PG is a red polypoid nodule that is often formed by trauma-caused lobular hyperplasia of the skin, or mucosal capillary and venules. It usually has effects on aesthetics, which was the most common reason for clinic visits[8-10]. PG occurs at any age; in this study, most patients were children and adolescents, and males were slightly more than females. The primary sites of oral and maxillofacial PG among our participates were lips, and PG happened more prone in mucosa than skin.
The regular therapies for PG include surgery excision, cryotherapy and CO2 laser ablation. The surgical operation has been wildly used in past decades. The process usually includes resecting pedunculated tissue, and scaling or electrocogulating the residual. Surgery excision has a high cure rate and low recurrence rate, but anesthesia is usually unavoidable; besides, intraoperative bleeding, scarring, pigmentation and hypopigmentation are common, and operation at tricky and cosmetically sensitive sites such as mouth, lip and toe could be difficult. Considering anesthesia-related risks, cryotherapy is safer for PG; it does not cause bleeding during the operation, and scars were rare after healing. However, the contact freezing depth acquires high proficiency, and repeated treatments may be needed to thoroughly erase the neoplasm. As a relatively novel therapeutic modality, sclerotherapy showed satisfied clinical effects. The topical application of timolol eye drops and propranolol was effective, and distinct adverse reactions were rarely reported. However, topical treatment is usually lengthy, and the application of β-adrenergic blockers, especially through oral administration, has certain risks of slowing down the heart rate, causing hypoxemia, hypertension or hyperglycemia[11-13].
Laser therapy has produced successful results in the clinic, with the advantages of minimal pain and elimination for sutures. In the present day, more and more operations were conducted with ultrapulsed CO2 laser. The ultrapulsed CO2 laser has an output wavelength of 10, 600 nm, which is mainly absorbed by water in the skin. The generated energy heats the tissue, which destroys lesion by evaporation and ablation, and the thermal effect at dermis also induces cell regeneration to repair the damaged tissue. Ultrapulsed CO2 laser produces a fine focusing spot to precisely control the range of treated site and causes less irritation for surrounding tissue, therefore reduces adverse effects such as local edema, hyperpigmentation, hypopigmentation and scar formation, and suitable for operation at tricky sites. However, CO2 ablation creates open wounds and therefore has a certain chance of bleeding, recurrence and scaring[5, 16, 17]. Long-pulsed 1,064 nm Nd: YAG laser was reported with cosmetically favorable therapeutic outcomes for PG. Its typical features include the deep penetration down to the tissue, thermocoagulation effect for oxyhemoglobin, and contraction function for capillary. It can be absorbed by met-hemoglobin and solidifies hemoglobin, which destroys red blood cells and forms thrombus that clogs capillaries, leading to local hypoxia and hemostasis[16, 17, 20]. It can also disinfect the surgical wound with mildest postoperative pain, swelling and pigmentation. Despite its advantages, Nd: YAG penetrates so deeply that not only the capillaries of the granulation tissue, but those beneath lesion might also be solidified, which makes it difficult to judge if the granulation tissue was removed thoroughly. Apart from that, this strategy alone usually requires multiple sessions of treatment for eradication, and may also leave local coloration and depression[2, 19, 22, 23].
In this present study for PG treatment, by combining ultrapulsed CO2 laser and long-pulsed 1,064 nm Nd: YAG laser, we expected to unite their advantages, i.e. the vaporization effects of the former, and the coagulation and vasoconstriction function of the later, thereby reducing the bleeding during the operation and thoroughly removing the lesion with a clear visual field of the operation area, in order to maximize the therapeutic effect and minimize the postoperative complications. According to our follow-up records, all patients (20/20) were cured by one session of combined treatment with no recurrence in 12 months. Notably, PG involved in this study were all located at the oral and maxillofacial areas, which are usually cosmetically sensitive. This combined treatment showed not only a high cure rate, but also mild adverse effects and high satisfaction.
In summary, in the treatment of oral and maxillofacial PG, we firstly combined ultrapulsed CO2 laser with long-pulsed 1,064 nm Nd: YAG laser. With the principle of selective photothermal action, the ultrapulsed CO2 laser and long-pulsed Nd: YAG laser combined therapeutic strategy can effectively reduce bleeding during operation, improve the accuracy and safety of this medical cosmetic treatment with satisfactory outcomes. However, future research with controlled design, larger sample size, longer follow-up and investigation would be helpful to further verify the efficacy of this combined laser treatment.