Laser excision of Leukoplakia of the tongue

This case is doing well in follow up. She underwent Laser Excision of the tongue lesion. 

Laser is just a precise cutting tool. Tongue normally bleeds heavily so Laser sometimes creates problem as this alone is insufficient to control the bleeding. Laser is better for smaller lesions and conventional cautery is needed to control the bleeding. 

Leukoplakia of tongue

I

Leukoplakia of tongue is very common in India because of rampant use of tobacco products and poor orodental hygiene.


How do we treat Leukoplakia?
Leukoplakia is a potentially malignant Disorder
Other lesion is erythroleukoplakia, which is more sinister

Incidence off oral cancers is 50-100 times higher in Leukoplakia.
The progression is difficult to predict.
In whom  and when cancer develops is unpredictable.

And how we do prevent progression of Leukoplakia to cancer?

•Smoking cessation • Moderation of alcohol use • Diet with adequate antioxidants • Improve oral hygiene I Trauma/ eliminate candida 'Surgical excision of high risk lesions • Surveillance • • 


Grade of dysplaia is important
Anatomical location has prognosis value.
Ploidy analysis has prognosis value.

Colour
Location
Dysplaia
Ploidy

Since most of leukoplakia are asymptotic the intervention objective is to prevent malign transformation

Chemoprevention trial
The COCHRANE COLLABORATION is gold standard

Electronic cigarettes is not therapeutic option
DRINKSMETER
To identity weekly alcohol abuse.
Improve diet
Anything yellow

Progression of Leukoplakia tongue over years.

Tongue Lesion on 03 Dec 2011.

This is a common site in India where people chew tobacco and beetle nuts.This patient had this whitish lesion on lateral part of tongue for last one year and it is progressively increasing in size.

Same patient as above on 22 Jan 2020

patient lost to follow up but seen by other doctors. got biopsied multiple times and again presenting with a painful ulcer just ahead of white patch. this time lesion feels indurated. Multiple biopsy of the lesion taken and sent for HPE.