Surgical excision of lobular capillary hemangioma with laser under N2O/O2 conscious inhalational sedation in an uncooperative pediatric patient, Frankl class 2: a case report
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20222170Keywords:
Pyogenic granuloma, LCH type, N2O, Inhalational sedationAbstract
Here, we report a case of lobular capillary hemangioma (LCH) associated deleterious oral habit on lateral border of the tongue in an anxious child excised under nitrous oxide (N2O) sedation using soft tissue diode laser. LCH are rapidly growing vascular lesions and are common occurrence over tongue, but to be associated with deleterious oral habit is an uncommon occurrence. A 9-year-old female child was brought to the dept by her parent due growth on the tongue. The child was quite anxious and displayed negativity towards examination and treatment. The child was classified as Frankl 2 on the behaviour rating scale. A pre-anaesthetic check-up was carried out on the child as it was envisaged to carry out the treatment under inhalational sedation. The anaesthesiologist along with crash cart were present throughout the procedure to cater to any adverse events. The excision was done with 980-nm soft tissue diode LASER to reduce intraoperative haemorrhage, enhance patient comfort and improve postoperative healing. A novel combination of inhalational sedation with soft tissue diode LASER with all necessary precautionary protocols as used in management of this child may be an useful approach for successful and uneventful management. To highlight the importance of proper use of pharmacologic methods in behaviour management as well as surgical techniques for better management of these vascular lesions in children.
References
Eversole LR. Clinical outline of oral pathology: diagnosis and treatment. BC Decker, Hamilton. 2002;3:113-4.
Greenberg MS, Glick M. Burket’s oral medicine: diagnosis and treatment. BC Decker, Hamilton. 2003;10:141-2.
Jafarzadeh H, Sanatkhani M, Mohtasham N. Oral pyogenic granuloma: A review. J Oral Sci. 2006;48:167-75.
Neville BW, Damm DD, Allen CM, Bouquot JE. Soft tissue tumors. In: Oral and Maxillofacial Pathology. Philadelphia: W. B. Saunders. 2004;2:437-95.
Ashley PF, Chaudhary M, Lourenço-Matharu L. Sedation of children undergoing dental treatment. Cochrane Database Syst Rev. 2018;12(12).
Popescu SM, Dascalu IT, Scrieciu M, Mercut V, Moraru I, Tuculina MJ. Dental anxiety and its association with behavioral factors in children. Curr Health Sci J. 2014;40(4).261-4.
Soldani F, Manton S, Stirrups DR, Cumming C, Foley J. A comparison of inhalation sedation agents in the management of children receiving dental treatment: a randomized, controlled, cross-over pilot trial. Int J Paediatr Dentistry. 2010;20(1):65-75.
Pisano M, Sammartino P, Di Vittorio L. Use of Diode Laser for Surgical Removal of Pyogenic Granuloma of the Lower Lip in a Pediatric Patient: A Case Report. Am J Case Rep. 2021;22.
Mcdonald RE, Avery DR, Dean JA. McDonald and Avery's Dentistry for the Child and Adolescent. Elsevier Inc. 2010;9:212-24.
Klingberg G, Broberg AG. Dental fear/ anxiety and dental behaviour management problems in children and adolescents: A review of prevalence and concomitant psychological factors. Int J Paediatr Dent. 2007;17:391-406.
Shindova MP, Belcheva AB. Behaviour evaluation scales for pediatric dental patients review and clinical experience. Folia Med (Plovdiv). 2014;56:264-70.
Sharma A, Tyagi R. Behavior Assessment of Children in Dental Settings: A Retrospective Study. Int J Clin Pediatr Dent. 2011;4(1):35-9.
American Academy of Pediatric Dentistry. Use of Nitrous Oxide for Pediatric Dental Patients. Pediatr Dent. 2018;40:281-6.
American Dental Association. Oral Health Topics-Nitrous oxide: dental best practices for nitrous oxide oxygen. 2019. Available at: https://www.ada.org/en/member-center/oral-health-topics/nitrous-oxide. Accessed on 25 May, 2022.
Ruixiang Y, Danny W, Chay PL, Vivian Yung YW, Chai Kiat C, Marie Therese H. Nitrous oxide inhalation sedation in dentistry: An overview of its applications and safety profile. Singapore Dental J. 2019;39.
Clark MS. Contemporary issues surrounding nitrous oxide. In: Malamed SF, ed. Sedation: A Guide to Patient Management. 6th ed. St. Louis, Mo. Mosby Elsevier. 2018:253-63.
Standards in Conscious Sedation for Dentistry. Report of an independent expert working group. London: Society for the Advancement of Anaesthesia in Dentistry. 2000.
Australian Dental Association. Policy statement 6.17 conscious sedation in dentistry. Including the ADA recommended guidelines for conscious sedation in dentistry and guidelines for the administration of nitrous oxide inhalation sedation in dentistry. 2017.
Pilch BZ. Head and Neck Surgical Pathology. Philadelphia: Lippincott Williams and Wilkins. 2001;389-90.
Genovese WJ, Santos MT, Faloppa F, Merli LA. The use of surgical diode laser in oral hemangioma: A Case Report. Photomed Laser Surg. 2010;28:147-51.
Gokhale ST, Naik NS, Singla D, Singh A, Bhattacharya D. The Combined use of Diode LASER and Conscious Sedation in the Excision of Pyogenic Granuloma in A Nine-Year-Old Patient. J Clin Diagn Res. 2015;9(12):ZD01-02.
