The patient returned for a 1-week postoperative appointment (Figure 4), reporting no complications, a lessening of the whitish area, and a decrease in the size of the nodule in the tongue. He was surprised at the decrease in the size of the lesion, saying, “it was almost gone.” Subsequently, at a 1-month postoperative appointment (Figure 5), the lesion was visibly gone and no nodule or firmness was noted in the tongue where the lesion had previously been located.
Past treatment modalities for oral hemangiomas usually involved medication (eg, systemic steroid treatment), sclerotherapy, embolization, x-ray therapy, or excisional surgery. These treatment methods carry several unwanted side effects, including bleeding, risk of infection, and systemic complications as the patient in the present case discovered from an earlier attempt to treat his lesion. Bleeding was a major factor in his previous treatment, as was postoperative discomfort. Using photocoagulation with a diode laser eliminated the need to incise the lesion, which greatly increased the patient’s acceptance of treatment and overall perception of care.
Other than the patient reporting a feeling of warmth, the minimally invasive procedure had no visible or reported adverse effects on him. Postoperative symptoms were mild, and other than the lesion hardening slightly into a nodule due to photocoagulation of the lesion site (which dissipated with time and eventually disappeared over a 1-month period), the healing was uneventful. Variables that could affect the outcome of diode-laser photocoagulation include:
Size of the lesion.
• Type of handpiece used to disperse the laser energy into the targeted tissue.
• Wavelength of the diode laser (810 nm, 940 nm, 980 nm, 1060 nm).
• Time of laser interaction with the targeted tissue.
• Distance of the laser from the targeted tissue.
• Number of applications and time interval.
Further research and clinical studies are needed to help standardize this approach to provide the most efficient and effective treatment to the patient.
Through the successful resolution of a lingual hemangioma using a 940-nm diode laser and special handpiece attachment, this case report demonstrates the potential advantages of innovative laser photocoagulation treatment as an alternative to more invasive, surgical methods. No injectable anesthetic was used. Because no incisions were made, no bleeding was reported. This less invasive nature of treatment averted complications involved with incising a vascular lesion such as the need for suture placement and resulting scarring. Additionally, due to the bactericidal effect of the laser, the chances of postoperative infection and discomfort to the patient were reduced.
The use of a 940-nm diode laser offers an alternative, less-invasive treatment modality for patients presenting with hemangiomas of the oral cavity. While there are a few previously published clinical studies demonstrating this procedure, further case studies and clinical research are needed to standardize a treatment protocol using the 940-nm diode laser.
Dr. Koceja has no relevant financial relationships to disclose.
1. Coluzzi DJ. Fundamentals of dental lasers: science and instruments. Dent Clin North Am. 2004;48 (4):751-770.
2. Dostalova T, Jelinkova H, Housova D, et al. Diode laser-activated bleaching. Braz Dent J. 2004;15 spec no:SI3-SI8.
3. Walsh LJ. The current status of low level laser therapy in dentistry. Part 1. Soft tissue applications. Aust Dent J. 1997;42(4):247-254.
4. Qadri T, Miranda L, Tunér J, Gustafsson A. The short-term effects of low-level lasers as adjunct therapy in the treatment of periodontal inflammation. J Clin Periodontol. 2005;32(7):714-719.
5. Pinheiro AL, Cavalcanti ET, Pinheiro TI, et al. Low-level laser therapy in the management of disorders of the maxillofacial region. J Clin Laser Med Surg. 1997; 15(4):181-183.
6. Deppe H, Horch HH. Laser applications in oral surgery and implant dentistry. Lasers Med Sci. 2007;22 (4):217-221.
7. Genovese WJ, dos Santos MT, Faloppa F, de Souza Merli LA. The use of surgical diode laser in oral hemangioma: a case report. Photomed Laser Surg. 2010;28(1): 147-151.
8. Fekrazad R, Am Kalhori K, Chiniforush N. Defocused irradiation mode of diode laser for conservative treatment of oral hemangioma. J Lasers Med Sci. 2013;4(3):147-150.
9. Donnelly LF, Adams DM, Bisset GS III. Vascular malformations and hemangiomas: a practical approach in a multidisciplinary clinic. AJR Am J Roentgenol. 2000;174(3):597-608.
10. Buckmiller LM, Richter GT, Suen JY. Diagnosis and management of hemangiomas and vascular malformations of the head and neck. Oral Dis. 2010;16 (5):405-418.
About the Author
Michael K. Koceja, DDS