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QUI NTESSENCE I NTERNATI ONAL

ORAL MEDICINE/ORAL SURGERY
Lip and oral venous varices treated by
photocoagulation with high-intensity diode laser
Luciane H. Azevedo, DDS, PhD
1
/Aluana Del Vechio, DDS, PhD
1
/

Edgar
Nakajima,

DDS, MS
1
/Vivian Galletto, DDS
1
/Dante A. Migliari, DDS, PhD
2
Lip and oral venous varices are acquired benign vascular lesions characterized by a dark-
blue to violaceous papule or nodule, commonly found on the ventral tongue and lower lip.
Altnougn tnoso losions aro usually asymptomatio, tnoy oan blood i in|urod. Tnis study
assessed the effectiveness of photocoagulation with high-intensity diode laser in the treat-
mont o tnoso losions. Tnirty-two pationts (14 mon and 18 womon, moan ago, 56 yoars)
with lip and oral venous varices were examined and treated with a noncontact diode laser.
With one exception, all cases were successfully treated with a single irradiation exposure
sossion. Hoaling was oomploto in about 2 to 3 wooks, nono o tno pationts oxporionood
complications or recurrence. Photocoagulation with high-intensity diode laser was proven
to be safe and effective for the treatment of lip and oral venous varices, with consistent
results. (Quintessence Int 2013:44:171174)
Key words: diode laser, lip and oral sites, photocoagulation, venous varices
1
Research Fellow, Department of Stomatology and Laser
Institute for Dentistry, School of Dentistry, University of So
Paulo, So Paulo, Brazil.
2
Associate Professor, Department of Stomatology and Laser
Institute for Dentistry, School of Dentistry, University of So
Paulo, So Paulo, Brazil.
Correspondence: Dr Dante A. Migliari, Universidade de S
Paulo, Faculdade de Odontologia, Departamento de
Estomatologia, Av Prof Lineu Prestes, 2227, Cidade Universitria,
So Paulo, SP - Brazil 05508-900. Email: damiglia@usp.br
Venous varices are a type of acquired vas-
cular malformation that represents focal
dilation of a single vein and is mostly seen
in elderly individuals and on the legs.
1
Oral
sites most affected by venous varices are
the tongues ventral surface and the buccal
and retrocomissural mucosae. When on the
lip, they are known as venous lakes.
2

Clinically, lip and oral venous varices usu-
ally appear as dark-blue to violaceous pap-
ules that blanch when pressure is applied.
Once formed, lip and oral venous varices
persist throughout life. Except for occa-
sional hemorrhaging and possible cosmetic
problems, the lesions present no complica-
tions.
1

Poports o troatmont on lip and oral
vonous varioos aro soaroo. Tnis study was
undertaken to assess the effectiveness of
high-intensity diode lasers in the treatment
of this condition.
PATIENTS
A total o 32 pationts (14 mon and 18
womon), ranging in ago rom 25 to 72 yoars
(moan ago, 56 yoars) woro inoludod in tnis
study. Tnoro woro 35 losions, o wnion 26
woro on tno lips, 5 on tno labial oommis-
sure, 3 on the buccal mucosa, and 1 on the
tonguo's vontral suraoo. Tno moan suraoo
diamotor was 0.9 om (standard doviation,
0.17). Diagnosos woro mado on a olinioal
basis, with clinicians testing that the lesions
were easily compressed and blanched
slowly under pressure.
Laser procedure
A nign-intonsity, 2 to 3W diodo lasor
(Lasoring 808, DTM) was usod in a nonoon-
tact technique under local anesthesia.
Irradiation was delivered with a 300-m
diameter exible quartz ber. It was kept 2
to 3 mm from the lesion in continuous wave
mode for 10 seconds, with a mean uency
of 20 J/cm
2
and quick circular movements.
Troatmont ondod wnon blanoning and visi-
172 VOLUME 44 NUMBEP 2 FEBPUAPY 2013
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Azevedo et al
ble shrinkage of the lesion was evident.
When necessary, another cycle was carried
out with a 30-second interval to prevent
noat damago. Ator troatmont, analgosios
woro prosoribod as nooossary. Any oompli-
cations were treated and recorded.
RESULTS
Immediately after laser treatment, all
patients developed slight swelling in the
treated area that lasted 1 to 2 days.
Postoperative pain was minimal in most
patients, and only one patient felt analge-
sios woro nooossary. Nono o tno pationts
oxporionood blooding. Tissuo slougning
occurred within 2 to 3 days, and healing
with re-epithelization was complete 2 to 3
wooks ator troatmont. Nono o tno typioal
advorso ooots (nypor- or nypopigmonta-
tion, atropny, or wrinklod toxturo) woro
obsorvod ator oomploto noaling (Figs 1
and 2). No roourronoo was soon in any
pationt during 8 to 14 montns o ollow-up
(moan, 8 montns).
DISCUSSION
Clinical uses of various modalities of laser
have been used for the treatment of vascu-
lar lesions.
2-5
High-intensity diode lasers are
preferable for lip and oral venous varices
since diode lasers penetrate deeper than
tnoir argon oountorparts. Tno 810 to 830 nm
diode laser beam is poorly absorbed by
water but selectively absorbed by hemoglo-
bin. Duo to its poor absorption by wator, a
high-intensity diode laser penetrates into
tno tissuo to a doptn o 4 to 5 mm. As it
passes through the tissue, the laser beam
generates heat when absorbed by hemo-
globin, tnus ooagulating tissuo (to a doptn
o about 7 to 10 mm) in a proooss known as
photocoagulation.
6
High-intensity diode
laser photocoagulation does not generate
pigmentary and/or textural changes in treat-
ed areas, which are commonly seen when
using defocused continuous carbon diox-
ido (CO
2
) lasors.
Diagnosos o lip and oral vonous varioos
are performed largely on a clinical basis,
with the clinician observing that the lesion is
soft to the touch and blanches on pressure.
Fig 1 Clinical presentation, treatment, and follow-up. (a) A well-circumscribed lip and
oral varix lesion on the vermillion border of the lower lip on presentation, (b) immedi-
ately after photocoagulation with high-intensity diode laser, and after (c) 7 days and (d)
3 weeks of follow-up.
a b c
d
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Azevedo et al
However, because of a thrombus formation
within, lesions sometimes become rm and
dark and can mimic a benign tumor or a
melanoma if the lesion is on the lip or neck.
In such cases, a biopsy should be per-
formed instead of laser surgery.
7
Since no
such mimicry was observed in any of the
present cases, no biopsy or histologic
examination was deemed necessary.
A drawbaok o using a surgioal lasor to
treat lip and oral venous varices is the lack
of histologic examination. However, this
exam is required only when there is some
doubt on the clinical diagnosis.
In the present study, the diode-laser
photocoagulation technique was effective
in the treatment of lip and oral venous vari-
oos. Tnis toonniquo is also praotioal sinoo
diode-laser devices are portable and have
a signicantly lower cost than other high-
powor lasors, namoly Nd:YAG, argon, and
CO
2
lasers. Cryosurgery and electrocautery
are also low-cost surgical devices, but may
cause scarring, particularly in lesions on the
lip border.
Surgeons should be attentive when
using high-intensity diode lasers since they
can generate excessive heat when not used
Fig 2 Clinical presentation, treatment and follow-up. (a) A lip and oral venous varix
lesion on the buccal mucosa, near the labial commissure before photocoagulation with
high-intensity diode laser, on presentation, (b) immediately after photocoagulation, and
after (c) 7 days and (d) 3 weeks of follow-up.
properly, potentially resulting in severe
damage to the normal tissue around the
lesion.
6

CONCLUSION
In the cases presented, the diode-laser
photocoagulation technique provided a
safe and effective treatment, with a consis-
tent outcome.
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