Diode Laser Photocoagulation of Intraoral and Perioral Venous Malformations After Tridimensional Staging by High Definition Ultrasonography

摘要： Objective: To determine optimal settings for use of diode lasers to treat vascular malformations in the head and neck. Background: Diode lasers are generally accepted as effective tools to treat vascular malformations in the head and neck, yet there are no standardized treatment protocols for this treatment approach. Settings for these lasers, in addition to laser type and size and lesion depth are important variables for designing appropriate treatments for vascular malformations. Materials and methods: Vascular venous malformations (VeMs) were classi?ed into ?ve groups according to high-de?nition ultrasound measurements of super?cial dimensions (<1, 1–3, and >3 cm) and lesion extension depth (￡5, and >5 mm). Using a 800 – 10 nm diode laser for surgical procedures, we treated lesions by two different approaches: trans-mucous/cutaneous photocoagulation (8 and 12 W pulsed wave for cutaneous and mucosal lesions, respectively) and intralesional photocoagulation using a laser set to 13 W in the pulsed wave modality to treat both cutaneous and mucosal lesions. Results: We treated 158 vascular VeMs. According to preoperative staging, there were 52 lesions in Group A (super?cial dimension <1 cm), 28 in Group B1 (super?cial dimension from 1 to 3 cm, extension depth ￡5 mm), 16 in Group B2 (super?cial dimension from 1 to 3 cm, extension depth >5 mm), 42 in Group C1 (super?cial dimension >3 cm, extension depth ￡5 mm), and 12 in Group C2 (super?cial dimension >3 cm, extension depth >5 mm). All Group A lesions showed complete healing after a single laser treatment, whereas 7%, 10%, 12%, and 16% of lesions classi?ed in Groups B1, B2, C1, and C2, respectively, required further treatments. Conclusions: The laser settings de?ned in this study were associated with a reduced number of laser applications needed for effective treatment of vascular VeMs. Moreover, the cooling of irradiated tissues, together with prolonged application of a topical regenerative gel, provided good treatment acceptability, reduced the number of postoperative complications, and promoted faster healing of covering tissues.