Cryosurgery for Benign Oral Lesions

Oral cavity is easily accessible

The moisture of the mouth and the soft tissue favor the rapid spread of ice ball

Possibility of using a local cream for anesthesia

Ease of postoperative follow-up and possibility of reapplication in case of residual disease

Minimum risk of postoperative bleeding

Postoperative infections are rare

Complications are rare

Healing is good

Cure rates are high

Table 10.2

Cryosurgery in benign oral diseases

Disease	Indications	Freezing time
HPV disease (Warts, condylomata acuminata, papillomas, focal epithelial hyperplasia)	+ + +	10–20 s
Fibroma	+ +	15–20 s
Mucocele	+ +	10–20 s
Pyogenic granuloma (as long as it is a confirmed diagnosis)	+	20–30 s
Venous lake	+++	15–30 s
Palatal papillary hyperplasia	+	30 s
Melanocytic macules of the lower lips	++	3–5 s
Lymphangioma	++	15–20 s
Hemangiomas (mostly small)	+++	15–20 s
Familial acanthosis nigricans	+++	15–20 s
Median lip fissure	+	10 s

10.4 Cryosurgical Techniques for Oral Cavity

Generally, for a lege artis cryosurgical procedure, a proper diagnosis, a good understanding of the basic principles of cryosurgery, a written consent from the patient, adequate illumination, use of sterilized equipment (probes, tips), and a chronometer are required.

For cryosurgery with LN as cryogen, we use the dipstick technique, the open (spray) or semi-open (cone) technique, and mainly the close (probe) technique [2].

Selection of the candidate lesion, its location in the oral cavity, its size, and the number of lesions are critical for a favorable result.

Selection of cryogen (liquid nitrogen vs. nitrous oxide) depends on several reasons. In general, nitrous oxide (NO) is preferred for benign oral lesions. Selection of a cryogen will depend on the experience of the cryosurgeon, availability of cryosurgical equipment, and location, size, and infiltration of the lesion. For instance, in lesions on the lips and posterior oral cavity, both cryogens can be used. For lesions located in the posterior oral cavity NO is used (better control of the technique, avoidance of the liquefaction of LN). For small and superficial lesions, nitrous oxide is preferred. For example, NO is used for superficial mucoceles in children, while LN–CryoProbe technique is preferred for venous lake in the lips [9, 10].

10.5 Cryosurgery as First-Choice Treatment in the Oral Cavity [4, 5, 7, 11, 12]

There are a number of lesions where cryosurgery stands as the first choice of treatment. It gives extremely satisfactory results in less than a week with almost no scar. The postoperative procedure is very simple, and no local anesthesia is required. It is an office procedure that takes very little time. The treatment protocol is suggested in Table 10.3.

Table 10.3

Treatment protocol

Name

Address

Date

Clinical photograph (before treatment)

Diagnosis

Location and size of the lesion

Histologic examination (if needed)

Technique

Freezing and thaw time

Cryogen used

Complications

Follow-up

Clinical photograph (after treatment)

The lesions are:

Venous lake

Small hemangiomas (Fig. 10.1a–c)

Fig. 10.1

(a) Hemangioma on the right buccal mucosa. (b) Treatment with close (probe) technique, freezing time: 15 s; double freeze-thaw cycles. (c) 1 year later

Lymphangioma

Mucocele (Figs. 10.2a–d and 10.3a, b)