Vaporization techinque by CO2 laser as a treatment of the oral leukoplakia: clinical study

Aim: To determine the sufficient safety margins during laser vaporization of oral leukoplakia as a trial to reduce the recurrence. Introduction: Definitive treatment of oral leukoplakia is essential because of its recurrence and potentiality to the malignant transformation. CO2 laser vaporization is characterized by being with minimal damage to the adjacent tissues, limited scarring, little wound contraction, and low post-operative complications. Materials and Methods: This study was conducted on 36 true leukoplakia lesions and diagnosed in 34 patients (20 Females and 14 Males). The range of the patients age was between 39 and 79 years. The lesions were divided into three groups; Group A: 11 lesions in 11 patients, in which the laser vaporization was done for the entire lesion adding a maximum of 1 mm of safety margins; Group B: 9 lesions in 7 patients, in which the laser vaporization was done for the lesion adding at least 3 mm of safety margins; and finally the Control Group: consists of 16 lesions in 16 patients. During six months after the laser vaporization, four follow-up visits were performed in order to evaluate the healing course and to evaluate the recurrence rate and its degree. Results: Among all the completely healed lesions, 75% of which were in groups A and B while 25% were in the Control Group. In this study, it was observed that some of the vaporized lesions which showed partial or complete recurrence after 6 months of follow-up, have shown an initial recurrence after 3 weeks of laser vaporization. The best results were obtained in patients with no history of smoking habits as the complete healing was 87.5% (7 of 8 lesions) and the complete recurrence was 12.5% (1 of 8 lesions). However, in ex-smokers, the complete healing was 41.5% (5 of 12 lesions), the partial recurrence was 41.5% (5 of 12 lesions), and complete recurrence was 17% (2 of 12 lesions). Discussion: The primary treatment of oral leukoplakia focuses on the elimination of associated risk factors (smoking, alcohol, and local irritating factors). In the literature, the recurrence rate varies between 13.6 and 40.7%, while in our study, after 6 months of follow-up, it was 45% in Group A and 33% in Group B. Conclusion: The recommended optimal safety margins should be at least 3 mm in width; in addition, deep surgical margins may be related to the recurrence of oral leukoplakia. Further research can be performed to evaluate the immediate re-vaporization of the lesions which showed an initial recurrence after 3 weeks of vaporization.