Laser management of oral leukoplakias: a follow-up study of 70 patients.

OBJECTIVES/HYPOTHESIS: To assess the efficacy of laser therapy for the management of premalignant oral lesions. STUDY DESIGN: The study group consisted of seventy consecutive laser-treated patients with oral leukoplakia. The microscopic diagnosis included idiopathic focal keratosis, dysplasias of all grades, and verrucous hyperplasia (proliferative verrucous leukoplakia). Thirty-nine patients had some degree of microscopic dysplasia and six demonstrated high-risk proliferative verrucous leukoplakia. The clinical appearances of the lesions were white (homogeneous leukoplakia) in 48, red and white (erythroleukoplakia) in 8, and verrucous in 14. There were 38 men and 32 women in this group. The average age was 63 years (range, 31-90 y). METHODS: Lasers employed were the CO2 and Nd:YAG lasers, and standard laser safety protocols were used. RESULTS: There was no postoperative infection, hemorrhage, or paresthesia Two patients developed pyogenic granulomas in their surgical sites. Fifty-five of 70 patients were followed for more than 6 months; follow-up averaged 32 months (range 6-178 mo). Twenty-nine patients had complete control of their lesions; 19 patients had small recurrences removed with subsequent laser surgeries, leading to control; 2 patients had complete recurrences; and 5 patients developed squamous cell carcinoma at the lesion site. Verrucous lesions had an especially high rate of recurrence (83%), with 9 of 12 ultimately controlled with subsequent surgeries. CONCLUSIONS: Laser surgery of oral leukoplakia is an effective tool in a complete management strategy that includes careful clinical follow-up, patient education to eliminate risk factors and report suspicious lesions, and biopsy of suspicious lesions when appropriate. However, recurrence and progression to cancer remain a risk.

Nd:YAG and CO2 laser therapy of oral mucosal lesions.

OBJECTIVE: Experiences gained in the management of oral mucosal lesions by CO2 and Nd:YAG laser therapy in an outpatient clinic treated over an 80-year period are described. SUMMARY BACKGROUND DATA: Lasers have indications for use in dentistry for incision, excision, and coagulation of intraoral soft tissue. Advances in laser technology have provided delivery systems for site-specific delivery of laser energy with short interaction items on tissue to be ablated. This study retrospectively evaluates a series of clinical case studies. METHODS: Sixty-four patients with a variety of benign oral soft tissue lesions were treated by laser excision. Thirty-five patients were treated by a pulsed fiberoptic delivered Nd:YAG contact laser, and 29 by a continuous free-beam CO2 non-contact laser. The largest group of lesions treated were leukoplakia (39 cases). Other lesions excised and biopsied were lichen planus, squamous papilloma, pyogenic granuloma, focal melanosis, nonhealing traumatic ulceration, hemangioma, and lymphangioma. All patients were followed postoperatively (mean 6.8 months, range 1-36 months). RESULTS: Laser excision was well tolerated by patients with no intraoperative or postoperative adverse effects. All patients healed postsurgically with no loss of function. CONCLUSIONS: CO2 and Nd:YAG lasers are successful surgical options when performing excision of benign intraoral lesions. Advantages of laser therapy include minimal postoperative pain, conservative site-specific minimally invasive surgeries, and elimination of need for sutures.