|Year : 2018 | Volume
| Issue : 3 | Page : 328-330
Squamous papilloma treated with diode laser
Bhavna Barthunia1, Neeral Barthunia2, Shaik Mohammed Asif3
1 Department of Oral Medicine and Radiology, Daswani Dental College and Research Hospital, Kota, Rajasthan, India
2 Department of Orthodontics and Dento Facial Orthopedics, Daswani Dental College and Research Hospital, Kota, Rajasthan, India
3 Department of Diagnostic Sciences and Oral Biology, College of Dental Surgery, King Khalid University, Abha, Kingdom of Saudi Arabia
|Date of Submission||14-Feb-2018|
|Date of Acceptance||16-Apr-2018|
|Date of Web Publication||18-Oct-2018|
Dr. Bhavna Barthunia
Department of Oral Medicine and Radiology, Daswani Dental College and Research Hospital, Kota, Rajasthan
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Oral squamous papilloma is a benign tumor of unknown origin which arises from stratified squamous epithelium and appears as a cauliflower-like growth with finger-like projections seen on the tongue, palate, and other parts of oral cavity. The treatment modalities include surgery, cold steel excision, cryosurgery, and laser ablation. Here, we report a case of squamous papilloma on buccal mucosa treated with a diode laser.
Keywords: Diode laser, oral, squamous papilloma
|How to cite this article:|
Barthunia B, Barthunia N, Asif SM. Squamous papilloma treated with diode laser. J Indian Acad Oral Med Radiol 2018;30:328-30
| Introduction|| |
Squamous papillomas are asymptomatic, benign, exophytic mass commonly seen on the palate, uvula, and vermilion border of the lip. The cause is mainly human papilloma virus (HPV) types 6 and 11. The occurrence of the lesions is influenced by smoking, coexistent infections, dietary deficiencies, and hormonal changes. We report a case of squamous papilloma on buccal mucosa induced because of tobacco and treated with diode laser.
| Case Report|| |
A 52-year-old healthy male patient reported to private dental hospital with a chief complaint of growth on the left buccal mucosa since 6 months. He noticed the growth 4 months back which was groundnut size and has progressed to the present size. Growth was painless, but the patient complaint of discomfort whenever touched with the tongue. He had a history of chewing 10–12 gutkhas per day and keeps the quid on the left buccal mucosa since 15 years for half an hour and used to spit out the quid.
Medical and family histories were non-significant. He reported no such growths anywhere else on his body. On examination, his vital signs were within normal limits. Mouth opening was reduced to 18 cm when measured with help of a ruler. On intra-oral examination, a single raised cauliflower-like growth was seen on the left buccal mucosa extending anteriorly 1 cm away from the corner of the mouth and posteriorly to third molar region [Figure 1]. The growth was homogeneous, raised, non-tender, immobile, and rough in nature with circumscribed borders. Differential diagnosis of verrucous carcinoma, xanthoma, and papillary hyperplasia was given. As it was a private dental hospital and considering the financial status of the patient, no further investigations were advised except laser ablation. The most prominent part of the growth was excised first for histopathological examination.
BIOLASE (Epic) 10 W 940 nm, diode laser was set at excision mode, continuous pulse using e4 (400 μm tip) at 1.5–1.8 W; a protective eyewear was worn by the patient and the operator, and a portion of the growth was excised and the specimen was sent for histopathological examination. Histopathology showed stratified squamous epithelium with well vascularized stroma and infiltration of chronic inflammatory cells [Figure 2]. Final diagnosis of squamous papilloma was given.
|Figure 2: H and E section showing stratified squamous epithelium, vascularized stroma, and chronic inflammatory cells|
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Since the growth was large, we decided to excise in two phases. Using the same parameters of diode laser as above, a section of the growth was excised completely. Since the growth was deep, a slight bleeding was noticed which was controlled by hemostatic effect of diode laser. The patient was prescribed mild analgesics and antiseptic mouthwashes and recalled after a week for removal of the second half of the growth and to check for re-epithelization. After a week, healing and new mucosal growth was seen in the area where ablation had been done. The patient reported no post-operative complications and was ready for ablation of the second half of the tissue. Similar parameters and safety measures were followed and the posterior half of the tissue was excised and he was recalled after a week for follow up. The patient reported with complete healing of the lesion and no postoperative complications [Figure 3]. The patient was kept under observation and asked to report after 15 days, but he did not follow up.
|Figure 3: Complete healing after a week postlaser ablation of the entire growth|
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| Discussion|| |
Oral squamous papillomas are innocuous lesions associated with human papilloma (types 6 and 11) virus. The differential diagnosis of squamous papilloma includes verrucous carcinoma, xanthoma, papillary hyperplasia, and condyloma acuminatum. Our case was diagnosed based on clinical and histological characters of the lesion. Histologically, squamous papillomas show squamous epithelium arrayed in finger-like projections, normal maturation pattern, presence of hyper parakeratosis in the epithelium producing perinuclear pale/clear halos, pyknosis, and the occasional presence of basilar hyperplasia. Excision of the tumor was done by diode laser. A study conducted by Natekar et al. compared surgical treatment of leukoplakia using diode, CO2 laser, and cryosurgery. The authors concluded that laser therapy seems to offer better clinical significant results than cryotherapy. Pain was significantly higher in patients treated with CO2 laser when compared with diode laser and scar formation was totally absent in patients treated with lasers when compared with the cryosurgery group. Various researches have described the uniqueness of diode laser which states that reduced postoperative pain of laser excision is due to reduced thermal damage to the surrounding tissue and sealing of small lymphocytic vessel leading to decrease in pain and edema. The disadvantages reported on diode laser application are similar to other lasers like delayed repair for larger lesion. To avoid these complications, we planned to excise the tumor in two parts.
| Conclusion|| |
Oral squamous papilloma is a benign proliferating tumor which is asymptomatic and characterized by painless growth. Diode laser can be used for treatment of papilloma because of easy application, better coagulation, less or no complications of pain, and swelling.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Jaju P, Suvarna PV. Desai RS, Squamous papilloma: Case report and literature review, Int J Oral Sci 2010;2:222-5.
Saraswathi N, Nidoni M. Oral squamous papilloma of the palate – A case report. Int J Dent Sci Res 2014;2:17-8.
Natekar M, Raghuveer HP, Rayapati DK, Shobha ES, Prashanth NT, Rangan V, et al
. A comparative evaluation: Oral leukoplakia surgical management using diode laser, CO2
laser, and cryosurgery. J Clin Exp Dent 2017;9:e779-84.
Goharkhay K, Moritz A, Wilder-Smith P, Schoop U, Kluger W, Jakolitsch S. Effects on oral soft tissue produced by a diode laser in vitro
. Lasers Surg Med 1999;25:401-6.
[Figure 1], [Figure 2], [Figure 3]