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| CASE REPORT |
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| Year : 2015 | Volume
: 9
| Issue : 2 | Page : 114-117 |
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Diode laser treatment of an oral squamous papilloma of soft palate
PS Rakhewar, Harshal P Patil, Manojkumar Thorat
Department of Periodontology, SMBT Dental College and Hospital, Sangamner, Maharashtra, India
| Date of Web Publication | 26-Nov-2015 |
Correspondence Address:
Harshal P Patil
Department of Periodontology, SMBT Dental College and Hospital, Sangamner - 422 008, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0976-2868.170564
Oral squamous papilloma is one of the most common benign epithelial neoplasm, frequently seen on the tongue, palate, uvula, and gingiva; and found to be associated with human papillomavirus (HPV) 6 and 11. Treatment laser-assisted surgery is common because of several advantages such as successful hemostasis, devoid of sutures, wound sterilization, and minimal postoperative pain and edema. The aim of this report is to present the case of oral squamous papilloma of the soft palate in a 57-year-old male patient and its management with a diode laser.
Keywords: Diode laser, soft palate, squamous papilloma
How to cite this article:
Rakhewar P S, Patil HP, Thorat M. Diode laser treatment of an oral squamous papilloma of soft palate. J Dent Lasers 2015;9:114-7 |
| Introduction | |  |
The papilloma is an exophytic growth made up of numerous small finger-like projections which result in a lesion with a roughened, verrucous or cauliflower-like surface.[1] According to WHO, definition papilloma is "a range of localized hyperplastic exophytic and polypoid lesions of hyperplastic epithelium with a verrucous or cauliflower-like morphology." It is most frequently found on the tongue and palate, uvula, gingiva and normally associated with infection by the human papillomavirus (HPV), HPV-6, and HPV-11.[2],[3],[4],[5] Papilloma is the fourth most common around 3–4% of all biopsied oral soft tissue lesions.[1]
| Case Report | | |
A 57-year-old male patient reported to the Department of Periodontology for a routine checkup and oral prophylaxis. The patient had a history of smoking since 20 years 4–5 cigarettes per day. Past medical, dental, and personal history was noncontributory. Intraoral examination revealed generalized chronic marginal gingivitis. At the time of intraoral examination a growth was observed on the right side of the soft palate which was previously also noticed by the patient himself since 7–8 years back and stable in size without any discomfort.[3],[4] The growth was exophytic, sessile, nontender, whitish in color with a cauliflower-like appearance [Figure 1], firm in consistency, and approximately 7 mm × 7 mm × 5 mm in size. Lymph nodes were not palpable. Routine blood investigations were carried out and are within normal range. Patient consent was taken before the surgical treatment. Instead of using surgical blade we planned to use soft tissue laser. The lesion was completely excised from the soft palate under local anesthesia with diode laser (iLase, Biolase, 2.5 W,) [Figure 2] and [Figure 3] postoperative instructions were given to the patient and advised to take analgesics and antibiotics as prescribed (Diclofenac sodium 50 mg for 2 days in two divide dosage). The patient was asked to gargle with 10 ml of chlorhexidine 0.2% twice a day for 2 weeks. The excised tissue was kept in the 10% formalin and sent to the Oral Pathology Department [Figure 4]. Recall visit was scheduled at next day, 7 days, 15 days after 1 month, and 6 months intervals to see the recurrence of the lesion. The patient had slight discomfort for 1st week after the laser treatment. Histopathological report (H and E, staining) [Figure 5] and [Figure 6] revealed parakeratinized stratified squamous epithelium arranged in fingerlike proliferations with an abundance of keratin and parakeratinized plugging. The epithelium is hyper proliferated deep within the connective tissue in the form of long bulbous rete ridges. At some places, connective tissue septa are seen within the epithelium. Overlying epithelium shows koilocytes with degenerated nuclei at some places. Underlying subepithelial, connective tissue is fibrocellular with loosely and regularly arranged collagen fiber bundles and variable sized engorged and dilated blood vessels. Deeper part of connective tissue shows densely arranged collagen bundles, nerve bundles, and adipocytes. Healing was noticed uneventful on recall visits without any recurrence [Figure 7],[Figure 8],[Figure 9],[Figure 10]. | Figure 1: Intraoral photograph of the patient showing exophytic, sessile, nontender, and whitish cauliflower-like growth
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 | Figure 2: Excision of the lesion under local anesthesia using diode laser
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 | Figure 5: Microscopic view of papilloma showing stratified squamous epithelium arranged in fingerlike proliferations with abundance of keratin, parakeratinized plugging, and presence of thin connective tissue cores (H and E, original magnification, ×40)
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 | Figure 6: High power microscopic view showing stratified squamous epithelium arranged in fingerlike proliferations (H and E, original magnification, ×100)
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| Discussion | | |
Squamous papilloma is benign mucosal masses commonly induced by HPV-6 and HPV-11.[1] The palatal complex is the most common site of occurrence, but it can be found to affect the uvula, tongue, lips, and gingiva. These lesions are characterized by an exophytic, painless sessile growth, and the digitiform surface projections give it a "cauliflower"-like appearance. Papilloma usually takes up the color of the adjoining mucosa but sometimes appear whitish if the surface is hyperkeratotic.[2],[3]
The clinical view and the locations of the lesion in the present case were appropriate to common identifications of oral squamous papilloma. On the base of the clinical knowledge, the provisional diagnosis of squamous papilloma of soft palate was made and differentiated from the other common benign and malignant lesions seen in the oral cavity such as fibroma, verruciform xanthoma, papillary hyperplasia, and condyloma acuminatum.[6] The oral pathology report confirmed the presurgical clinical diagnosis. The lesions are commonly asymptomatic as seen in the present case. Squamous papilloma is of two types one is isolated-solitary, and other is multiple-recurring. The isolated-solitary type is usually found in an adult's oral cavity, and multiple recurring found in children.[3],[4],[6]
Treatment of choice for these lesions is surgical removal and also can be performed with electrocautery, cold-steel excision, laser ablation, cryosurgery, or intralesional injections of interferon. In this case, surgical excision was performed with a diode laser.
The laser assisted surgery has several advantages such as:[7]
- Precise tissue removal with greater visibility, a clear, dry field due to sealing off the blood vessels, and lymphatic
- Reduces the risk of blood-borne transmission of disease due to its sterilization effect when it cuts
- Minimal pain and swelling have been reported after surgery
- Wound get sealed with a biological dressing so less postoperative infection has been reported
- Wound healing without scar formation and contraction
- Less damage to adjacent normal tissue; and
- Better access to parts of the oral cavity, e.g. the mandibular lingual, retro molar, and parapharyngeal areas.
Because of these benefits, laser surgery has better patient acceptance, often less operative time, and fewer postoperative adverse sequelae. Medically compromised patients, including HIV-positive and mentally retarded patients can be treated by laser.[7]
| Conclusion | | |
Although squamous cell papilloma is a common benign lesion of the oral cavity, care has to be taken while excising these lesions from the soft palate because of high vascularity. Therefore, laser can be the better choice than the routine surgical therapy.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Rajendran R. Benign and malignant tumors of oral cavity. In: Rajendran R, Sivapathasundharam B, editors. Shafer's Textbook of Oral Pathology. 7 th ed. New Delhi: Elsevier; 2012. p. 81-3.  |
| 2. | Abbey LM, Page DG, Sawyer DR. The clinical and histopathologic features of a series of 464 oral squamous cell papillomas. Oral Surg Oral Med Oral Pathol 1980;49:419-28. [ PUBMED] |
| 3. | Jaju PP, Suvarna PV, Desai RS. Squamous papilloma: Case report and review of literature. Int J Oral Sci 2010;2:222-5. |
| 4. | Misir AF, Demiriz L, Barut F. Laser treatment of an oral squamous papilloma in a pediatric patient: A case report. J Indian Soc Pedod Prev Dent 2013;31:279-81. [ PUBMED]  |
| 5. | 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. |
| 6. | Neville BW, Damm DD, Allen CM, Bouquot JE. Epithelial pathology. In: Textbook of Oral and Maxillofacial Pathology. 2 nd ed. Philadelphia; Toronto: W.B. Saunders; 2002. p. 316-7. |
| 7. | Rossmann JA, Cobb CM. Lasers in periodontal therapy. Periodontol 2000 1995;9:150-64. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]
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