Success Rate of Benign Oral Squamous Papilloma Treatments After Different Surgical Protocols (Conventional, Nd:YAG, CO2 and Diode 980 nm Lasers): A 34-Year Retrospective Study

Abstract

Objective: The aim of our retrospective study is to compare the long-term recurrence rate of the benign oral squamous papilloma (OSP) with different laser-assisted treatments and conventional procedures (use of scalpels) aiming to suggest the most suitable surgical protocol showing the lowest recurrence rate. Background: A retrospective multicenter DATA collection between 1985 and 2019 covering 781 OSP cases concerning different surgical protocols used for the treatment of OSP was done and included the use of different laser wavelengths [neodymium-doped yttrium-aluminum-garnet (Nd:YAG), carbon dioxide (CO₂), and Diode 980 nm] and the conventional surgeries using the scalpel. The age, sex, and the oral location of the OSP were noted. Methods: Three different surgical protocols were selected in our study: protocol 1 regrouped surgical procedures performing the excision of OSP with an in-depth safety margin of 1 mm and just at the base of the tumor with reduced excision of the grossly normal marginal mucosa around the tumor (0-1 mm). Protocol 2 and 3 were similar to protocol 1, but with an additional excision of 1-2 mm and ≥3 mm of the grossly normal marginal mucosa, respectively, for group 2 and 3. All laser-treated OSP wounds were left without sutures. In the conventionally treated OSP, sutures were regularly performed. Follow-up was done after 15 days and at 1, 6, and 18 months. The three included wavelengths were Nd:YAG (1064 nm), CO₂ laser (10,600 nm), and diode laser (980 nm). Results: After 18 months of follow-up, the highest success rate was obtained with protocol 3 (100% with Nd:YAG, 99% with CO₂, 98.4% with diode, and 99% with the scalpel), which was significantly higher than the values of protocol 2 (96.6% with Nd:YAG, 91% with CO₂, 96% with diode, and 95% with the scalpel) and the protocol 1 (38% with Nd:YAG, 29% with CO₂, 33% with diode, and 30% with the scalpel). The oral locations of OSP were 30% on palates, 30% on the tongue, 16% on cheek, 14% on lips, and 10% on other locations. Conclusions: The lowest recurrence rate was observed when a minimum of three millimeters (≥3 mm) of grossly normal aspect mucosa around the OSP was included in the excisions. The laser wavelengths and the use of scalpel did not show any significant difference in terms of recurrence.

Keywords: laser; oral; papilloma; surgery; treatment.