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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 11  |  Issue : 1  |  Page : 22-23

Laser treatment of a giant squamous papilloma in a pediatric patient


Department of DVL, Dr. S. N. Medical College, Jodhpur, Rajasthan, India

Date of Web Publication23-Jun-2017

Correspondence Address:
Durgesh Sonare
Room No. 94, PG Hostel, MDM Hostel Campus, Jodhpur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdl.jdl_19_16

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  Abstract 

Oral squamous papilloma is a benign proliferation of the stratified squamous epithelium, which results in a papillary or verrucous exophytic mass induced by human papillomavirus. These oral mucosal lesions are usually symptomless and have little progression. Laser-assisted surgery is rampant nowadays with several bonuses including rapid hemostasis, being free of sutures, wound sterility, and negligible postoperative pain and edema. The objective of this report is to present a giant squamous papilloma over tongue in a pediatric patient. The lesion was excised with the help of a diode laser and the healing was uneventful in follow-up visit after 1 month. Giant squamous papillomas can rarely be found in children's oral cavity and laser can be used by clinicians to treat these kinds of lesions. It should be considered as an alternative to conventional surgery.

Keywords: Diode laser, giant, pediatric, tongue papilloma


How to cite this article:
Vats G, Sonare D, Jain V, Kachhawa D. Laser treatment of a giant squamous papilloma in a pediatric patient. J Dent Lasers 2017;11:22-3

How to cite this URL:
Vats G, Sonare D, Jain V, Kachhawa D. Laser treatment of a giant squamous papilloma in a pediatric patient. J Dent Lasers [serial online] 2017 [cited 2020 May 29];11:22-3. Available from: http://www.jdentlasers.org/text.asp?2017/11/1/22/208944


  Introduction Top


Oral squamous papillomas are benign proliferations of the stratified squamous epithelium caused by human papillomavirus (HPV). They are mostly exophytic in nature, clinically seem soft, and are usually whitish pink. The sites of predilection include the tongue, soft palate, and uvula, but any area of the oral cavity may be affected by such lesions. Oral squamous lesions are worrisome due to their appearance, which may mimic exophytic carcinoma or verrucous carcinoma or condyloma acuminatum. Hence, their malignant-looking nature may be deceiving. However, such cases have an insidious rather than an acute presentation and these lesions often show benign character on pathological examinations.[1],[2],[3]

The use of laser in oral surgery has been extensive over the last few decades with favorable experiences. Among the commonly available lasers today, the diode laser is frequently used. Better bleeding control, clarity of vision, and ease in tissue manipulation are some of its advantages.[4],[5] We herein report a pediatric case of a giant squamous papilloma treated with diode laser and the postoperational follow-up.


  Case Report Top


A 2-year-old boy presented with a complaint of soft tissue mass on his tongue. According to the history, this lesion occurred 9 months ago; however, his parents neglected until they recognized the expansion of the lesion. Furthermore, feeding difficulties and surface ulceration of the lesion had added to the woes of the patient. Clinical examination revealed a pink-colored lesion over the posterior aspect of the tongue which was approximately 3 cm × 2.5 cm × 2 cm. Systemic examination was unremarkable. The lesion was completely excised under local anesthesia with diode laser. Histopathological examination revealed a fibrovascular core surrounded by benign squamous epithelium along with hyperkeratosis, focal parakeratosis, and hypergranulosis [Figure 1]. A month later, clinical follow-up showed complete tissue healing [Figure 2].
Figure 1: A fibrovascular core surrounded by benign squamous epithelium along with hyperkeratosis, focal parakeratosis, and hypergranulosis

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Figure 2: Pre- and post-surgical view

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  Discussion Top


Squamous papillomas are benign masses of the mucosa, commonly induced by HPV-6 and HPV-11. The lesions seldom measure more than 1 cm and appear as whitish-pink exophytic, verrucous granules with surface alterations. They may be found on the vermilion part of the lips and on any intraoral mucosal site, with a preferable localization to the hard and soft palate and the uvula.[1],[3],[6],[7] Clinical picture of the location of the lesion in the present case was not appropriate to the common identification of oral squamous papilloma due to its massive size. The lesions are routinely asymptomatic,[3] but in the present case, it had caused trouble due to its size. Squamous papillomas are traditionally divided into two types: isolated solitary and multiple recurring. Although the isolated solitary type is usually found in adults' oral cavity,[3] the clinical view of the lesion in the present case was appropriate with the isolated solitary type. According to this situation, the isolated solitary type of squamous papilloma should be considered although these are not usually found in children's oral cavity.

Surgical removal is the treatment of choice for such lesions and can be performed with electrocautery, cold-steel excision, laser ablation, cryosurgery, or intralesional injections of interferon.[3],[6] In our case, surgical excision was done using diode laser. Laser-assisted surgery has an edge due to the following: excellent control of bleeding, high precision in tissue destruction, devoid of any sutures, wound sterilization, and mild postoperative pain.[4] No analgesic was required after the excision, and wound healing was rapidly achievable. Thus, laser-assisted surgery may prove to be a tolerable procedure for pediatric patients to remove masses such as oral squamous papilloma.


  Conclusion Top


Squamous papillomas can be found in children's oral cavity and it is important to clinch the diagnosis of such lesions. Laser can be used by clinicians to treat such oral lesions and should be considered as a replacement to obsolete methods of surgery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Carneiro TE, Marinho SA, Verli FD, Mesquita AT, Lima NL, Miranda JL. Oral squamous papilloma: Clinical, histologic and immunohistochemical analyses. J Oral Sci 2009;51:367-72.  Back to cited text no. 1
    
2.
Khalighi HR, Hamian M, Abbas FM, Farhadi S. Simultaneous existence of giant cell fibroma and squamous papilloma in the oral cavity. Int J Mol Sci 2011;2:153-6.  Back to cited text no. 2
    
3.
Jaju PP, Suvarna PV, Desai RS. Squamous papilloma: Case report and review of literature. Int J Oral Sci 2010;2:222-5.  Back to cited text no. 3
    
4.
Monteiro LS, Mouzinho J, Azevedo A, Câmara MI, Martins MA, La Fuente JM. Treatment of epulis fissuratum with carbon dioxide laser in a patient with antithrombotic medication. Braz Dent J 2012;23:77-81.  Back to cited text no. 4
    
5.
Elanchezhiyan S, Renukadevi R, Vennila K. Comparison of diode laser-assisted surgery and conventional surgery in the management of hereditary ankyloglossia in siblings: A case report with scientific review. Lasers Med Sci 2013;28:7-12.  Back to cited text no. 5
    
6.
Goodstein LA, Khan A, Pinczewski J, Young VN. Symptomatic squamous papilloma of the uvula: Report of a case and review of the literature. Case Rep Otolaryngol 2012;2012:329289.  Back to cited text no. 6
    
7.
Boj JR, Hernandez M, Espasa E, Poirier C. Laser treatment of an oral papilloma in the pediatric dental office: A case report. Quintessence Int 2007;38:307-12.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]



 

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