Surgical treatment of patients with oral mucous lichenoid lesions using high-level laser light

Purpose: To improve the efficiency of surgical treatment of patients with lichenoid lesions of oral mucous using high-level laser light. Material and methods. 102 patients (78 women and 24 men) aged 24–81 with erosive-ulcerative and hyperkeratotic form of the lichen planus of the oral mucous were examined and operated. All patients were randomly divided into four groups: in Group 1 (n = 25), lichenoid lesions were excised with Er: YAG laser scalpel in the ablation mode; in Group 2 (n = 23), Nd: YAG laser light was used to ablate the affected areas; in Group 3 (n = 28), patients were operated on with the technique combining Er: YAG and Nd: YAG laser light for ablation and coagulation; in Group 4 ( control group) (n = 26) scalpel No 15 C was used. Results. Findings of biochemical analyses have shown that patients operated with laser light had less pronounced inflammatory response what can indicate less trauma to tissues. It has been clinically shown that laser surgical technologies in patients with oral mucous lichen planus had a decreased intensity of pain and collateral edema; wound healing process was shorter compared to patients operated on with a scalpel. Conclusion. Laser technologies having intraoperative advantages and more favorable postoperative period, if to compare to traditional techniques, improve the effectiveness of surgical treatment, reduce the rate of complications and disease recurrences. As it has also been shown by our trial, that Er: YAG laser is preferable in patients with erosive-ulcerative form of lichen planus, while Nd: YAG laser is preferable in case of damaged mucous membrane till muscle layer; for the hyperkeratic form, combination of Er: YAG and Nd: YAG lasers is recommended.

high-level lasers, Er:YAG laser, Nd:YAG laser, lichen planus, oral mucous, galvanism

1. Vavilova T.P., Yanushevich O.O., Ostrovskaya I.G. Saliva. Analytical opportunities and perspectives. M.: Binom, 2014: 312. [In Russ.].

2. Lebedev K.A., Mitronin A.V., Ponyakina I.D., Sagan L.G., Legoshin S.N. Galvanic currents in the mouth cavity and the galvanism syndrome. Cathedra – Kafedra. Stomatologicheskoe obrazovanie. 2015; 51: 28–31. [In Russ.].

3. Gorina E.R., Volkov E.A., Yermoliev S.N. Dynamic electrochemical potential of the oral mucosa in patients with lichen planus. Meditsinskii sovet. 2015; 11: 60–63. [In Russ.].

4. Yevgrafova A.A., Tarasenko I.V., Vavilova T.P., Tarasenko S.V. Clinical and biochemical assessment of the surgical treatment of verrucose leukoplakia in the mouth mucous membrane using laser technologies. Kursk scientific journal “Chelovek i zdorovie”. 2011; 3: 50–54. [In Russ.].

5. Molochkova Yu.V. Lichen planus and lichenoid dermatoses. M.: GEOTAR-Media, 2016: 200. [In Russ.].

6. Tarasenko I.V., Vavilova T.P., Tarasenko S.V. Variations in the number of growth factors during reparative processes in rat bone tissue after various approaches for the formation of bone tissue defects. Rossiiskaya stomatologiya. 2011; 4 (5): 40–43. [In Russ.].

7. Tarasenko S.V., Shatokhin A.I., Umbetova K.T., Stepanov M.A. T-cells immunity in the pathogenesis of oral lichen planus. Stomatologiya. 2014; 1 (93): 60–63. [In Russ.].

8. Yusupova L.A., Iliyasova E.I. Lichen planus: modern aspects of pathogenesis and care. Prakticheskaya meditsina. 2013; 1–4 (73): 13–16. [In Russ.].

9. Crincoli V., Di Bisceglie M.B., Sciventti M. et al. Oral lichen planus: update on etiopathogenesis, diagnosis and treatment. Immunopharmacol Immunotoxicol. 2011; 33: 11–20.

10. González-Moles M.Á., Ruiz-Ávila I., González-Ruiz L. et al. Malignant transformation risk of oral lichen planus: A systematic review and comprehensive meta-analysis. Oral Oncol. 2019 Sep; 96: 121–130.

11. Gorsky M., Epstein J.B. Oral lichen planus: malignant transformation and human papilloma virus: a review of potential clinical implications. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, Oral Endodontology. 2011; 111 (4): 461–464.

12. Fernández-González F., Vázquez-Álvarez R., Reboiras-López D. et al. Histopathological findings in oral lichen planus and their correlation with the clinical manifestations. Medicina Oral Patología Oral y Cirugia Bucal. 2011; 16 (5): 641–646.

13. Fornaini C., Raybaud H., Augros C., Rocca J. New clinical approach for use of Er:YAG laser in the surgical treatment of oral lichen planus: a report of two cases. Photomed Laser Surgery. 2012; 30 (4): 234–238.

14. Jairo Robledo-Sierra, Isaäc van der Waal. How general dentists could manage a patient with oral lichen planus. Med. Oral Patol. Oral Cir. Bucal. 2018 Mar 1; 23 (2): e198–202.

15. Elewa R., Altenburg A., Zouboulis C.C. Recalcitrant severe erosive cutaneous lichen planus treated with extracorporeal photopheresis monotherapy. British Journal of Dermatology. 2011; 165 (2): 441–443.

16. Lavanya N., Jayanthi P., Umadevi К. Рао, Ranganathan К. Oral lichen planus: An update on pathogenesis and treatment. J. Oral Maxillofac Pathol. 2011; 15 (2): 127–132.

17. Regezi J.A., Sciubba J.J., Jordan R.C.K. Oral pathology: clinical pathologic correlation. [S.p.]: Elsevier, 2012: 97.

18. Tziotzios C., Lee J.Y.W., Brier T. et al. Lichen planus and lichenoid dermatoses: Clinical overview and molecular basis. AAD JOURNALS. 2018 Nov; 79 (5): 789–804.

19. Yildirim B., Senguven B., Demir C. Prevalence of Herpes simplex, Epstein Barr and Human papilloma viruses in oral lichen planus. Medicina Oral Patología Oral y Cirugia Bucal. 2011; 16 (2): 170–174.