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Table of Contents   
SHORT COMMUNICATION  
Year : 2013  |  Volume : 24  |  Issue : 2  |  Page : 278
Laser vaporization of extravasation type of mucocele of the lower lip with 940-nm diode laser


1 Department of Prosthodontics, Babu Banarsi Das College of Dental Sciences, Lucknow, Uttar Pradesh, India
2 Department of Oral Medicine and Radiology, Babu Banarsi Das College of Dental Sciences, Lucknow, Uttar Pradesh, India
3 Department of Conservative Dentistry, Babu Banarsi Das College of Dental Sciences, Lucknow, Uttar Pradesh, India

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Date of Submission18-Mar-2011
Date of Decision19-Oct-2011
Date of Acceptance10-Dec-2011
Date of Web Publication20-Aug-2013
 

   Abstract 

A 43-year-old male presented with an asymptomatic swelling of the lower labial mucosa. Examination revealed that the tip of maxillary canine was causing trauma on the affected side. A diagnosis of extravasation type of mucocele was established clinically. Vaporization of the mucocele was done with a 940-nm diode laser in contact mode. The lesion healed uneventfully and there has been no recurrence for 3 months.

Keywords: Diode laser, laser surgery, laser therapy, mucocele

How to cite this article:
Agarwal G, Mehra A, Agarwal A. Laser vaporization of extravasation type of mucocele of the lower lip with 940-nm diode laser. Indian J Dent Res 2013;24:278

How to cite this URL:
Agarwal G, Mehra A, Agarwal A. Laser vaporization of extravasation type of mucocele of the lower lip with 940-nm diode laser. Indian J Dent Res [serial online] 2013 [cited 2020 Feb 25];24:278. Available from: http://www.ijdr.in/text.asp?2013/24/2/278/116684
Dental Lasers are increasingly becoming popular in dental clinics owing to their better work efficiency patient comfort, faster healing with minimal scar formation and avoidance of medicines and injectable local anesthetics. One such example is reported in this article wherein Soft Tissue Laser was preferred over conventional surgical intervention for the treatment of Mucocele.


   Case Report Top


A 43-year-old male presented with the complaint of a swelling on the lower lip. History revealed that the swelling had appeared 2 weeks back and had slowly increased to the present size. The patient was asymptomatic and his concern was only for esthetic reasons.

On examination, 1 cm × 1 cm swelling was present on the lower labial mucosa near the right angle of the mouth. The swelling was well defined and soft and fluctuant, with normal overlying mucosa. There was no sign of any sinus, fistula, or pus discharge [Figure 1]. Further examination revealed that the tip of maxillary canine was causing trauma to the affected area. On the basis of the clinical history and the physical findings, a diagnosis of extravasation type of mucocele was established.
Figure 1: Swelling on the lower labial mucosa near the right angle of the mouth

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The patient was informed about both conventional and laser treatment options for the lesion, and he opted for laser treatment. The sharp tip of the canine was first rounded off to prevent further trauma. A topical anesthetic (lignocaine 2%) was sprayed on and around the lesion. A 940-nm diode laser (Ezlase ® , Biolase Technology Inc., Irvine, California) with a fiber tip of diameter 400 μm was initiated on the initiation cork provided by the company. A power setting of 1.3 Watts, 0.10 ms pulse interval, and 0.05 ms pulse duration was set in the laser machine. Safety goggles were worn by the patient, doctor, and the assistant before starting the procedure. The boundary of the lesion was first marked with laser in contact mode to determine the extent of the surgery [Figure 2]. A higher power setting of 1.7 Watts, with 0.10 ms pulse interval and 0.05 ms pulse duration, was used for vaporization of the lesion. The fiber tip was used in contact mode with a to-and-fro motion within the depth of the lesion. High-speed suction was used for smoke evacuation. The patient experienced no discomfort during the treatment except for a pricking sensation at a few points. There was no bleeding during the procedure. After the vaporization, the power setting was changed to a lower value (LLLT, low-level laser therapy) of 0.6 Watts and in a continuous and defocused (noncontact mode) mode the hand piece was run around the operated area in a circular motion to form a protective coagulated layer of proteins over the lesion. The patient was advised not to consume hot and spicy food for a day [Figure 3]. A topical anesthetic and chlorhexidine gluconate gel (2%) was prescribed to the patient, along with an oral analgesic to be taken in case of discomfort. The patient was recalled after 24 hours for follow-up. However, he did not come for the follow-up visit and was seen next only after 3 months had elapsed. There had been no recurrence over the 3 months and, on examination, the labial mucosa was healthy [Figure 4].
Figure 2: Demarcation of the surgical area using diode laser at low power settings

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Figure 3: Operative site after the formation of the chelating layer

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Figure 4: Normal healthy labial mucosa after 3 months

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   Discussion Top


Extravasation type of mucocele results from trauma to the minor salivary glands or their ducts, leading to pooling of mucin in the vicinity of the gland or the duct. The various treatment options available for the treatment of mucocele are cryosurgery, intralesional corticosteroid injection, micro-marsupialization, and marsupialization of the mucocele. However these techniques are associated with relatively high incidence of recurrence and surgical intervention is usually necessary for a permanent cure. [1] However, the conventional surgical approach arouses apprehension in the patient and is associated with bleeding and postoperative pain.

Treatment of mucocele with lasers is a viable treatment option. Laser management is preferable over the conventional surgical procedure as it provides good hemostasis, reduced postoperative swelling, reduction in bacterial population at the surgical site, lesser need for suturing, faster healing, and less postoperative pain. [2] Various types of lasers like CO 2 , [1],[3] erbium, [4] and diode lasers [5] are used for complete excision of the mucocele. Argon [6] and Nd: YAG [7] lasers are used for vaporization of the mucocele. Lasers provide satisfactory results with low recurrence rates and are well tolerated by the patients.

The diode laser is an excellent soft tissue surgical laser. It has relatively good affinity for pigments (like hemoglobin) and therefore has good hemostatic capability. These lasers are relatively poorly absorbed by the tooth structure and so soft tissue surgery can be safely performed in close proximity to enamel, dentin, and cementum. Small size, a portable instrument, good cutting efficiency, and comparatively low cost are the advantages of diode lasers. [8]

In the present case, diode laser was used for vaporization of the mucocele. The lesion was delineated using low power settings and then it was vaporized at a high power setting. The patient experienced no discomfort during the treatment except for a pricking sensation at a few points. There was no bleeding during the procedure. Following vaporization, the power setting was lowered and the laser was operated in continuous and defocused mode to create a protective chelated layer of denatured proteins over the lesion. This prevented oral fluids and any irritant material from coming in contact with the surgical site and also prevented postoperative discomfort. The duration of the entire procedure was 3-4 minutes. No recurrence was reported after 3 months. Histopathology could not be done as the mucocele was completely vaporized.

Clinical observation suggests that vaporization with a diode laser is effective in eliminating extravasation mucocele. It is better than excision of the mucocele along with the surrounding salivary glands because the size of the wound is less, thereby decreasing healing time and postoperative discomfort.

Thus, in case of extravasation type of mucocele, vaporization with a diode laser is an effective form of treatment.

 
   References Top

1.Yagüe-García J, España-Tost AJ, Berini-Aytés L, Gay-Escoda C. Treatment of oral mucocele-scalpel versus CO2 laser. Med Oral Patol Oral Cir Bucal 2009;14:469-74.  Back to cited text no. 1
    
2.Coleton S. Lasers in surgical periodontics and oral medicine. Dent Clin North Am 2004;48:937-62.  Back to cited text no. 2
    
3.Huang IY, Chen CM, Kao YH, Worthington P. Treatment of mucocele of the lower lip with carbon dioxide laser. J Oral Maxillofac Surg 2007;65:855-8.  Back to cited text no. 3
    
4.Boj JR, Poirier C, Espasa E, Hernandez M, Espanya A. Lower lip mucocele treated with an erbium laser. Pediatr Dent 2009;31:249-52.  Back to cited text no. 4
    
5.Pedron IG, Galletta VC, Azevedo HL, Corrêa 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.  Back to cited text no. 5
    
6.Neumann RA, Knobler RM. Treatment of oral mucous cysts with an argon laser. Arch Dermatol 1990;126:829-30.  Back to cited text no. 6
    
7.Jinbu Y, Tsukinoki K, Kusama M, Watanabe Y. Recurrent multiple superficial mucocele on the palate: Histopathology and laser vaporization. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:193-7.  Back to cited text no. 7
    
8.Coluzzi DJ. Fundamentals of dental lasers: Science and instruments. Dent Clin North Am 2004;48:751-70.  Back to cited text no. 8
    

Top
Correspondence Address:
G Agarwal
Department of Prosthodontics, Babu Banarsi Das College of Dental Sciences, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.116684

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

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