Evaluation of a New Method for the Treatment of Invasive, Diffuse, and Unexcisable Lymphangiomas of the Oral Cavity with Defocus CO2 Laser Beam: A 20-Year Follow-Up

Objective: The aim of our study is to evaluate the efficiency of a new therapeutic method using CO2 laser to avoid mutilation or total excision for the treatment of invasive, large and unexcisable oral lymphangiomas. Background data: Cystic lymphatic malformations, or lymphangiomas, are mature lymphatic malformations, consisting of abnormal lymphatic vessels. Surgical excision is considered by most surgeons to be the treatment of choice for lymphangioma. Laser beam has been used to treat superficial or small lymphatic malformations by excision or by photocoagulation, and to excise or photocoagulate small lymphangiomas. Patients and methods: Seventeen patients with diffuse and unexcisable lymphangiomas were treated using a CO2 laser with specific settings: beam was 2 W in noncontact and defocus mode, power density was 0.63 W/cm(2) for irradiation time in the range of 3-5 min, and the estimated energy density range was 114.65-191.02 J/cm(2). The beam diameter at the tissular impact point was +/- 2 cm. The laser beam was defocused to provoke a deep heat generation that would dry up the lymphatic tissues and induce deep tissue necrosis that heals by fibrous tissue process. Results: The results were satisfactory and stable, with localized recurrence in three cases. The recurrent areas were re-treated using the same technique successfully and with no further recurrence. Conclusions: The use of CO2 laser under the suggested irradiation conditions can be considered a useful technique for the treatment of invasive lymphangiomas.