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| CASE REPORTS |
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| Year : 2019 | Volume
: 13
| Issue : 2 | Page : 52-55 |
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Diode laser excision of pyogenic granuloma: A case report
Vineet Bansal, Aravinda Konidena, Amrit K Mann, Farheen Farooq
Department of Oral Medicine and Radiology, Swami Devi Dyal Hospital & Dental College, Barwala, Haryana, India
| Date of Web Publication | 14-Nov-2019 |
Correspondence Address:
Prof. Aravinda Konidena
Department of Oral Medicine and Radiology, Swami Devi Dyal Hospital & Dental College, Barwala, Haryana.
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdl.jdl_8_19
Pyogenic granuloma is a commonly occurring inflammatory hyperplasia of the skin and oral mucosa in females. It is a misnomer that is characterized histologically by angiomatous proliferation rather than a granulomatous lesion. This tumorlike growth is considered to be nonneoplastic in nature and has a varied clinical presentation. We present one such case of pyogenic granuloma, which was excised with diode laser along with relevant review of literature. Keywords: Diode laser, granuloma, inflammatory hyperplasia, pyogenic granuloma
Key messages: The use of laser for soft tissue surgeries such as removal of pyogenic granuloma would lessen stress and fear of patients and would also minimize discomfort during and after surgery.
How to cite this article:
Bansal V, Konidena A, Mann AK, Farooq F. Diode laser excision of pyogenic granuloma: A case report. J Dent Lasers 2019;13:52-5 |
| Introduction | |  |
Pyogenic granuloma is a common inflammatory hyperplastic lesion also known as Crocker and Hartzell's disease, granuloma pyogenicum, granuloma pediculatum benignum, benign vascular tumor, and during pregnancy as granuloma gravidarum.[1] The word “epulis” is derived from Greek “epi” and “elon,” meaning “on the gingiva” and represents any lesion that appears on the gingiva, not necessarily implicating the true nature of the lesion. The term “pyogenic granuloma” is a misnomer because the lesion does not contain pus and is not strictly speaking a granuloma. Trauma, poor oral hygiene, low-grade local irritation, or certain kinds of drugs precipitate the hyperplastic response.[2] It is common in females and may be associated with high levels of steroid hormones.
| Case History | | |
A 30-year-old woman presented to our department with a chief complaint of a painless swelling on gums of front region of the lower jaw since six months. She gave a history of a pea-sized swelling initially, which gradually increased to the present size and was associated with physical interference while chewing but not bleeding. She did not recollect any history of trauma or was not under gestation. Her medical history was significant for light periods, and she was under hormonal treatment for the same from a gynecologist since two years. General physical examination revealed no other abnormalities, and there was no generalized lymphadenopathy. On clinical examination, a single, well-defined pale pink, roughly spherical gingival growth of 2.5 × 2.5cm size was seen arising from lingual gingiva of 31, 32, 33, and 34 [Figure 1]. The surface was smooth without ulceration and showed few blood vessels coursing along the surface [Figure 2]. On palpation, it was found to be pedunculated, soft to firm in consistency, non-tender, compressible, but not reducible or fluctuant. Hard tissue examination revealed missing 18 and 38 and spacing between 32 and 33.,
On the basis of history and clinical findings, a provisional diagnosis of pyogenic granuloma was made, and a differential diagnosis of peripheral ossifying fibroma, fibroma, and peripheral giant cell granuloma was considered. Radiological examination with an Intraoral periapical radiograph revealed no evidence of subgingival calculus or foreign bodies or any other significant findings [Figure 3]. Excisional biopsy with diode laser was planned. After local anesthesia, the lesion was excised with a 980-nm diode laser using an initiated tip in continuous mode with 1 W setting. It was ensured that the lesion was completely excised by trimming up the remnants of the soft tissue adjacent to the tooth to prevent recurrence of the lesion. Intraoperatively, there was no bleeding from the lesion [Figure 4]. The excised tissue was sent for histopathologic examination, which revealed angiomatous tissue with endothelial cell proliferation and inflammatory cell infiltrate in the form of few neutrophils, lymphocytes, and plasma cells covered by parakeratinized epithelium, based on which a final diagnosis of pyogenic granuloma was established. The patient was recalled after one week, and her postoperative healing was uneventful [Figure 5]., ,
| Discussion | | |
Hullihen's description in 1844 was most likely the first “pyogenic granuloma” reported in the English literature; however, it was named so only in1904 by Hartzell. Pyogenic granuloma occurs in all age groups, children to older adults, but is more frequently encountered in females in their second decade due to the increased levels of circulating hormones, estrogen and progesterone. Jafarzadeh et al.[3] have reviewed the correlation of oral pyogenic granuloma, pregnancy, and the role of oral hormonal contraceptives in detail. Our patient also was under hormonal treatment for light periods.
Clinically, it presents as an elevated, smooth or exophytic, lobulated, sessile, or pedunculated growth that may show ulcerations or may be covered by yellow fibrinous membrane. Gingiva, especially the marginal gingiva, is affected more than the alveolar part, as was the case of our patient. Lips, tongue, or buccal mucosa may also be affected. Its size varies from a few millimeters to several centimeters, and it is usually slow growing, asymptomatic, and painless, but at times it grows rapidly. The color varies from red, reddish purple to pink depending on the vascularity of the growth.[1] Our patient presented with a slow-growing, well-defined, pale pink exophytic, and pedunculated growth of the lingual gingiva.
Radiographic findings are absent in pyogenic granuloma as in our case. Differential diagnosis of pyogenic granuloma includes peripheral giant cell granuloma, peripheral ossifying fibroma, fibroma, peripheral odontogenic fibroma, hemangioma, conventional granulation tissue, hyperplastic gingival inflammation, Kaposi's sarcoma, bacillary angiomatosis, angiosarcoma, and non-Hodgkin’s lymphoma. Histologically, pyogenic granuloma shows prominent capillary growth within a granulomatous mass.
Although the conventional treatment for pyogenic granuloma is surgical excision, a recurrence rate of 16% has been reported.[4] Rai et al.[5] introduced laser as a powerful tool for the treatment of pyogenic granuloma. They used diode laser with the following specifications: wavelength 808nm (±10), output energy 0.1–7.0 W, and input power 300 VA for the removal of Pyogenic Granuloma.[5] Diode lasers have the advantages of being less invasive, sutureless procedures over conventional excision. Rapid healing can be observed within a few days of treatment, and as blood vessels are sealed, there is a reduced need for postsurgical dressings. It also depolarizes nerves, thus reducing postoperative pain, and also destroys many bacteria and viral colonies that may potentially cause infection. Reduced postoperative discomfort, edema, scarring, and shrinkage have all been associated with its use.[2]
Akbulut et al.[6] stated that diode lasers are useful for oral soft tissue surgical procedures because their specific wavelength (810–980nm) is absorbed by water (although less than the carbon dioxide laser wavelength) and also other chromophores, such as melanin, and in particular, oxyhemoglobin. Moreover, the exclusive use of this laser by contact or at an extremely close distance avoids damage, due to “beam escape,” in an open field, which makes it much safer than other laser sources. Also diode laser has a higher tissue ablation capacity and enough hemostatic properties compared to most laser systems.[6] It has also been documented in numerous studies that laser creates locally sterile conditions, which would result in the reduction of bacteremia concomitant to the operation.[7]
| Conclusion | | |
Diode laser can be effectively used for the excision of pyogenic granuloma to minimize discomfort during and after surgery.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Bhaskar SN, Jacoway JR. Pyogenic granuloma—Clinical features, incidence, histology, and result of treatment: Report of 242 cases. J Oral Surg 1966;24:391-8.  |
| 2. | Kirschner RE, Low DW. Treatment of pyogenic granuloma by shave excision and laser photocoagulation. Plast Reconstr Surg 1999;104:1346-69. |
| 3. | Jafarzadeh H, Sanatkhani M, Mohtasham N. Oral pyogenic granuloma: A review. J Oral Sci 2006;48:167-75. |
| 4. | Newman MG, Takei H, Klokkevold PR, Carranza FA.Carranza's Clinical Periodontology. 10th ed. The Netherlands: Elsevier Publication Amsterdum; 2006. p. 176-7. |
| 5. | Rai S, Kaur M, Bhatnagar P. Laser: A powerful tool for treatment of pyogenic granuloma. J Cutan Aesthet Surg 2011;4:144-7. [ PUBMED] [Full text] |
| 6. | Akbulut N, Kursun ES, Tumer MK, Kamburoglu K, Gulsen U. Is the 810-nm diode laser the best choice in oral soft tissue therapy? Eur J Dent 2013;7:207-11. [Full text] |
| 7. | Asnaashari M, Azari-Marhabi S, Alirezaei S, Asnaashari N. Clinical application of 810nm diode laser to remove gingival hyperplasic lesion. J Lasers Med Sci 2013;4:96-8. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
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