Holy Moly-Huge mucocoele - Laser Dentistry Forum

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August 30, 2004 at 6:13 pm #3384 Reply

Samuel Moss
Spectator

Hi,

A few weeks ago, a patient related that his son was going to an oral surgeon to have a large mucocoele removed. He asked about IV sedation, stitches, and future scarring. I told him about my laser and that I thought the procedure might be able to be done without any shots and definitely no sutures and that the scarring issue was no issue at all. He said that this lesion was “kinda big.”

I used my trusty Er,cr:YSGG laser with a 6.0 mm sapphire tip setting at 1.5W, 11/7 water/air. The procedure took about 15 minutes, most of which was stopping to take photos. I’m not too good with this uploading of photos stuff, but here goes. BTW, he comes in later today for his 3 week followup photo.
I’ve tried to do this a couple of times today, and the photos are on the LDF server. Hope to get them up.

Mossman

mucocoele before

[img]https://www.laserdentistryforum.com/attachments/upload/mucocoele before reduced size.JPG[/img]

mucocoele exposed

[img]https://www.laserdentistryforum.com/attachments/upload/mucocoele exposed reduced size.JPG[/img]

during laser surg

[img]https://www.laserdentistryforum.com/attachments/upload/during laser surg–reduced size.JPG[/img]

1 week post op

[img]https://www.laserdentistryforum.com/attachments/upload/after cautery reduced.JPG[/img]

[img]https://www.laserdentistryforum.com/attachments/upload/1 week post op.JPG[/img]

August 31, 2004 at 1:59 am #10719 Reply

drkdds
Spectator

Mossman,
Is this a procedure you have routinely treated via blade?

Anesthesia?

Did you place the patient on any meds?

How was the patients discomfort post-op? Looks like it hurts!

August 31, 2004 at 5:32 am #10720 Reply

lookin4t
Spectator

I’m assuming you had to use anesthetic.

I would have preferred to see some primary closure here. If you’re worried about a scar, you didn’t decrease the chance of it happening here.

To be really honest, when I’ve done this with a scalpel and 6-0 to 7-0 sutures I’ve had better looking post-ops. If you are actually worried about a scar here I would consider primary closure.

August 31, 2004 at 1:25 pm #10721 Reply

Samuel Moss
Spectator

Doug and lookin4t,

I used to do these with local anesthetic, blade, surgical scissors, and sutures. Plus, I had never seen one quite this large. However, I used no local; just the TAC alternative topical, reapplying it when he would raise his hand indicating stinging. He didn’t really get a chance to raise it much, as I would repeatedly stop and just bathe the surgical area with the TAC topical.

I gave no post op meds, just OHI as to rinsing with warm salt water. As with all my patients, I call for the 1st few days to walk them through the healing process as well as to get their feedback. The 1 week post op photo looked ulcerous, but he said it was not painful and did not feel like an ulcer.

I am posting the week 3 postop photo today and you can see that there is no hint of scarring. FWIW, I did tell mom and dad that mucocoeles can come back.

Mossman

August 31, 2004 at 10:57 pm #10727 Reply

Swpmn
Spectator

Impressive healing at three weeks Moss. How old is the patient?

Al

September 1, 2004 at 12:14 am #10722 Reply

Samuel Moss
Spectator

Hey Al,

This little guy is 12 years old. On regular size (pea size) mucocoeles they usually look like this 3 week followup at 1 week. It’s hard to believe that he never hurt.

Mossman

September 1, 2004 at 1:35 am #10723 Reply

ELLIOT ROGOFF
Spectator

A very nice result. Just goes to show that the healing capacity is unbelievably great with the laser. Also their are many ways to do this. I might have tried a CO2 to reduce the time and the bleeding. But the healing probably would be identical. Nice Job.

September 1, 2004 at 3:58 am #10728 Reply

arrowsmith
Spectator

Please tell me that the thumb I see retracting the lip belonged to the patient’s father!

September 1, 2004 at 9:03 am #10725 Reply

Kenneth Luk
Spectator

Hi,
Great result.
Laser wounds generally looks worse than you think in the beginning but heal with excellent reults.
ken

September 1, 2004 at 8:01 pm #10726 Reply

Robert Gregg DDS
Spectator

Nicely done Sam,

Laser wounds are UGLY wounds, that heal very nicely. They often must heal by secondary intention such as this case.

That blood blister on the thumb looks like it’s healing nicely too. Did you biostim?

Bob

September 3, 2004 at 2:30 am #10724 Reply

Glenn van As
Spectator

Sam: Nice stuff, I am amazed that you were able to do this without anaesthetic. I was hoping to try some of Ron Kaminers magic potion but I guess it got hung up at the border cuz I was never able to get it.

What are the Canadian folks here using for topical. The best I can do is One Touch Topical by Hagar. Anybody got anything that they use.

thanks

Glenn

Good job Mossman……I always appreciate when someone goes out of their way to show a case. It takes kahunas and a thick skin.

Now Hack2, you gotta admit the healing looked nice and a scalpel and sutures needs anaesthetic so there was some advantage to this one in my book.

Glenn

September 3, 2004 at 2:46 am #10718 Reply

Anonymous
Guest

QUOTE

Quote: from Glenn van As on 10:30 pm on Sep. 2, 2004
Anybody got anything that they use.
thanks

Glenn

Glenn , here’s one you can have a compounding pharmacist make for you-

Benzocaine 20%
Lidocaine 6%
Tetracaine 4%
Phenylephrine qs to 30 grams

I got this from James Jesse DDS and am very happy with it.
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