Treatment of mucocele with diode laser

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Treatment of mucocele with diode laser

Case Report

Ruchi Pandey, Krishnajaneya Reddy Pathakota, Pradeep Koppolu, Vijayalakshmi Bolla Department of Periodontics, Sri Sai Dental College, Vikarabad, Andhra Pradesh, India

Abstract Mucocele is commonly occurring lesion in the oral cavity, mostly involving minor salivary glands, resulting from rupture or obliteration of the ducts leading to their glandular contents (mucinous) being released subepithelially. Etiological factors include trauma, parafunctional habits, lip biting, etc.; and if left untreated may lead to permanent bump in the area of occurrence. Various treatment modalities have been advocated for mucocele among which lasers being the most recent and advanced. In the present case reports, diode laser was used for the excision of mucocele on the lower lip, the advantages being minimal discomfort, bleeding, recurrence, and better compliance among patients.

Key words Diode laser, mucocele, parafunctional habits

Introduction Mucocele is commonly occurring lesion in oral mucosa containing mucin that may result from alteration in minor salivary gland.[1] It is well‑defined as tissue swelling composed of pooled mucus that escaped into the connective tissue from a severed excretory duct.[2] The incidence rate is high and it is the second most commonly occurring lesion after irritational fibroma in the oral cavity,[3‑5] prevalent in second decade of life with no sex predilection. Commonly involving lower lip; followed by tongue, buccal mucosa, palate, and retromolar area. Clinically mucocele is few millimeters to centimeters, painless, fluctuant, and imparts transparent to bluish hue. Etiology for mucocele was well‑described by Yamasoba et al., in 1990 which includes trauma and obstruction of salivary duct mainly in minor salivary gland.[6]

We report two case reports where diode laser has been used for excision of mucocele on the lower lip.

Case Reports Case report 1

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Since mucocele has high recurrence rate, various treatment approaches have been made like surgical, cryosurgical, intralesional corticosteroids, marsupialization, micromarsupialization, and lasers.[7] Different kinds of lasers are available with varying wavelength and absorption coefficient, diode lasers especially 810 nm is absorbed by melanin and hemoglobin due to this property it has ability to precisely cut, coagulate, ablate, or vaporize the target soft tissue.[8] Diode lasers are easy to move and handle since they do not have water or airlines. Lasers causes less trauma, improved healing, and faster recovery time when compared with conventional methods.

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DOI:

10.4103/0976-2868.118457

A systemically healthy 15‑year‑old boy came to the private hospital with a chief complaint of swelling in lower left labial mucosal region since one month gives history of lip biting [Figure 1]. On clinical examination; lesion is soft, fluctuant, painless, approximately 1 × 1 cm in size giving a light bluish hue with no involvement

Correspondence: Dr. Ruchi Pandey, H NO 3‑5‑167, Fl No. 302, Srilakshmi residency, Street No‑2, Narayanguda, Hyderabad, Andhra Pradesh, India. E‑mail: [email protected]

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Journal of Dental Lasers January - June 2013 Issue 1 Vol 7

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Pandey, et al.: Diode lasers in treatment of mucocele

of lymph nodes, suggestive of a mucocele. Treatment plan was explained, written informed consent was drawn from the patient’s guardian. Laser excision (Picasso, AMD Laser Technologies, USA; wavelength of 810 nm) [Figures 2 and 3] was done under local anesthesia (2% lignocaine with 1:80000 epinephrine), using 300 µm diameter tip at 1.3 W. Patient was prescribed 600 mg brufen as per required and to break the habit lip bumper was given. There was uneventful healing with no recurrence reported after 1 year follow‑up [Figures 4 and 5].

Case report 2 A female patient aged 24 years came to the department of periodontics with a chief complaint of localized swelling on the right labial mucosa of lower lip, gives an history of recurrent swelling which increases and then decreases in size due to release of its contents. On thorough intraoral examination lesion was 1 × 1 cm in size, soft fluctuant, and gives transparent hue, sharp

cusp was noted in relation to 13 [Figure 6]. Lesion was excised under local anesthesia, using 300 µm tip diameter at 0.8-1.2 W in continuous mode and the charred tissue was removed gently in between the procedure to minimize the heat produced in the local area [Figure 7] occlusal adjustment made in relation to 13. Postoperative instructions were given which included use of 600 mg brufen as required, along with 0.15% of benzydamine hydrochloride (Tantum) mouthwash daily three times for 1 week. Healing was uneventful with no adverse effects (bleeding, edema, and paresthesia), and reported no recurrence even after 1 year [Figure 8].

Discussion On thorough clinical and radiographical examination and considering various possible diagnosis like mucus retention cyst, lipoma, mucoepidermoid carcinoma (low grade), and sialolith; the lesion was

Figure 1: Mucocele located on the left side of the lower lip

Figure 2: Excision of the lesion using laser

Figure 3: Intraoral the charred layer and no bleeding after excision

Figure 4: One week postoperative view

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Figure 5: One year postoperative view showing uneventful healing

Figure 6: Mucocele on the right side of the lower lip

Figure 8: One year postoperative view showing uneventful healing

lasers.[12]

Conclusion

Figure 7: Excision of the lesion using laser

diagnosed as mucocele. It can be treated by using various modalities which include surgical with variable recurrence rate if not removed along with the feeder gland.[9] In the present cases, diode laser was used for excision of mucocele, which showed minimal patient discomfort, postoperative pain, and edema with no bleeding and recurrence even after 1 year follow‑up. In an animal study, Jin et al., reported that diode laser is considered a good cutting device for oral mucosa.[10] When compared to other lasers like argon, neodymium:yttrium‑aluminum‑garnet (Nd:YAG) and carbon dioxide lasers, the diode laser shares similar feature that is intensely absorbed in hemoglobin, results in elevating the temperature and thus promoting coagulation and carbonization of soft tissues, such as the oral mucosa and results in minimum discomfort and scarring.[11] Diode laser is cost‑effective, according to Gontijo et al., diode laser is more appropriate for soft tissue surgery (wavelength 810 nm) when compared to the other

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The diode lasers have been effective in treatment of mucocele in the case reports since minimum use of anesthesia, less bleeding, no scarring, no postoperative discomfort, more patient acceptance, and most importantly it is precise and provides a sterilized field. Thus diode lasers can be considered in treatment of mucocele.

References 1. Bagan Sebastian JV, Silvestre Donat FJ, Penarrocha Diago M, Milian Masanet MA. Clinico‑pathological study of oral mucoceles. Av Odontoestomatol 1990;6:389‑91,394‑5. 2. Phillip S, Eversole LR, Wyscoki GP. Salivary gland disorders. Contemporary Oral and Maxillofacial Pathology. 2nd ed. St Louis: Mosby; 2003 p. 332. 3. Baramash HD. Mucoceles and ranulas. J Oral Maxillofac Surg 2003;61:369‑78. 4. Baramash H. The etiology of superficial oral mucoceles. J Oral Maxillofac Surg 2002;60:237‑8. 5. Knapp MJ. Oral disease in 181, 338 consecutive oral examinations. J Am Dent Assoc 1971;83:1288‑93.

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6. Yamasoba T, Tayama N, Syoji M, Fukuta M. Clinicostatistical study of lower lip mucoceles. Head Neck 1990;12:316‑20. 7. Pedron IG, Galletta VC, Azevedo LH, Correa L. Treatment of mucocele of the lower lip with diode laser in pediatric patients: Presentation of 2 clinical cases. Pediatr Dent 2010;32:539‑41. 8. Pirnat S. Versatility of an 810 nm diode laser in dentistry: An overview. J Laser Health Acad 2007;4:1‑8. 9. Langlais RP, Miller CS. Nodules of the lip. Color Atlas of Common Oral Diseases. 1st ed. Philadelphia: Lippincott Williams and Wilkins; 1992. p. 32‑3. 10. Jin JY, Lee SH, Yoon HJ. A comparative study of wound healing following incision with a scalpel, diode laser or Er, Cr:YSGG laser in guinea pig oral mucosa: A hisological and immunohistochemical analysis. Acta Odontol Scand

2010;68:232‑8. 11. Romanos G, Nentwig GH. Diode laser (980 nm) in oral and maxillofacial surgical procedures: Clinical observations based on clinical applications. J Clin Laser Med Surg 1999;17:193‑7. 12. Gontijo I, Navarro RS, Haypek P Ciamponi AL, Haddad AE. The applications of diode and Er; YAG lasers in labial frenectomy in infant patients. J Dent Child 2005;72:10‑6.

How to cite this article: Pandey R, Pathakota KR, Koppolu P, Bolla V. Treatment of mucocele with diode laser. J Dent Lasers 2013;7:43-6. Source of Support: Nil, Conflict of Interest: None declared.

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