Diode Laser Approach for Excision of Solitary Mucocele

Abstract

Oral mucoceles or mucoceles are communal minor salivary gland lesions, and they are clinically categorized by the presence of single or multiple, spherical-shaped fluctuant nodules which are asymptomatic and pain free. Application of diode laser for removal of mucosal lesions in the oral cavity is relatively new and viably better alternative to its precedent methods. The added advantage of using a laser includes lesser bleeding, improved or reduced healing time, and its affinity to melatonin that prevents further or recurrent pigmentation.

INTRODUCTION

Oral mucoceles or mucoceles are communal minor salivary gland lesions, and they are clinically categorized by the presence of single or multiple, spherical-shaped fluctuant nodules which are asymptomatic and pain free.[1] The literature suggests that the occurrence rate is higher in the lower lip when compared to other sites.[2,3,4] The other affected areas include tongue, palate, cheek, and floor of the mouth.[4,5] Mucocele arises from mechanical trauma to the excretory duct of the salivary glands. This causes duct rupture that leads to extravasation of mucin to the connective tissue stroma (mucus extravasation phenomenon).[6,7]

Treatment procedures for mucocele removal include not only conventional surgical technique which is most widely performed but also electrosurgery, cryosurgery, micromarsupialization, and marsupialization. Steroids injections were also reported.[8,9,10] Application of diode laser for removal of mucosal lesions in the oral cavity is a relatively new and viably better alternative to its precedent methods.[11] The added advantage of using a laser includes lesser bleeding, improved or reduced healing time, and its affinity to melatonin that prevents further or recurrent pigmentation.[12]

CASE REPORT

A 27-year-old man presented to the emergency department with swelling on his lower lip. The patient was free of any pain; however, he was complaining about the growing swelling and its effect on the overall facial profile of his face. The swelling has been growing in size for the past 3 months and sometimes causes obstruction while biting or chewing. On being examined clinically, a swelling appearing 10 mm was found on the lower left lip [Figures 1 and 2]. The patient was suggested for diode laser excision of the swelling and the patient agreed.

Figure 1.

Preoperative image of the lesion

Figure 2.

Preoperative image of the lesion facial view

The lesion was excised with a diode laser with a wavelength of 980 ± 10 nm in continuous wave, with output energy of 1 W. Minimal infiltration of local anesthesia, of concentration 1:2,00,000 Xylocaine, was given and the circumferential incision was placed around the swelling Figures 3-7. There was an absence of bleeding during the procedure. 3-0 silk sutures were placed. The utilization of sutures was efficacious because of the larger area of the surgical site Figures 8-10.

Figure 3.

Circumferential incision given

Figure 7.

Surgical site calibration

Figure 8.

Sutures placed

Figure 10.

Postoperative after 2 months (facial view)

Figure 4.

Circumferential incision given

Figure 5.

Mucocele excised

Figure 6.

Excised mucocele sample

Figure 9.

Postoperative after 2 months

DISCUSSION

Blood, lymphatic vessels, related muscles, nerves, and salivary gland tissues, which can be serous or mucous in type, make up oral tissues on surfaces subjected to abrasion during mastication, such as the roof of the mouth (palate) and gums, a stratified squamous keratinized epithelium is observed (gingiva). The stratified squamous keratinized epithelium serves as the body's first line of defense against traumatic abnormalities. Tissue fluids, compounded proteins, chromophoric chemicals, and the heme group of blood hemoglobin species are among the components of an oral tissue bio-sample that are required for application of laser.

The oral cavity's mucocele is the second most common lesion. In the age bracket of 10–29 years, the rate of occurrence is higher. Mucocele is characterized by a mucin buildup.[13] It has a dome-like form to it. They usually have a bluish color to them.[14,15,16] Mucocele is most commonly found on the lower lip, followed by the buccal mucosa and mouth floor.[17] Traditional scalpel incision and/or surgical excision, marsupialization, micromarsupialization, corticosteroid injection, sclerosing agent, cryosurgery, electrosurgery, and laser are all validated procedures for treating mucocele in the literature.[16]

Diode lasers provide a faster wound healing and recovery rate than their rivals. Due to its antibacterial and anti-inflammatory qualities, this laser therapy has the extra benefit of improving wound healing without infection or edema.[18]

Soft-tissue laser-assisted procedures have the advantages of minimum intraoperative bleeding, edema, and postoperative pain, besides very little surgical time, scarring, and coagulation. The size of a surgical site determines whether or not sutures are used. Procedures involving small or significant soft-tissue excision, implant exposure with or without bone trimming, can be performed in patients with bleeding problems.[19]

This instance is consistent with prior reports of mucocele excision using a diode laser. The huge amount of tissue removed and the level of patient comfort further supports the novel fact that it can be employed for big mucocele as well.

CONCLUSION

Diode laser is an inevitable boon for future dentistry. Its ease of avail, atraumatic nature, and integrated advantage over conventional methods spur today's clinical practitioners for their routine work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.