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Subjects:
Dentistry, Oral Surgery & Medicine
Oral mucoceles are non-neoplastic cystic lesions of major and minor salivary glands that commonly occur in the oral cavity. All studies indicated successful clinical results on mucocele excision with better intra- and post-operative indicators. The general characteristics and outcomes were summarized, and the quality of the studies was assessed using CARE guidelines. The reduction or absence of pain and bleeding, hemostasis, reduced operating time, minimal analgesic consumption, and an antibacterial effect were among the advantages of laser irradiation in the included studies. The laser has proven itself to play an effective role in the treatment of oral mucocele in paediatric patients.
- dental laser
- oral pathology
- oral medicine
- paediatric surgery
- mucocele
- pedodontics
1. Introduction
Mucoceles are primarily classified under two headings: extravasation and retention types. Extravasation mucoceles are caused due to mechanical trauma in salivary ductal cells that culminates in the accumulation of mucin in the extracellular space. The retention type, which is a much rarer occurrence, is due to the result of mucin retention because of salivary ducts or acini obstruction [2]. The common site of mucoceles is the lower lip while other locations where mucoceles have been observed also include the ventral surface of the tongue, upper lip and floor of the mouth [3]. Although often asymptomatic, a mucocele, owing to its size and site of lesion can also cause a feeling of discomfort and pain, and subsequently compromise the functionality of the mouth. The traditional treatment for oral mucoceles of smaller size is surgical excision, while on the other hand marsupialization is employed for larger lesions [4].
The literature has reported a consistent number of cases of oral mucoceles in pediatric patients [5]. Although mucoceles are benign in nature, its presence can act as a major impediment to feeding and respiration [6]. The presence of pediatric mucoceles in infants is a frequent cause of concern and apprehension for parents [7]. In addition to an accurate and prompt diagnosis, the application of a treatment modality that effectively counters the limitations posed by dentistry in children is also essential. Dental treatment in pediatric patients, owing to their anxiety and fears, pose a challenge to clinical practitioners [8]. In addition, limitations in taking therapeutic actions may lead to general anesthesia instead of local ones, especially at younger ages, thereby further adding to the concern over complications caused by general anesthesia [7]. Similar to other soft tissue conditions in pediatric patients, an intervention that uses the minimum invasive approach reduces pain, requires only a short procedure time and is devoid of complications can provide more benefits and comfort to patients with oral mucoceles [8]. In this regard, technological advancements in dentistry have vitiated undesirable effects of such limitations, as the intraoral and extraoral use of dental lasers for performing surgical methods on oral soft tissue conditions has been met with successful results [9].
The last few decades have witnessed lasers as a helpful tool in the field of dentistry. Lasers have been utilized in various capacities that have subsequently revolutionized the diagnosis and treatment of oral lesions [10]. Primarily, the lasers operate through a laser-tissue interaction interface. The numerous advantages of lasers include their relative safe use, pain reduction, minimum invasion, shortening the time of surgical interventions, ability to achieve a precise cut, better accessibility and visibility of the surgeon due to bloodless field, analgesic effect and photobiomodulation promoting tissue healing and regeneration; these characteristics, therefore, make it a viable candidate for use in the excision of soft tissue lesions, including mucoceles [5,11]. Primarily, soft tissues lasers are of various types; diode, CO2 and YAG family lasers are the most commonly used, with each possessing unique benefits [11]. Diode lasers are poorly absorbed by hard dental tissues in contrast to the skin pigments melanin and hemoglobin, which readily absorb their irradiation with far greater thermal effects [12]. Usage of lasers, especially CO2 lasers, has also reportedly shown effective results due to the high absorption of its photons in water [13].
2. Current Insights
The mucocele is one of the most common oral lesions. Different treatment modalities have been adopted in the past for its management, i.e., surgical excision, electrocautery, cryosurgery, marsupialization, and laser therapy. Conventional surgical excision with and without marsupialization remains the gold standard treatment protocol, as it pre-vents recurrence and is cost-effective. Despite these advantages, it might be associated with complications such as lip disfigurement, damage to adjacent salivary ducts, numbness, and scarring [38,39,40,41].
Lasers in dentistry began to gain popularity in the 1990s. They are used in dentistry as an adjunct or independent treatment tool. The main goal of using lasers over conventional treatment is to overcome the disadvantages of conventional treatment modalities [10]. Literature shows that laser therapy has limited postoperative bleeding, pain, complications, damage to the surrounding structures, shorter healing time, and relapse, as compared with scalpel excision [42]. Furthermore, studies have discovered that lasers in dentistry are highly tolerable and acceptable for children, which can improve treatment outcomes and make surgery and recovery easier [43,44]. This study evaluated 17 articles, where a total of 183 peadiatric patients with mucoceles were treated with different lasers [21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37]. The studies by Yagüe et al. and Wu et al. [24,26] reported cases of conventional surgical excision and laser, and they reported conclusively that laser therapy resulted in a more comfortable postoperative outcome for the patient, as compared to surgical excision.
The optimal type of laser for oral soft tissue surgeries is not clearly documented. The effectiveness of the Diode, CO2, and YAG families of lasers were assessed in this study. Out of the total included articles, 10 studies used diode lasers of various wavelengths [25,27,28,29,30,31,33,35,36,37]. Furthermore, a majority of the studies reported adequate postoperative healing with minimal or no scarring, no post-operative discomfort or pain, nor any other complication, and recurrence in the treated lesions. In addition, less procedure time, good surgical site visualization, and hemostasis were also achieved [25,27,28,29,30,33,35,36,37]. In this review, all the studies included a follow-up period that varied from 8 days to 1 year. However, the study by Chinta et al. [31] reported a case where reoccurrence was seen after 4 weeks of using a diode laser. For the prevention of future recurrences, excision was performed again, and a thermoplasticised splint was used as an adjunct to prevent nail biting and irritation of the lip from the incisors. No recurrence was observed after 6-month follow-up. Moreover, Romeo et al. [27] used KTP, Er, Cr: YSGG and diode lasers for removal of the mucocele and found that a diode laser offered optimum bleeding control and high cutting efficiency due to the higher affinity of a diode laser for hemoglobin.
Additionally, 05 studies assessed CO2 laser of various wavelengths (10–600 nm) and observed minimal pain or discomfort, no or reduced bleeding, and uneventful healing with a follow-up of 3 weeks to 1 month [21,22,24,26,32], even though Huang et al. and Wu et al. [21,26] reported that 2 of their cases developed a recurrent mucocele. Three of the studies utilized an Er,Cr:YSGG laser (2780 nm) and reported no discomfort or bleeding, little or no scarring, without recurrence [23,27,34]
Results of the reviewed studies indicate that the lasers have proven to be a safe and effective treatment modality for oral mucocele removal. It is well accepted by young patients because it is painless and has minimal or no postoperative complications. Therefore, it should be considered as the first choice or a better alternative to surgical excision, especially in paediatric patients.
Although the result of the included studies was favorable, there were certain limitations of this study. For instance, the included studies failed to provide considerable in-formation about timeline, patient perspective, and laser energy. A majority of the studies failed to report the recurrence rates, as most of the studies had a follow-up period of less than a month [21,22,24,25,26,27,30,32,33,34,36]. This review only included case reports and case series. Future studies should include clinical trials for comparison with conventional surgical procedures in different groups. Nonetheless, an increased number of patients should be reported for diversity; more importantly, long-term post-surgical follow-up periods and clinical correlation should be emphasized to predict the actual outcome of the laser radiation in the treatment of pediatric mucoceles.
This entry is adapted from the peer-reviewed paper 10.3390/ma15072452
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