Managing Benign and Malignant Oral Lesions with Carbon Dioxide Laser: Indications, Techniques, and Outcomes for Outpatient Surgery

Abstract

Purpose Because of its affinity for water-based tissues, carbon dioxide (CO₂) laser has become an instrument of choice for treating oral mucosa conditions, ranging from inflammatory to malignant lesions. The aim of this work is to systematically evaluate the outcomes of laser surgery over a wide range of lesions, while providing a solid and reproducible protocol for CO₂ laser surgery in the outpatient management of oral lesion.

Methods Seventy-eight patients underwent 92 laser outpatient procedures for treatment of a wide range of benign and malignant lesions. We performed 60 removals, 11 exeretic biopsies, 15 vaporizations, and 3 vaporization/removal combined. We analyzed laser parameters applied for each technique and provided a systematic evaluation of surgical results.

Results No problems occurred intraoperatively in any of the patients. Five patients complained marginal pain, while 3 patients had postsurgery bleeding. All treatments were successful, with the notable exception of 3 relapsing verrucous proliferative leukoplakias and an infiltrating squamous cell carcinoma of the tongue requiring radicalization. We did not record any adverse reactions to drugs or lesions due to laser action. Concordance between clinical diagnosis and pathology results was at 94.8%.

Conclusions Our data indicate that CO₂ laser is a solid choice for outpatient treatment of oral lesions. This technique grants painless and almost bloodless treatment, with negligible recurrence rates. Providing a solid reference for laser settings and operative techniques could provide a foundation for further exploring this tool while offering the basis for a positive comparison between different surgical techniques and options.

Keywords

laser surgery - oral lesions - CO₂ - leukoplakia - benign oral lesions - outpatient procedures

• References

• 1 Wigdor HA, Walsh Jr JT, Featherstone JDB, Visuri SR, Fried D, Waldvogel JL. Lasers in dentistry. Lasers Surg Med 1995; 16 (02) 103-133
• 2 Asnaashari M, Zadsirjan S. Application of laser in oral surgery. J Lasers Med Sci 2014; 5 (03) 97-107
• 3 Asnaashari M, Mohebi S, Paymanpour P. Pain reduction using low level laser irradiation in single-visit endodontic treatment. J Lasers Med Sci 2011; 2 (04) 139-143
• 4 Natekar M, Raghuveer HP, Rayapati DK. , et al. A comparative evaluation: oral leukoplakia surgical management using diode laser, CO2 laser, and cryosurgery. J Clin Exp Dent 2017; 9 (06) e779-e784
• 5 Komori S, Matsumoto K, Matsuo K, Suzuki H, Komori T. Clinical study of laser treatment for frenectomy of pediatric patients. Int J Clin Pediatr Dent 2017; 10 (03) 272-277
• 6 Matsumoto K, Suzuki H, Asai T. , et al. Clinical investigation of carbon dioxide laser treatment for lingual leukoplakia. J Oral Maxillofac Surg Med Pathol 2015; 27 (04) 493-497
• 7 Nammour S, Zeinoun T, Namour A, Vanheusden A, Vescovi P. Evaluation of different laser-supported surgical protocols for the treatment of oral leukoplakia: a long-term follow-up. Photomed Laser Surg 2017; 35 (11) 629-638
• 8 Mogedas-Vegara A, Hueto-Madrid J-A, Chimenos-Küstner E, Bescós-Atín C. Oral leukoplakia treatment with the carbon dioxide laser: A systematic review of the literature. J Craniomaxillofac Surg 2016; 44 (04) 331-336
• 9 Thomson PJ, Goodson ML, Cocks K, Turner JE. Interventional laser surgery for oral potentially malignant disorders: a longitudinal patient cohort study. Int J Oral Maxillofac Surg 2017; 46 (03) 337-342
• 10 Goodson ML, Sugden K, Kometa S, Thomson PJ. Complications following interventional laser surgery for oral cancer and precancerous lesions. Br J Oral Maxillofac Surg 2012; 50 (07) 597-600
• 11 Jerjes W, Upile T, Hamdoon Z. , et al. CO2 laser of oral dysplasia: clinicopathological features of recurrence and malignant transformation. Lasers Med Sci 2012; 27 (01) 169-179
• 12 Tambuwala A, Sangle A, Khan A, Sayed A. Excision of oral leukoplakia by CO2 lasers versus traditional scalpel: a comparative study. J Maxillofac Oral Surg 2014; 13 (03) 320-327
• 13 López-Jornet P, Camacho-Alonso F. Comparison of pain and swelling after removal of oral leukoplakia with CO₂ laser and cold knife: a randomized clinical trial. Med Oral Patol Oral Cir Bucal 2013; 18 (01) e38-e44
• 14 Dost F, Lê Cao K, Ford PJ, Ades C, Farah CS. Malignant transformation of oral epithelial dysplasia: a real-world evaluation of histopathologic grading. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117 (03) 343-352
• 15 Thomson PJ, Goodson ML, Cocks K, Turner JE. Interventional laser surgery for oral potentially malignant disorders: a longitudinal patient cohort study. Int J Oral Maxillofac Surg 2017; 46 (03) 337-342
• 16 Hanna R, Parker S. The advantages of carbon dioxide laser applications in paediatric oral surgery. A prospective cohort study. Lasers Med Sci 2016; 31 (08) 1527-1536
• 17 Pié-Sánchez J, España-Tost AJ, Arnabat-Domínguez J, Gay-Escoda C. Comparative study of upper lip frenectomy with the CO2 laser versus the Er, Cr:YSGG laser. Med Oral Patol Oral Cir Bucal 2012; 17 (02) e228-e232
• 18 Romeo U, Palaia G, Tenore G, Del Vecchio A, Nammour S. Excision of oral mucocele by different wavelength lasers. Indian J Dent Res 2013; 24 (02) 211-215
• 19 Romeo U, Russo C, Palaia G. , et al. Biopsy of different oral soft tissues lesions by KTP and diode laser: histological evaluation. ScientificWorldJournal 2014; 2014: 761704
• 20 Rizoiu IM, Eversole LR, Kimmel AI. Effects of an erbium, chromium: yttrium, scandium, gallium, garnet laser on mucocutanous soft tissues. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996; 82 (04) 386-395
• 21 Romeo U, Libotte F, Palaia G. , et al. Histological in vitro evaluation of the effects of Er:YAG laser on oral soft tissues. Lasers Med Sci 2012; 27 (04) 749-753
• 22 Brouns ER, Baart JA, Karagozoglu KH, Aartman IH, Bloemena E, van der Waal I. Treatment results of CO2 laser vaporisation in a cohort of 35 patients with oral leukoplakia. Oral Dis 2013; 19 (02) 212-216
• 23 Chainani-Wu N, Lee D, Madden E, Sim C, Collins K, Silverman Jr S. Clinical predictors of oral leukoplakia recurrence following CO₂ laser vaporization. J Craniomaxillofac Surg 2015; 43 (09) 1875-1879
• 24 Del Corso G, Gissi DB, Tarsitano A. , et al. Laser evaporation versus laser excision of oral leukoplakia: A retrospective study with long-term follow-up. J Craniomaxillofac Surg 2015; 43 (06) 763-768