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Neodymium:Yttrium aluminum garnet laser in the management of oral leukoplakia: A case series.

Das S, Mohammad S, Singh V, Gupta S - Contemp Clin Dent (2015)

Bottom Line: Pain and slough were evaluated by Wicoxon rank test (P = 0.0001 statistically significant) which decreased from 24 h to 1-week and became nil in subsequent follow-ups.Similarly, McNemar's test (P = 0.001 statistically significant) was used for evaluation of burning sensation, paresthesia, infection and recurrences.It is convenient, economical with minimum complications and morbidities.

View Article: PubMed Central - PubMed

Affiliation: Department of Head and Neck Oncology, Mazumdar Shaw Cancer Centre, Narayana Hrudalaya, Bengaluru, Karnataka, India.

ABSTRACT

Objectives: Oral leukoplakia is a nonscrappable whitish patch described as a potentially malignant disorder with high prevalence in India. Besides medicinal treatment, neodymium: Yttrium aluminum garnet (Nd: YAG) laser is also used for the management of oral leukoplakia. This study evaluated the role of Nd: YAG laser in the management of oral leukoplakia and also investigated postoperative complications along with long-term prognosis of the disease.

Settings and designs: The study is a prospective cohort study conducted for 24 months (June 2011 to May 2013) in Lucknow.

Materials and methods: The study comprised of 42 patients, both male and female of Indian origin and diagnosed with oral leukoplakic lesions. Patients with biopsy proven squamous cell carcinoma and medically compromised are excluded from the study. All patients has undergone ablation of lesion by pulsed Nd: YAG laser and were followed after 24 h, 72 h, 1-week and then successively for 1, 3, 6 months and then 1(st) and 2(nd) postoperative years.

Results: Pain and slough were evaluated by Wicoxon rank test (P = 0.0001 statistically significant) which decreased from 24 h to 1-week and became nil in subsequent follow-ups. Similarly, McNemar's test (P = 0.001 statistically significant) was used for evaluation of burning sensation, paresthesia, infection and recurrences. Recurrence was noted in 2 patients but following the second application, there were no recurrences over the period of further follow-up. None of the patient suffered from an infection, paresthesia or anesthesia.

Conclusion: Hence, Nd: YAG laser was found to be effective in ablating leukoplakia. It is convenient, economical with minimum complications and morbidities.

No MeSH data available.


Related in: MedlinePlus

Six months postoperative follow-up showing complete eradication of the lesion
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Figure 4: Six months postoperative follow-up showing complete eradication of the lesion

Mentions: The 1064 nm Nd: YAG laser (Fotona d.d. Stegne 7, 1000 Ljubljana, Slovenia, EU) with a power range of 1–15 W was used for the study. Laser delivery was done through a 300 μm fiberoptic system with R-21 handpiece. The operating surgeon, assistant and the patients eyes were protected with laser protection glasses. Nd: YAG laser was set at an average power of 2.5–3.5 W in free running pulsed mode in most of the cases. The power is slightly raised up to a maximum of 5 W (N = 10) in cases of lesions involving the palatal mucosa, attached gingiva or lesions classified as verrucous leukoplakia. The power should always be customized for each patient based on the tissue characteristics of the lesional site. The beam was directed as perpendicular as possible onto the tissue with a suitable clearance margin of 5–6 mm [Figure 2]. Once the surgical outline is defined, parallel lines of application of laser was placed within marginal outline, using a process known as “rastering.” Constant speed was maintained to create uniform depth and to prevent heat accumulation at a single site. Wet gauze was used to mop the surgical site and also cleansing of the fiberoptic tip containing charred tissue. A pale pink base that does not bleed indicates removal of the epithelium at the level of basement membrane. The surgical site was left to heal by secondary intention [Figure 3]. All patients postoperatively were prescribed analgesics (tablet aceclofenac 100 mg) twice daily till 3rd postoperative day. All patients were followed 24 h, 72 h, 1-week and successively for 1st, 3rd, and 6th months, 1st year and 2nd postoperative year [Figures 4 and 5].


Neodymium:Yttrium aluminum garnet laser in the management of oral leukoplakia: A case series.

Das S, Mohammad S, Singh V, Gupta S - Contemp Clin Dent (2015)

Six months postoperative follow-up showing complete eradication of the lesion
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4374315&req=5

Figure 4: Six months postoperative follow-up showing complete eradication of the lesion
Mentions: The 1064 nm Nd: YAG laser (Fotona d.d. Stegne 7, 1000 Ljubljana, Slovenia, EU) with a power range of 1–15 W was used for the study. Laser delivery was done through a 300 μm fiberoptic system with R-21 handpiece. The operating surgeon, assistant and the patients eyes were protected with laser protection glasses. Nd: YAG laser was set at an average power of 2.5–3.5 W in free running pulsed mode in most of the cases. The power is slightly raised up to a maximum of 5 W (N = 10) in cases of lesions involving the palatal mucosa, attached gingiva or lesions classified as verrucous leukoplakia. The power should always be customized for each patient based on the tissue characteristics of the lesional site. The beam was directed as perpendicular as possible onto the tissue with a suitable clearance margin of 5–6 mm [Figure 2]. Once the surgical outline is defined, parallel lines of application of laser was placed within marginal outline, using a process known as “rastering.” Constant speed was maintained to create uniform depth and to prevent heat accumulation at a single site. Wet gauze was used to mop the surgical site and also cleansing of the fiberoptic tip containing charred tissue. A pale pink base that does not bleed indicates removal of the epithelium at the level of basement membrane. The surgical site was left to heal by secondary intention [Figure 3]. All patients postoperatively were prescribed analgesics (tablet aceclofenac 100 mg) twice daily till 3rd postoperative day. All patients were followed 24 h, 72 h, 1-week and successively for 1st, 3rd, and 6th months, 1st year and 2nd postoperative year [Figures 4 and 5].

Bottom Line: Pain and slough were evaluated by Wicoxon rank test (P = 0.0001 statistically significant) which decreased from 24 h to 1-week and became nil in subsequent follow-ups.Similarly, McNemar's test (P = 0.001 statistically significant) was used for evaluation of burning sensation, paresthesia, infection and recurrences.It is convenient, economical with minimum complications and morbidities.

View Article: PubMed Central - PubMed

Affiliation: Department of Head and Neck Oncology, Mazumdar Shaw Cancer Centre, Narayana Hrudalaya, Bengaluru, Karnataka, India.

ABSTRACT

Objectives: Oral leukoplakia is a nonscrappable whitish patch described as a potentially malignant disorder with high prevalence in India. Besides medicinal treatment, neodymium: Yttrium aluminum garnet (Nd: YAG) laser is also used for the management of oral leukoplakia. This study evaluated the role of Nd: YAG laser in the management of oral leukoplakia and also investigated postoperative complications along with long-term prognosis of the disease.

Settings and designs: The study is a prospective cohort study conducted for 24 months (June 2011 to May 2013) in Lucknow.

Materials and methods: The study comprised of 42 patients, both male and female of Indian origin and diagnosed with oral leukoplakic lesions. Patients with biopsy proven squamous cell carcinoma and medically compromised are excluded from the study. All patients has undergone ablation of lesion by pulsed Nd: YAG laser and were followed after 24 h, 72 h, 1-week and then successively for 1, 3, 6 months and then 1(st) and 2(nd) postoperative years.

Results: Pain and slough were evaluated by Wicoxon rank test (P = 0.0001 statistically significant) which decreased from 24 h to 1-week and became nil in subsequent follow-ups. Similarly, McNemar's test (P = 0.001 statistically significant) was used for evaluation of burning sensation, paresthesia, infection and recurrences. Recurrence was noted in 2 patients but following the second application, there were no recurrences over the period of further follow-up. None of the patient suffered from an infection, paresthesia or anesthesia.

Conclusion: Hence, Nd: YAG laser was found to be effective in ablating leukoplakia. It is convenient, economical with minimum complications and morbidities.

No MeSH data available.


Related in: MedlinePlus