is slow

 2. In lesions of the tongue the procedure can limit its function.

 3. Volume of lesion can be beyond capacity

 4. Extensive lesions are difficult to treat.

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Disadvantages of Cryosurgery
As with the advantages of cryosurgery, the disadvantages can also be categorized into those for the clinician and
those for the patient.

Disadvantages for the clinician include the following:

 Liquid nitrogen needs to be delivered and stored. A liquid nitrogen generator may be purchased. If that is not
done, nitrous oxide tanks or other supplies will need to be replenished as needed.
 The clinician must be certain of the diagnosis because no tissue will be sent for pathology.
 Cryosurgery is not as accurate as a scalpel or laser in cosmetic work.

Disadvantages for the patient include:

 Erythema and swelling are the norm. Blistering is common.
 May require multiple visits.
 Hypopigmentation.
 Damage to adjacent structures such as joints and bones may lead to lameness and fracture.
 Risk of uncontrolled freezing - resulting in destruction of normal tissue.
 Accurate Pinpoint Precision, Freezing Power
and Pressure with the touch of your Fingertip!

 Manufacturers have devised various metal

attachments to serve as heat-conducting probes
for cryotherapy. Copper, because of its high
conductivity, is typically used
 CryoProbe’s different micro
applicators tips allow pinpoint
accuracy to treat skin lesions from
1mm to 8mm in size!

Blue dot applicator White dot applicator Green dot applicator Yellow dot applicator
Applications 1-3 mm Applications 2-4 mm Applications 3-6 mm Applications 4-10 mm
 Simple pencil type grip for easy use .
 Very accurate application .
 Freezes to -89ºC and to a depth of 3mm .
 Interchangeable ‘contact’ heads for special applications
including GUM, Podiatry & Dermatology .
 Avoids all of the storage and transport problems associated with
traditional cryotherapy
 Once a cylinder has been attached CryoAlfa can be kept in a
drawer without degradation of the N20 contents for
approximately 3 months .
 Can be easily transported for use in home visits .
 The level of cold generated can be adjusted by the rate at which
the button is depressed.

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With the CryoProbe you will be able to treat (but not limited) to the following lesions successfully:
• Adenomas

• Epuli

• Pappilomas

• Granulomas

• Warts

• Small Sarcoids

• Eye Lid Tumors

You will be able to quickly and easily treat skin lesions that you could not treat before without
undesired side effects!
 ACTINIC CHELITIS

EROSIVE LICHEN PLANUS SKIN TAGS

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 VIRAL WARTS

SOLAR KERATOSES
SEBORRHOEIC KERATOSIS
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 TOUNGE CARCINOMA

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RT/15/CRYOSURGERY/45 3/8/2017 5:27:52 AM 44
 VASCULAR MALFORMATIONS

 LEUKOPLAKIA

 HYPERPLASTIC LESIONS

 MUCOUS CYST

 FACIAL PAIN

 TMJ PAIN

 ORAL CANCER

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46
 1. Cold urticarial patient develop redness and swelling in the skin

 2. Cryoglobulinemia, abnormal blood protein results in gel formation

resulting in ischemia or gangrene

 3. Raynaud’s phenomena

 4. Paroxysmal cold hemoglobinuria,hemoglobin is released from

lysed red cells and is excreted in urine

 5. Peripheral vascular disease

 6. Patients undergoing immunosuppressive therapy

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 Cardiac Conditions

Psychological:
CONTRA- Peripheral Nerve Injuries
INDICATIONS
TO ICE Vasospastic Disease
TREATMENT
Peripheral Vascular Disease

Cold Sensitivity

RT/15/CRYOSURGERY/45 3/8/2017 5:27:52 AM 48

 Cryotherapy is an effective treatment method for a variety of lesions of the

head and neck region. It is advantageous over surgery and is well accepted

by patients.

 Many a times it is used when the conventional therapy either fails or is

contraindicated. But unless the physician is confirmed of the diagnosis and

volume of lesion it is not advisable to use it.

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 1. Cryosurgery – a practical manual – paola pasquali
 2. Web
 3. Cryotherapy- a novel treatment modality in oral lesions- international
journal of pharmacy and pharmaceutical sciences. Issn- 0975-1491 vol 5,
suppl 4, 2013
 4. Reade pc. Cryosurgery in clinical dental practise.Int dent j 1979;29:1-
11.
 5. Leopard pj. Cryosurgery and its applications in oral surgery. Br j of oral
surg 1975;13:128-52.
 6. Orpwood rd. Cryosurgical apparatus. In: bradley pf, ed , cryosurgery of
maxillofacial region. Vol.1.Boca raton, florida: crc press, 1986.

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THANK YOU