Different CO2 laser vaporization protocols for the therapy of oral precancerous lesions and precancerous conditions: a 10-year follow-up

Wound healing after therapy of oral potentially malignant disorders with a 445-nm semiconductor laser: a randomized clinical trial

OBJECTIVES

Oral potentially malignant disorders (OPMDs) are the most clinically relevant precursor lesions of the oral squamous cell carcinoma (OSCC). OSCC is one of the 15 most common cancers worldwide. OSCC is with its high rate of mortality an important cause of death worldwide. The diagnosis and therapy of clinically relevant precursor lesions of the OSCC is one of the main parts of prevention of this malignant disease. Targeted therapy is one of the main challenges concerning an oncologically safe tissue removal without overwhelming functional and aesthetic impairment.

MATERIALS AND METHODS

In this randomized controlled trial, a newly introduced intraoral 445-nm semiconductor laser (2W; cw-mode; SIROLaser Blue, Dentsply Sirona, Bensheim, Germany) was used in the therapy of OPMDs. Duration and course of wound healing, pain, and scar tissue formation were compared to classical cold blade removal with primary suture by measuring remaining wound area, tissue colorimetry, and visual analogue scale. The study includes 40 patients randomized using a random spreadsheet sequence in two groups (n1 = 20; n2 = 20).

RESULTS

This comparative analysis revealed a significantly reduced remaining wound area after 1, 2, and 4 weeks in the laser group compared to the cold blade group (p < 0.05). In the laser group, a significantly reduced postoperative pain after 1 week was measured (p < 0.05).

CONCLUSION

Laser coagulation of OPMDs with the investigated 445-nm semiconductor laser is a safe, gentle, and predictable surgical procedure with beneficial wound healing and reduced postoperative discomfort.

CLINICAL RELEVANCE

Compared to the more invasive and bloody cold blade removal with scalpel, the 445-nm semiconductor laser could be a new functional less traumatic tool in the therapy of OPMDs. The method should be further investigated with regard to the identification of further possible indications.

TRAIL REGISTRATION

German Clinical Trials Register No: DRKS00032626.

KTP 532 Laser Assisted Surgery for Oral Cavity Malignancy-A Retrospective Study

Aims and Objective

To determine the effectiveness of KTP 532 in surgically treating early and early advanced oral malignancy with no surgical reconstruction of primary site.

Materials and methods

It is a retrospective study of 67 cases operated between 2000 to 2013 including T1, T2 and Early T3 cases, approved by ethical committee. All the cases underwent Laser assisted excision of tumour with or without Neck Dissection or Adjuvant Radiotherapy. Age of the cases varied from 20 to 80 years with mean age of 49 years. 47 cases were males and 20 were females. 26 cases in the study had neck nodes clinically whereas 41 cases had N0 status. Neck dissection was done (SOND or MRND) in 61 cases. In 6 cases (N0) no neck dissection was done.

Results

61 cases had no loco-regional residual disease on their last follow up. Six cases had loco-regional recurrence within 6 months and salvage surgery was done. The overall mean survival was 81 months (92, 82 and 71 months in Stage I, II,III respectively). 3 year disease free survival rate was 91% as calculated using Kaplan- Meier Scale. In all these cases tumour was excised with KTP 532 laser and no reconstruction was done. Wound was allowed to heal with secondary intention.

Conclusion

Laser assisted excision of oral malignancy is an alternative to conventional treatment with more precision, less morbidity, shorter hospital stay and better functional outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-022-03214-x.

Developmental synergism in the management of oral potentially malignant disorders

Oral potentially malignant disorders (OPMDs) are associated with an increased risk of occurrence of cancers of the oral cavity or lips. The unifying theme of OPMDs is their potential risk for cancer development. Therefore, the primary objective of the management should be to prevent carcinogenesis. Beyond diagnosis, current strategies for the management of OPMDs predominantly include non-surgical and surgical interventions and a "watch-and-see" approach, such as disease monitoring or surveillance, and preventive strategies. Though no optimal clinical treatment has gained universal approval for reducing or preventing malignant development of OPMDs. Therefore, an urgent need exits for improved treatment properties and effective predictive markers for OPMDs treatment. This review aims to outline recent synergism regarding to the management of OPMDs. Developing new technologies and improved application parameters to promote the treatment efficacy and a novel management prescription approach to OPMDs are proposed.

Case report of spongiotic gingivitis in an adult male treated with novel 9,300-nanometer carbon dioxide laser low-energy ablation

BACKGROUND AND OVERVIEW

To date, only about 125 cases of juvenile or adult spongiotic gingivitis have been described in the literature, primarily from retrospective biopsy searches. Spongiotic gingivitis is a relatively new, often misdiagnosed, periodontal pathology that was originally attributed only to juveniles. This is the first case report to our knowledge on spongiotic gingivitis diagnosed in a middle-aged adult man and treated with a novel carbon dioxide (CO₂) laser low-energy ablation therapy.

CASE DESCRIPTION

A 56-year-old man sought treatment for a localized erythematous lesion on the facial gingiva of the maxillary left central incisor (tooth no. 9). Initial treatment was conventional excisional surgery and biopsy. Diagnosed as spongiotic gingivitis, it reoccurred in the same location within 4 months. It was then treated in 3 sessions using a novel 9,300-nm CO₂ laser low-energy ablation set at 0.4 W and 1.25-mm cut width for an irradiance of 33.3 W/cm² and energy density of 0.21 J/cm². The lesion was significantly reduced and has shown no hyperplastic reoccurrence to date.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

This case report brings to dental professionals' attention that acute spongiotic gingivitis may occur in older adults, not just juveniles. As such, spongiotic gingivitis may be underreported in adults with localized gingivitis, possibly attributed to toothpastes containing sodium laurel sulfate. 9,300-nm CO₂ laser therapy may successfully treat lesions such as acute spongiotic gingivitis without the need for anesthesia or additional medications. This report may also encourage further research on treatment modalities, biopsy of lesions resembling this entity, and improved reporting of adult spongiotic gingivitis to better understand this unique gingival pathology.

Treatment of plaque-like oral lichen planus with CO2 laser

Background:

Oral lichen planus (OLP) is a chronic autoimmune disease, which annoys the patients for several years. It presents with various clinical forms. Although plaque-like form of OLP is usually asymptomatic, it could transform to a malignant lesion. Therefore, treatment considerations are essential to reduce the development of oral cancer. Laser therapy is a newer modality for treatment of plaque-like lesions.

Aims:

This study aimed to perform laser therapy for plaque-like lesions of OLP.

Methods:

We described some plaque-like OLP lesions evaporated with CO2 laser. The power of 4–7 watt as continuous wave (CW) and defocused mode was employed for evaporation. The complications and recurrence were evaluated in the follow-up sessions.

Results:

In some patients, mild keratotic lesions were observed in the follow-up sessions. Most patients were satisfied with treatment process and reported mild burning after treatment. No complication was observed in the patients.

Conclusion:

CO2 laser could be employed for OLP lesions; however, some degrees of recurrence may occur.

Laser excision of oral leukoplakia: Does it affect recurrence and malignant transformation? A systematic review and meta-analysis

Oral leukoplakia (OL) is a white lesion with high potential of recurrence and malignant transformation. The variable clinical and histopathological features of OL may potentially impact both treatment and prognosis. Current literature shows that post treatment rates of recurrence and malignant transformation vary widely. The use of surgical lasers have been proposed with the objective of improving outcomes. We performed a systematic review and a comprehensive meta-analysis dedicated to pooling the rates of recurrence and malignant transformation of OL lesions treated using the main types of surgical lasers available. Scopus, MEDLINE/PubMed, and Embase were searched electronically. A total of 36 articles met the inclusion criteria. Selected studies included OL lesions that were treated by evaporation or excision using Nd:YAG laser, Er:YAG laser, CO2 laser, KTP laser, or diode laser. The results of this systematic review and meta-analysis suggest that surgical laser excision of OL may decrease recurrence rates but have no effect on the malignant transformation of OL when compared with conventional treatments.

Outcome of CO2 laser vaporization for oral potentially malignant disorders treatment

Background

Oral cancer is a public health issue worldwide. Oral potentially malignant disorders (OMPDs) are lesions of the oral mucosa that are predisposed to malignant transformation. The mainstay of OMPDs treatment around the world is now the carbon dioxide (CO2) laser but the reported recurrence and malignant transformation rates vary widely in the literature. We aimed to estimate the recurrence and the malignant transformation rates of OPMDs treated with CO2 laser at the University Hospital of Bordeaux, in France, from 2010 to 2014, and to identify associated factors with recurrence or malignant transformation.

Material and Methods

We conducted a retrospective study in patients with a minimum follow-up of 12 months. Collected variables included characteristics of the patients (gender, age, alcohol and tobacco consumption, previous diagnosis of graft-versus-host disease, previous treatments for OPMD or for upper aerodigestive tract cancers and human immunodeficiency virus infection), characteristics of the lesions (form, colour, size, location, degree of dysplasia), laser treatment outcome (complications, recurrence, malignant transformation).

Results

Twenty-five patients were included. Mean follow-up was 28.9 months. Recurrence was observed in 11 patients (44%). Annual recurrence rate was 18.3% and annual malignant transformation rate was 1.7%. Hyperplasia without dysplasia was the only factor found to be statistically associated with recurrence.

Conclusions

Our results suggest that OMPDs treated by CO2 laser vaporization have high recurrence rates, particularly those presenting hyperplasia. A standardized definition of recurrence would be necessary for inter-study comparisons. Long-term follow-up is recommended in order to detect and treat squamous cell carcinoma in its early stages.

Key words:CO2 lasers, precancerous conditions, malignant transformation, oral cancer, recurrence.

Recurrence of vocal fold leukoplakia after carbon dioxide laser therapy

This work aims to analyze the recurrence of vocal fold leukoplakia after carbon dioxide (CO₂) laser resection. In this retrospective study, all patients undergoing CO₂ laser resection of vocal fold leukoplakia were followed up for at least 2 years. Recurrence was diagnosed as any presence of leukoplakia in the vocal cord subsequent to previous successful complete resection. A total of 326 patients with complete resection of vocal fold leukoplakia and follow-up subsequent surveillance laryngoscopy were studied. The recurrence rate, the recurrence time, and risk factors were evaluated. Of these, 52 (16.0%) patients experienced recurrence with a mean follow-up time of 50.5 ± 15.4 months. The mean time to recurrence was 16.2 ± 14.1 months. Univariate analysis showed that the size of lesion (P < 0.001, Pearson χ ² test; P < 0.001, log-rank test) and the pathological grade (P = 0.025, Pearson χ ² test; P = 0.028, log-rank test) were significantly related to recurrence. The size of lesion was an independent prognostic factor for recurrence using multivariate analysis (P = 0.001, logistic regression; P = 0.001, Cox proportional hazards model). Considering the possible recurrence of vocal fold leukoplakia, long-term follow-up is required after CO₂ laser resection. In conclusion, the size of lesion combined with the pathological grade are important risk factors that predict vocal fold leukoplakia recurrence.

Possible alternative therapies for oral lichen planus cases refractory to steroid therapies

Oral lichen planus (OLP) is a chronic inflammatory disorder with a multifactorial etiopathogenesis. Immune dysregulation plays a critical role in the development and progression of this disease. Patients' lives may be affected by pain caused by atrophic-erosive lesions. Given the obscure etiology, treatment is usually symptomatic. Topical steroids remain the mainstay of management. However, their therapeutic benefits are not always evident. There are substantial data on the possible therapeutic strategies that are effective in OLP cases refractory to steroids. This review provides an overview of the current approaches for the management of steroid-refractory OLP. The miscellaneous treatment regimens include tacrolimus, pimecrolimus, thalidomide, low-level laser therapy, photodynamic therapy, and surgical excision. Some results obtained from these studies were promising. However, further studies, especially randomized controlled trials with strict inclusion and exclusion criteria and larger sample sizes, are required for the evaluation of the long-term safety and efficacy of these therapies.

Oral leukoplakia treatment with the carbon dioxide laser: A systematic review of the literature

We conducted a systematic review of the literature to evaluate treatment of oral leukoplakia with the carbon dioxide (CO2) laser. A comprehensive search of studies published between 1981 and 2015 and listed in the PubMed (National Library of Medicine, NCBI) database yielded 378 articles which were screened in detail. Relevant studies were selected according to predetermined inclusion and exclusion criteria. A total of 33 articles met the final inclusion criteria and were analysed in detail in accordance with the PRISMA-P statement. These full-text papers were classified as synopses (n = 7), recurrence and malignant transformation studies (n = 17), comparative studies between CO2 laser and cold knife surgery (n = 3) and studies evaluating the efficacy of CO2, Nd:YAG and KTP lasers. According to the literature the CO2 laser is the workhorse of oral leukoplakia treatment due to its effectiveness and low associated morbidity. However, randomized clinical trials are needed to compare CO2 laser with other lasers. The results of our systematic review showed that there is no consensus regarding the factors involved in higher recurrence and malignization rates, so further studies are needed.

The treatment of oral leukoplakia with the CO2 laser: A retrospective study of 65 patients

The use of CO2 laser has become a routine procedure for the treatment of oral leukoplakia. In this retrospective study, we evaluated 65 patients with oral leukoplakia treated with CO2 laser vaporization. The main location was the tongue (n = 21/65, 32.3%). The initial biopsy showed mild/moderate dysplasia in almost half the patients (n = 29, 44.6%) and hyperplasia without dysplasia in around a third of the patients (n = 21, 32.3%). The recurrence and malignant transformation rates were 33.8% (n = 22) and 15.4% (n = 10), respectively. The follow-up mean (standard deviation) was 15.0 (10.6) months. The procedure-related complications rate was 7.7% (n = 5). The Kaplan-Meier curves for time to recurrence showed differences only for gingiva lesions compared to tongue lesions (log rank, p = 0.032). Malignant leukoplakia transformation is independent of treatment, although it seems advisable to treat leukoplakia with or without dysplasia.

The Ablation Properties of CO(2) Laser Irradiating to Absorption Media: An In Vitro Study

This study aimed to compare histological affected zone of tissue samples irradiated by defocused CO(2) laser at 1, 2, and 3W continuous wave with and without absorption media. The in vitro experiment was conducted in 70 tissue blocks. The samples were randomly allocated into 7 groups: 10 samples each group, namely, the groups irradiated with 1, 2, and 3W, defocused CO(2) laser for 5 seconds, the groups irradiated with 1, 2, and 3W, defocused CO(2) laser to the absorption media, and the media alone group as a control. Then the samples were stained with Masson's trichrome and measured the affected borders under light microscope at 10 × 10 magnification. There was no histological alteration in the groups irradiated with the defocused CO(2) laser to the absorption media while the groups without using the absorption media showed the tissue alteration by photoablation.