Forums › Laser Treatment Tips and Techniques › Soft Tissue Procedures › Mucocele Treatment
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ASISpectatorHi Folks,
Here’s a case of a mucocele I have been treating since late June of this year. A lovely 19 year old female with a recurring mucocele on the right just immediate inside of the vermillion border of her lower lip. She has been continually aggravating it by biting accidentally or not. It started about a year ago or so. It had been treated by a plastic surgeon 4 times in November to December 2002 by excision but it keeps recurring. She hadn’t been thrilled with the use of scalpel and sutures.
[img]https://www.laserdentistryforum.com/attachments/upload/smaccarthy1.JPG[/img]
Pre-op 8.5×6.5x2mm
[img]https://www.laserdentistryforum.com/attachments/upload/smaccarthy3.JPG[/img]
week 2 post-op after Biolitec 980nm 600u fibre 3W CW under local infiltration
[img]https://www.laserdentistryforum.com/attachments/upload/smaccarthy4.JPG[/img]
week 7 post-op with residual lesion on medial aspect; not evident clinically but detected by patient
[img]https://www.laserdentistryforum.com/attachments/upload/smaccarthy5.JPG[/img]
week 8 recurrence clinically evident
[img]https://www.laserdentistryforum.com/attachments/upload/smaccarthy6.JPG[/img]
immediate post-op after Biolitec 980nm 600u fibre 5W 0.04on/0.07off with irrigation under topical
[img]https://www.laserdentistryforum.com/attachments/upload/smaccarthy7.JPG[/img]
week 11, recurrence evident clinically; reduced in size
[img]https://www.laserdentistryforum.com/attachments/upload/smaccarthy8.JPG[/img]
immediate post-op after Biolitec 980nm 600u 5W 0.04/on0.07off with irrigation; deeper removal under topical
I can feel there is a deeper stalk like structure below upon palpation. Part of it could be scar tissue from repetitive treatment since November 2002. At the same time, during laser treatment under the scope, I can see a fluid-like substance where the recurrence is most apparent. This may go on to require additional treatment. The only encouraging thing is that the lesion appears to have reduced in size on subsequent recurrence. The patient has been amazingly upbeat throughout treatment as she feels there has been improvement.
Please advise.
Andrew
(Edited by ASI at 3:10 am on Sep. 24, 2003)
SwpmnSpectatorGuess the obvious question is did the surgeon biopsy the lesion? Question number two is if the lesion was excised four times was it biopsied a second time and perhaps sent to a another pathology lab? Anything of significance in the medical history?
Personally, I think you’ve done your part, provided a good service and I would refer further treatment to an oral/maxillofacial surgeon.
Al
Alfred WyattSpectatorI totally agree with Allen. You and the diode have done a very good job removing the lesion, but the reoccurances concern me. Are there any malaligned teeth or oral habits that could possibly be contributing to the problem?
whitertthSpectatorAndrew, very often there are residual structures that if they are not completely excised will cause a recurrence even if the patient is not biting her lip. If u feel something in there , there probably is something in there and at this point I would punt and send her yoa local oral surgeon to complete the task.
marc andre gagnonSpectatorhi andrew
I thing that now you have excised all the lesion but if you have recurrence it’s now the time to make a biopsy.
You have done an excellent job but it’s time to refer.
In a case like that I prefer to use anesthesic the first time because I want to be sure that I do the excision of all the lesion . -
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