Girish Rao et al 74 JAYPEE Hemostatic Effect of the CO 2 Laser Over Excision of an Intraoral Hemangioma Girish Rao, PS Tripthi, Kritika Srinivasan CASE REPORT ABSTRACT Hemangiomas are benign vascular tumors of the endothelial cells and characterized by increased number of normal or abnormal vessels filled with blood. Most true hemangiomas involute with time, but a certain small percentage does not, which may present with complications that require treatment. An estimated 10 to 20% of the true hemangiomas incompletely involute and require ablative treatment. Hemangiomas are probably one of the most underestimated and misunderstood vascular tumors and it is every diagnostician and clinician’s imperative to have a sound knowledge of these tumors to thus provide successful treatment to the patients. Conventional surgical excision of hemangioma can cause severe bleeding in the operative site, which on the other hand can be well controlled by the coagulative effect of the CO 2 laser, by virtue of a painless vaporization of the tissue. The purpose of this case study is to understand hemangiomas and the importance and efficacy of the minimally invasive, hemostatic effect of a CO 2 and little postoperative scarring and morbidity in comparison to the conventional surgical techniques. Keywords: Intraoral hemangioma, Laser excision, CO 2 laser, Hemostasis. How to cite this article: Rao G, Tripthi PS, Srinivasan K. Hemostatic Effect of the CO 2 Laser Over Excision of an Intraoral Hemangioma. Int J Laser Dent 2012;2(3):74-77. Source of support: Nil Conflict of interest: None declared INTRODUCTION In the past, our understanding of vascular anomalies had been hampered by confusing nosology. This confusion had been responsible for improper diagnosis, illogical treatment and misdirected research efforts. 1 Mulliken et al in 1982, categorized these conditions into two families: A family of self-involuting tumors, growing lesions that eventually disappear and enlarged or abnormal vessels present at birth and essentially permanent. Treatment of vasoformative tumors represents a challenge because the morbidity can range from minor bleeding and swelling to life-threatening hemorrhage and airway embarrassment. Conservative surgical management consists of periodic visits, parental support and photo documentation. It is the most common and longest established method of treatment followed. It provides the advantage of ease of surgeon’s skill and training, ease in handling of instruments and is cost- 10.5005/jp-journals-10022-1023 effective. However, excessive bleeding, considerable wound contraction leading to restriction of oral functions and constant need for cleaning and sterilization lowers the efficacy of this procedure. 2 Electrosurgery and cryosurgery are two other modalities which have high restrictions as a result of unpredictability, normal tissue damage, delay in healing as a result of presence of tissue debris and so. 2 After the development of the first laser, a ruby laser, by Theodore H Maiman (Nature; 1960), based on the concept of spontaneous and stimulated emission of radiation, medical and dental researchers soon began to study different types of lasers for extra- and intraoral surgical procedures. The earliest reports of use of laser were in 1977 by Lenz et al and in radiation therapy by Goldman in 1965. Due to its affinity for water-based tissues, the carbon dioxide (CO 2 ) laser has become a favorite instrument of oral surgeons for treatment of pathologic conditions of the oral mucosa (Sulewski 2000, Bornstein et al 2003a). Excising treatments can be performed faster with better comfort and clinical results as an outpatient procedure. The surgical interventions are sterile, hemostatic and without the requirement of any suturing depending on the size of the lesion. 3 MATERIALS AND METHODS A 32-year-old female patient reported to the dental unit with the swelling and growth on the inner side of the right cheek, between the middle and back teeth. She complained of a localized, recurrent blood-filled swelling since 3 years, which grew larger on each recurrence and would bleed spontaneously and cause discomfort on eating and talking. On general physical examination, it was found that the patient was normally built for her age with no defect in gait or stature, and there was no relevant medical history. Family history was also non-contributory. A comprehensive intraoral examination revealed a sessile purplish swelling of the right buccal mucosa, in the region between the maxillary right canine and first molar, approximately 3 cm in diameter. It was bluish red in hue and soft on palpation, well defined, with absence of any prominent pulsation (Fig. 1).