Cotton-swab cryotherapy for oral leukoplakia.

BACKGROUND: Oral leukoplakia (OL) is a common oral precancerous lesion. Cotton-swab cryotherapy (CSC) is commonly used for treating skin lesions but is rarely used for treating OL lesions. METHODS: Sixty OL lesions were treated by CSC once every 2 weeks until complete regression (CR) of the lesion had been achieved. RESULTS: CR was achieved in all 60 OL lesions after an average of 6.3 treatments with cryotherapy. The number of CSC treatments required to achieve CR was significantly fewer for OL lesions on oral mucosal sites other than the tongue, those <2 cm2, those with epithelial dysplasia, and those with a surface keratin thickness of <55 microm. Multivariate analyses showed that only the location and area of the OL lesions were independent factors influencing the number of CSC treatments required to achieve CR. CONCLUSION: For OL lesions with a mean surface area of < or = 1.8 cm2, CR can be achieved with fewer than 7 CSC treatments on average. CSC is a simple, safe, easy, conservative, and acceptable treatment modality for OL lesions.

Central ossifying fibroma: a clinicopathologic study of 28 cases.

BACKGROUND/PURPOSE: Central ossifying fibroma (COF) is the most common benign fibro-osseous lesion of the jaw. This retrospective study evaluated the clinical and histopathologic features of 28 COFs in Taiwanese patients. METHODS: Twenty-eight consecutive cases of COF were collected from 1988 to 2006. The clinical data and microscopic features of these cases were reviewed and analyzed. RESULTS: The mean age of patients at the time of diagnosis was 34 years. There were six male and 22 female patients. Twenty-six (93%) cases were found in the mandible and two (7%) in the maxilla. The most common sites for COFs were the molar region (17 cases, 61%), followed by the premolar (8 cases, 28%), and incisor/canine (3 cases, 11%) regions. Bone swelling or expansion (96%, 26/27) was the most frequent clinical presentation. Six (21%) COFs presented as a radiolucent lesion, 17 (61%) as a mixed lesion, and five (18%) as a radio-opaque lesion. No recurrence of the lesion was found after surgical excision in this series. Microscopically, COFs showed trabeculae of woven bone (25 cases) and/or lamellar bone (5 cases) and/or spherules of cementoid (19 cases) in a cellular fibrous connective tissue stroma. The stromal component was highly cellular in 21 cases, moderately cellular in seven cases, prominently vascular in 11, and collagenous in six. CONCLUSION: COFs occur more frequently in female patients and in those in the second to fourth decades of life. The most commonly affected site is the mandible, especially the molar region. The majority of COF lesions present as a well-defined, mixed lesion radiographically. Most COFs can be treated by conservative surgical excision without subsequent recurrence.

Photodynamic therapy outcome for oral verrucous hyperplasia depends on the clinical appearance, size, color, epithelial dysplasia, and surface keratin thickness of the lesion.

Our previous studies showed that oral verrucous hyperplasia (OVH) lesions can be successfully treated with a topical 5-aminolevulinic acid-mediated photodynamic therapy (topical ALA-PDT) protocol using a 635-nm light-emitting diode light source. In this study, we report the clinical outcomes of 36 OVH lesions treated by this protocol and assess what clinicopathological parameters of OVH lesions could influence PDT treatment outcomes. We found that all the 36 OVH lesions showed complete response (CR) after an average of 3.8 (range, 1-6) treatments of topical ALA-PDT. OVH lesions with an clinical appearance of a mass, with the greatest diameter <1.5 cm, with the pink color, with epithelial dysplasia, or with the surface keratin layer < or =40 microm needed significantly less mean treatment numbers of PDT to achieve a CR than OVH lesions with an outer appearance of a plaque or a combination type of peripheral plaque and central mass (p=0.000), with the greatest diameter > or =1.5 cm (p=0.011), with the white color (p=0.000), without epithelial dysplasia (p=0.043), or with the surface keratin layer > 40 microm(p=0.003), respectively. Multivariate analysis showed that only the clinical appearance of OVH lesions was the independent factor (p=0.0069). We conclude that complete regression of OVH lesions can be achieved by less than seven treatments of topical ALA-PDT once a week. The PDT treatment outcome for OVH depends on the outer appearance, size, color, epithelial dysplasia, and surface keratin thickness of the lesion.