Management of a Recurrent Pyogenic Granuloma of the Hard Palate with Diode Laser: A Case Report

An alternative method for esthetic and functional management of oral pyogenic granuloma

BACKGROUND

Pyogenic granulomas (PGs) are gingival enlargements which cause esthetic and functional problems that hinder chewing and maintaining oral hygiene. In this series consisting of six cases, we report the rehabilitation of PG using partly de-epithelialized gingival grafts.

METHODS

Following documentation of clinical measurements, a concurrent treatment plan of excision and reconstruction with partly de-epithelialized gingival grafts were followed for all the cases. Six months following procedures, clinical parameters were measured again and a short patient-reported outcome measures consisting of three questions were applied.

RESULTS

In histological evaluations, PG features were observed. In the fourth postoperative week, interdental papilla and attached gingiva were restored. Six months follow-up showed reduction in plaque and gingival indices, clinical attachment loss, and mobility. Mean keratinized tissue height was increased from 2.58 ± 2.20 to 6.66 ± 1.66 in the 6th month of operation. Oldest case was stable after 12 months of follow-up and no infection was found at grafting sites. Papillary coverage was achieved.

CONCLUSION

If the PG is not completely removed due to esthetic reservations, a recurrence may occur. Within our limitations, we can suggest that the immediate esthetic rehabilitation with partly de-epithelialized gingival graft presents a compatible approach in the treatment of mucogingival defects after aggressive excision of PG.

Laser Excisional Biopsy of Bleeding Tumor near Newly Erupted Tooth in an 11-Month-Old Patient under General Anesthesia

Pyogenic granuloma (PG) is a well-known tumor-like growth that commonly appears in the gingiva of the oral cavity. This reactive lesion can develop in response to local irritation, chronic low-grade trauma, long-term low-grade infection, or hormonal imbalances. PG is more frequently observed in individuals during their second and third decades of life, although it can occur at any age. It is more prevalent in young females than males, but on rare occasions, it can be found in children, even infants. Several treatment options exist for PG lesions, which apply after a final diagnosis specified by biopsy and histopathological investigations. Surgical excision is the most common treatment choice for PG lesions. However, comparisons between laser therapy and surgical excision have shown numerous advantages for laser treatment, making it a preferred option for soft tissue lesions. Laser excision offers benefits such as precise and deep incisions, preservation of sterile conditions, improved hemostasis, avoidance of sutures, and less invasive procedures resulting in reduced intra- and postoperative discomfort, pain, and bleeding. This report is aimed at presenting a case of an 11-month-old infant with a gradually growing pyogenic granuloma (PG) lesion that appeared in the palate behind the upper left first deciduous tooth, with a duration of approximately 2 months. The parents reported a history of bleeding associated with the lesion, which emerged after the eruption of the mandibular tooth. An excisional biopsy was done by the application of an 810 nm diode laser under general anesthesia, and the specimen was evaluated by a pathologist. No posttreatment complications or relapses were observed in this case.

10,600 nm High Level-Laser Therapy Dosimetry in Management of Unresponsive Persistent Peripheral Giant Cell Granuloma to Standard Surgical Approach: A Case Report with 6-Month Follow-Up

Peripheral giant cell granuloma (PGCG) is a non-neoplastic, tumour-like reactive lesion that exclusively involves the gingiva and/or the alveolar crest. The surgical approach with a scalpel has been the golden standard of treatment for PGCG, but the scientific literature reports a high rate of lesion recurrence. Hence, this unique case report aimed to evaluate the efficacy of λ 10,600 nm high-level laser therapy (HLLT) in eradicating persistent, aggressive, and recurrent PGCG that failed to respond to standard surgical treatment. A fit and healthy thirty-four-year-old Caucasian male presented with a two-month history of recurrent episodes of an oral mucosal lesion involving the buccal and lingual interdental papillae between the lower right second premolar (LR5) and lower right first molar (LR6), which was surgically excised with a scalpel three times previously. A λ 10,600 nm-induced HLLT was chosen as a treatment modality at a lower peak power of 1.62 W, measured with a power metre, emitted in gated emission mode (50% duty cycle), whereby the average output power reaching the target tissue was 0.81 W. The spot size was 0.8 mm. Ninety seconds was the total treatment duration, and the total energy density was 7934.78 J/cm2. Patient self-reporting outcomes revealed minimal to no post-operative complications. Initial healing was observed on the 4th day of the post-laser treatment, and a complete healing occurred at two-weeks post-operatively. The histological analysis revealed PGCG. This unique case report study demonstrated the efficacy of λ 10,600 nm-induced HLLT and its superiority to eradicate persistent aggressive PGCG over the standard surgical approach with minimal to no post-operative complications, accelerating wound healing beyond the physiological healing time associated with no evidence of PGCG recurrence at the six-month follow-up timepoint. Based on the significant findings of this unique study and the results of our previous clinical studies, we can confirm the validity and effectiveness of our standardised λ 10,600 nm laser dosimetry-induced HLLT and treatment protocol in achieving optimal outcomes. Randomised controlled clinical trials with large data comparing λ 10,600 nm with our dosimetry protocol to the standard surgical treatment modality at long follow-up timepoints are warranted.

A successful treatment with oral beta-blocker: A case report of a recurrent pyogenic granuloma in the external auditory canal

Pyogenic granuloma or lobular capillary hemangioma is a vascular proliferation of the skin and mucosal surface, most commonly in the oral or nasal cavity. To the best of our knowledge, a few cases of auricular pyogenic granuloma were published in the literature. In our case, a 14-year-old female complained of a recurrent pyogenic granuloma in the external auditory canal that regressed successfully with the oral beta-blocker treatment.

Lobular Capillary Hemangioma Masquerading as Pyogenic Granuloma of Anterior Mandible: A Case Report

Pyogenic granuloma (PG) is a reactive connective tissue disorder with female predilection, which exhibits a tumor-like mass with occasional bleeding and superficial ulceration. It most commonly occurs in the maxillary gingiva followed by the mandibular gingiva. It can also occur in extra gingival sites like buccal mucosa, labial mucosa, and palate. There are two histopathological types of PG, namely, a lobular capillary hemangioma (LCH) variant and a non-LCH variant. The various management methods include surgical resection or laser excision along with deep curettage, and there are various nonsurgical methods like local steroid injection, topical administration of various drugs, and sclerotherapy. During the surgical excision, there is a risk of bleeding, and the surgeon should be equipped for the same. The PG (both LCH and non-LCH variant) has an increased chance of recurrence because of which complete excision is mandatory along with the removal of the local irritants. In this case report, a 28-year-old female patient reported recurrent painless swelling in the lower front gums for the past nine months. The surgical excision was done in-toto along with the removal of local irritants (calculus). The swelling was sent for histopathological examination. The patient was kept on regular follow-ups. The patient was followed up continuously for nine months. The swelling did not recur after the excision. Hence, it was concluded that complete excision and removal of local irritants are extremely crucial to prevent a recurrence.

Establishing the efficacy and safety of the novel use of common salt for the treatment of pyogenic granuloma

BACKGROUND

Recurrent bleeding episodes are often a cause of significant anxiety in patients with pyogenic granuloma (PG). The idea of using common salt for the treatment of PG arose from the need for a relatively safe and effective treatment because of the recurrent nature of the lesion.

METHODS

A prospective open-label uncontrolled study of 50 patients was conducted. All cases were treated with ordinary table salt from a commercially available package. White soft paraffin was first applied over the perilesional skin, then sufficient salt to cover the entire lesion was applied and the area was occluded with surgical adhesive tape. All patients were followed up for any complications or recurrence.

RESULTS

Complete resolution of the lesion without any residual scar was seen in 100% of the cases, and 94% reported a decrease in the bleeding tendency of the lesion as an immediate response. The mean time to complete resolution was 14.77 days. Recurrence was noted in one patient after 11 months of resolution.

CONCLUSION

Owing to the relative ease in application, lack of scarring and excellent response, we consider salt application to be an ideal treatment for PG lesions, especially in children and anxious patients reluctant to undergo any procedure.

Therapeutic effects of diode laser on vascular epulis in esthetic area

Vascular epulis is a rare clinical disease. In our study, a case of vascular epulis in the cosmetic area was treated by diode laser, without recurrence and obvious inflammation in the surgical site 5 years after surgery. This case report indicates that the excision of vascular epulis in the cosmetic area of the anterior teeth by diode laser could be an alternatively safe and complementary approach in lieu of conventional surgery.

Pyogenic Granuloma of the Hard Palate

As the authors recently experienced a patient with pyogenic granuloma arising from the hard palate, they tried to review all the previously reported literatures with the emphasis on its clinical characteristics that can help the accurate diagnosis of this unusual lesion. Based on our experience and literatures review, clinicians should keep in mind that pyogenic granuloma should be taken into consideration in the differential diagnosis of the hard palatal mass despite its rarity. Although histopathological examination of the mass is the only way to arrive at a definitive diagnosis, the knowledge of the gross appearances of pyogenic granuloma with clinical features may be helpful for differential diagnosis.

Pyogenic granuloma: Clinicopathological and treatment scenario

Background:

Oral pyogenic granuloma is a soft-tissue lesion of the oral mucosa. This lesion has a tendency to reoccur after surgical excision.

Materials and Methods:

A total of 28 patients underwent surgical excision of pyogenic granuloma in the period from September 2014 to May 2016. Two surgical techniques were used to remove pyogenic granuloma: simple excision with root planing and modified excision with deep curettage.

Results:

Females (54%) were slightly more predominant than males (46%). The upper and lower jaws were almost equally affected by the lesion with more predilection toward the posterior region. The size of the lesion ranged from 0.5 to 3 cm in diameter with slow-growing rate. Rural residents were more affected (57%) than urban people. The lesion appears clinically as a small red mass with sessile base, and these clinical features were similar in pregnant and nonpregnant women. The recurrence rate was 14.8% and seen only in patients treated by simple excision. Histopathological feature was consistent with inflammatory hyperplastic lesion, and there was no radiographic evidence of bone resorption associated with the lesion.

Conclusion:

Modified excision with deep curettage prevents the recurrence of the lesion after 1-year follow-up.

Labial pyogenic granuloma related to trauma: A case report and mini-review

This paper reports a case of a labial pyogenic granuloma in the lower lip of a 15-year-old boy due to chronic trauma from the maxillary left central incisor. The case report is based on the CARE (CAse REport) Checklist developed by the Joanna Briggs Institute. A further aim is to present a mini-review about the link between labial pyogenic granuloma and trauma, through searching in three databases (MEDLINE, EMBASE, and Global Health) using a predefined search strategy and keywords. The Cochrane Library and PROSPERO were also searched for published and ongoing systematic reviews, respectively. Only five case reports were found that discussed the link between labial pyogenic granuloma and trauma. Chronic trauma was found to be the most common cause of pyogenic granuloma affecting the lip. Excisional biopsy was the preferable treatment due to the advantage of allowing histopathologic assessment, which is necessary to establish a definitive diagnosis. Dentists advise to include labial pyogenic granuloma in their differential diagnosis (ie, mucocele, cyst, abscess, hematoma, minor salivary gland trauma or tumor) when assessing lesions in the upper and lower lips, in particular when related to a history of trauma.

Clinical Efficacy and Patient Perceptions of Pyogenic Granuloma Excision Using Diode Laser Versus Conventional Surgical Techniques

The use of laser in oral surgery and periodontology is a matter of debate, mainly because of the lack of consensual therapeutic protocols. The aim of this study was to evaluate the surgical advantages of diode laser versus traditional surgery with a cold blade for the surgical excision of pyogenic granuloma (PG). Twenty-one patients (10 males, 11 females, aged 19-66 years; mean age: 46.5 years), requiring PG excision, were enrolled in the study. Through a randomized clinical trial design, all patients were randomly subjected to PG surgical excision with either diode laser or cold blade. Parameters analyzed were the speed of incision, time of intervention, intraoperative bleeding, number of stitches, and patient compliance. Histologic examination was performed before and after surgical excision of the lesions. Patients compiled a subjective evaluation questionnaire. Both treatments were successful in surgical excision of PG. However, the mean speed of incision was significantly reduced in diode laser group (0.61 ± 0.29 mm/s) compared with cold blade group (1.47 ± 1.23 mm/s) (P < 0.05). The mean lengths of time for the whole surgical intervention were significantly lower in diode laser group (221.15 ± 220.89 s) compared with cold blade group (316.10 ± 248.69 s) (P < 0.05). Moreover, diode laser induced a reduced intrasurgical bleeding, and a better gingival healing compared with cold blade surgical treatment. This study demonstrated that the use of diode laser showed additional advantages compared with cold blade in terms of less postoperative discomfort and pain for surgical removal of PG.

Efficacy of Nd-YAG laser for treatment of pyogenic granuloma on the fingers and toes

Pyogenic granuloma (PG) is a common benign vascular proliferation which often occurs on the head, neck, hands, and feet. Among the various treatment options for PG, surgical excision is the most effective treatment which offers the lowest overall recurrence rates and also provides the exact diagnosis. However, it could have difficulties to do the surgery when lesions are located on the fingers and toes, especially very near to the nails, so laser may be a very good alternative choice. In this article, we evaluated the clinical efficacy and safety of neodymium-yttrium aluminum garnet (Nd:YAG) laser for treatment of PG located on the fingers and toes. Twenty-one patients with 21 PGs located on the fingers and toes were treated by multispot Nd-YAG laser. We chose monopulse (pulse width 10.5-13.5 ms; energy 100-125 J/cm²); treatment interval was 3-4 weeks. All lesions disappeared after one or two treatments. There was no apparent scar formation, no impact on the function of the fingers and toes, no damage to nail growth, and no recurrence in more than 12-month follow-up. Nd-YAG is an effective and safety treatment option for treatment of PG located on the fingers and toes.

Pyogenic Granuloma - A Common Benign Vascular Tumor with Variable Clinical Presentation: New Findings and Treatment Options

Pyogenic granuloma is a common benign vascular tumour occurring in all ages. Both skin and mucous membranes can be affected. Of pathogenetic importance are trauma, BRAF mutations and probably herpes virus type 1, Orf virus and/or human papilloma virus type 2. The tumour consists of capillary proliferations, venules and fibromyxoid stroma. The development of a lesion occurs in three stages and bleeding is a common symptom. The tumour can mimic various other vascular lesions, solid tumours, and soft tissue infections. In recent years, targeted tumour therapies have become the most common cause of drug-induced pyogenic granulomas. The backbone of treatment is surgical procedures including laser therapy. New developments in medical drug therapy include topical and systemic beta-adrenergic receptor antagonists timolol and propranolol. Drug therapy is an alternative for young children, ocular and periungual pyogenic granuloma.