Liquid nitrogen cryotherapy in the management of oral lesions: a retrospective clinical study

Recurrence in Oral Leukoplakia: A Systematic Review and Meta-analysis

The management of oral leukoplakia (OL) is challenging because of a high risk for recurrence and malignant transformation (MT), and recurrent OL is associated with a higher risk of MT than nonrecurrent OL. The present meta-analysis aimed to examine the association between OL recurrence and surgical techniques used for their management as well as their clinicopathological factors. Electronic searches were conducted in EMBASE, PubMed, Scopus, and Web of Science to retrieve studies reporting OL recurrence after surgery. The pooled proportion of OL recurrence after surgical excision was estimated. Subgroup analyses were conducted based on the surgical technique, data type, grades of epithelial dysplasia, anatomical subsites, clinical type and size of the lesion, surgical margin, and risk habits. Meta-regression analyses were conducted to identify the association between age, sex, and follow-up duration and OL recurrence. The risk of MT based on the recurrence status was also estimated. A network meta-analysis was performed to determine the surgical modality associated with the least OL recurrence. Eighty studies with a total of 7,614 samples and various surgical modalities (laser-based techniques, conventional scalpel surgery, cryosurgery, and photodynamic therapy) were included in the meta-analysis. A pooled proportion of recurrence of 22% was observed. Laser-based surgeries resulted in fewer OL recurrences than other surgical modalities, and the combination of laser excision and vaporization was identified to be the best treatment approach. OL in the retromolar area and multiple sites, nonhomogeneous OL, advanced age, female sex, inadequate surgical margin, retrospective data, and betel quid chewing habit were significantly associated with higher OL recurrence. Recurrent OL showed a 7.39 times higher risk of MT than nonrecurrent OL. These results suggest that the combination of laser excision and vaporization might reduce OL recurrence. Furthermore, OL in older patients, females, and nonhomogeneous OL need close monitoring after any surgical therapy.

Histological evaluation of tissue destruction in mouse tongues caused by cryosurgery

Introduction

Cryosurgery is recognized as a treatment option for various types of oral lesions. Although cryosurgery is less invasive and easier to perform than surgical treatments, adverse events, such as stomatitis and scarring can occur if the freezing is excessive. There are few studies regarding the effects of cryosurgery on the surrounding soft tissues. Thus, this study investigated the extent of tissue destruction and healing progress in tongues of mice who underwent cryosurgery.

Methods

Eight-week-old male BALB/c mice were used. An instrument cooled with liquid nitrogen was lightly touched on the right side of the tongue for 5 s, and a second test was performed 10 s later. Histological evaluation was performed 3, 7, and 14 days after cryosurgery. Blood vessels were evaluated with India ink at 1, 3, 7, 14, and 21 days after cryosurgery.

Results

Destruction of the soft tissue spread to the left side of the tongue after 3 days. At 7 days, it was confirmed that the muscle tissue was in the process of repair and was completely repaired at 14 days. Although blood vessels were not confirmed at 3 days, they were visible after seven days and were confirmed at 21 days all over the tongue.

Discussion and Conclusion

These results indicated that the tissue destruction caused by cryosurgery was extensive and suggest that the duration and frequency of freezing should be minimized for clinical use.

Lay Summary

Cryosurgery is a treatment method for various types of oral lesions. Freezing the lesion causes the tissue to collapse, resulting in its disappearance. Although cryosurgery is less invasive and easier to perform than surgical treatments, adverse events, such as stomatitis and scarring can occur if the freezing is excessive. This study investigated the extent of tissue destruction and healing progress in tongues of mice who underwent cryosurgery.The right side of mice tongues were frozen by an instrument cooled with liquid nitrogen for 5 s, and a second test was performed 10 s later. The tissue destruction was evaluated at 3, 7, and 14 days after freezing. Blood vessels were evaluated with India ink at 1, 3, 7, 14, and 21 days after freezing. Tissue destruction spread to the left side of the tongue after 3 days. At 7 days, it was confirmed that the muscle tissue was in the process of repair and was completely repaired at 14 days. Blood vessel repair was confirmed at 21 days in the throughout tongue. These results indicated that the tissue destruction caused by cryosurgery was large and suggest that the duration and frequency of freezing should be minimized for clinical use.

Analysis of effects and indications of cryosurgery for oral mucoceles

Cryosurgery is a recognized method for the treatment of mucoceles in the oral cavity. In this study, cryosurgery was used for mucoceles at the lip or buccal mucosa, and the effect and the indication were evaluated clinically. The subjects were patients with a clinical diagnosis of mucocele on the lip or buccal mucosa and who chose cryosurgery after procedures for both surgical excision and cryosurgery for the lesion were explained. Cryosurgery was performed with a freezing device using liquid nitrogen without local anesthesia. Twenty-four patients chose cryosurgery, including seven preschool children. There were no serious adverse events during and after cryosurgery. Healing progress after cryosurgery was not affected by patient age, lesion size, or how long the patients had the lesion. Two cases later underwent surgical excision because cryosurgery was not successful. Twenty-three patients chose surgical excision, one case had a recurrence. The number of younger patients who chose cryosurgery was significantly higher than that who chose surgical excision. This study suggests that cryosurgery is effective for mucoceles of the lip or buccal mucosa and is a simple and safe treatment method, especially for preschool children.

Cryosurgery: A Simple Tool to Address Oral Lesions

AIM

The study was aimed at evaluating the efficacy of cryosurgery in the management of oral mucosal lesions. Time taken for healing, postoperative pain, secondary infection, and recurrence of lesion was evaluated.

MATERIALS AND METHODS

A total of 30 patients with oral mucosal lesions were included in the study. The patients were evaluated for pain and postoperative infection which was documented on the 1st, 3rd, 7th, 21st day after the procedure. Other parameters such as healing time and scarring were assessed at 21st day. Recurrence of the lesion was evaluated in the 3rd and 6th postoperative month. All these data were statistically evaluated.

RESULTS

The pain and swelling which reduced mainly during the 7th postoperative day which was highly significant. The discomfort of the patient was relatively less. Only three patients showed delayed healing out of all patients. Recurrence of lesion was noted in two cases which conclude to about 6.7%.

CONCLUSION

The cryosurgery is overall a better modality for treatment of oral lesions as it is more reasonable with adequate success. The procedure is relatively more acceptable and has shown to have a faster recovery.

Cryosurgery as an Option for the Treatment of Vascular Lesions of the Oral Cavity

Cryosurgery is a treatment modality consisting in the destruction of tissue by the application of extremely low temperatures. This causes irreversible damage to cellular metabolism, leading to tissue destruction within minutes, a mechanism that may be beneficial when used in diseased tissues. Because cryosurgery is effective, simple, and easy to perform, it has been used in the treatment of lesions in both medical and dental fields. This technique provides many advantages, such as easy operation, absence of intraoperative bleeding, and low infection rate. We report the case of a patient with a hemangiomatous lesion of the oral cavity who was treated with liquid nitrogen spray cryosurgery, with successful results at 18-month follow-up.

Cryotherapy for localized juvenile spongiotic gingival hyperplasia: preliminary findings on two cases

BACKGROUND

Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a distinct subtype of inflammatory gingival hyperplasia that shows lack of response to traditional periodontal treatment, and after surgical excision, recurrence rate of 6-16% has been reported.

CASE REPORT

Two girls (11- and 9-year-old) with multifocal red patches along the maxillary and mandibular labial gingiva showed no regression of the lesions after basic periodontal treatment. Surgical excision of focal lesion in each case was performed, which showed typical features of LJSGH. In both cases, the lesions presented recurrence. Hence, cryotherapy sessions in all lesions were performed.

CONCLUSION

Cryotherapy appears to be successfully in LJSGH and well received by paediatric patients.

Microwave Ablation: A Novel Treatment for the Mucoceles of Anterior Lingual Salivary Glands

PURPOSE

The objective of this study was to evaluate the efficacy of microwave ablation as a substitute for surgery in patients with a mucocele of the anterior lingual salivary glands.

MATERIALS AND METHODS

In the Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Sichuan University (Chengdu, China), 78 patients with a clinical diagnosis of a mucocele of the anterior lingual salivary glands underwent microwave ablation from November 2012 to May 2015. Outcome and data on age, gender, size of lesion, history of trauma, and duration of lesion development for each patient were collected.

RESULTS

In this series, all patients fully recovered and only 5 patients received a second ablation. Wound healing was uneventful in all cases and a small scar was observed in only 6 patients. No serious complications were observed except for local discomfort in 2 cases and tongue tip numbness in 3 cases, but the problems resolved within several days without management.

CONCLUSION

Microwave ablation is a safe, straightforward, less invasive, economic, and effective therapeutic method for a mucocele of the anterior lingual salivary glands and can be used as a primary treatment modality before considering surgery.

Micro-marsupialization versus surgical excision for the treatment of mucoceles

Background:

Mucocele is a common disorder of minor salivary glands which arises due to mucous accumulation resulting from their alteration. Several techniques have been described for the treatment. However, most of them are invasive or require costly armamentarium.

Purpose:

The present study was conducted to evaluate the efficacy of micro-marsupialization technique as an alternative to surgical excision for the treatment of mucoceles.

Materials and Methods:

A prospective study was conducted. A total of twenty patients were selected based on clinical diagnosis of mucoceles and were randomly divided into two groups comprising ten patients each. Micro-marsupialization was done in Group 1 patients and surgical excision in Group 2. Patient's gender, age, size, location, duration, complications, and recurrences were evaluated during various visits. Data between the two groups were analyzed by descriptive and analytical (Chi-square tests) statistics.

Results:

The mean age of the patients in Group 1 was 19.6 ± 9.6 years while in Group 2 was 21.9 ± 11 years. The most common location for mucocele in Group 1 as well as Group 2 patients was lower lip (60% and 80%, respectively). In Group 1, two patients had recurrence while in Group 2, one patient had a recurrence. All recurrent cases were subsequently treated by surgical excision. No statistically significant difference was found between the two methods.

Conclusion:

Micro-marsupialization technique is as efficacious as surgical excision for the treatment of mucocele. It is advantageous over surgical excision as it is simple to perform, is less invasive therefore not associated with complications associated with invasive procedure, and is well tolerated by patients.

Simple and Effective Cryosurgical Treatment of Various Oral Lesions

The objective of this study was to evaluate the efficacy of cryosurgery on 134 different benign oral lesions in 90 patients. All lesions were treated every 2 weeks until complete regression of the lesion had been achieved. Patients were examined at 2, 7, and 10 days, 2 and 4 weeks, and 3 and 6 months after the cryosurgery. The relationship between the number of cryosurgery applications to achieve complete regression and the type of lesions was assessed for statistical significance by one-way analysis of variance and with the Scheffé test. The mean application number of the cryosurgery was 1.82±0.49 for fibroma, 2.35±1.44 for vascular lesions, 1.50±0.70 for mucocele, 2.65±1.18 for lichen planus lesions. The difference between the type of the lesion and number of application was statistically significant for all groups (p< 0.05). Our data prove that a significantly fewer number of cryosurgery treatments are required to achieve complete regression for fibroma and mucocele lesions compared to lichen planus lesions. During the follow-up period, only 7 lichen planus lesions of 76 lesions recurred.