ABSTRACT-
Oral Erythroplakia is known as a rare possibly malignant lesion of the oral mucosa. Dental Erythroplakia is a professional medical term to describe any erythematous area over a mucous membrane that cannot be attributed to any pathology. Dental Erythroplakia are incredibly few, only the true, velvety, red homogeneous oral Erythroplakia has been clearly defined while the terminology for blended red and white lesions is complex, ill-defined and puzzling. Dental Erythroplakia is mainly seen in the middle aged and elderly. The most common affected areas are the soft palate, the ground of the mouth area and the buccal mucosa. A particular type of Dental Erythroplakia occurs in Chutta smokers in India. Lesions of Oral Erythroplakia are usually less than 1. 5 cm in diameter.
Keywords - Biopsy, Erythroplakia, Laser,
INTRODUCTION-
The phrase erythroplakia means "red patch", and comes from the Greek words ОППОёПОїП - "red" and ПО»Оѕ - "plate"
The World Health Organization defines dental erythroplakia the following:
"Any lesion of the dental mucosa that displays as bright red velvety plaques which can't be characterized clinically or pathologically as any other recognizable condition"
It has been reported that prevalence of Mouth Erythroplakia ranges between 0. 02%1 and 0. 2%2 (adapted from Reichart et al. )3 Clinically, it could be flat or depressed and sometimes it could be found together with leukoplakia (erythroleukoplakia); it pre-dominantly occurs in the floor of the mouth area, the tender palate, the ventral tongue and the tonsillar fauces. There are usually no symptoms. However, some patients may complain of a using experience and or sore. Heavy liquor usage and tobacco use are known to be important aetiological factors. The main purpose of discovering dental premalignant lesions is to prevent malignant transformation by initiating enough intervention. It is greatly approved that the dental premalignant lesions erythroplakia, show a substantial propensity to malignant change. The differential examination includes: erythematous candidiasis, early on squamous cell carcinoma, local irritability, mucositis, lichen planus, lupus erythematosous, medication effect and median rhomboid glossitis. 4 Surgical excision is the treatment of choice though more studies are needed. The treatment5 modalities include change of lifestyle factors such as tobacco and alcoholic beverages intake, medication with retinoids or antimycotics, surgical excision, cryosurgery, laser evaporation or laser excision. Laser beam surgery has turned into a reliable treatment6 option for dental malignancy as well as for precancerous lesions. Trusted lasers in oral and maxillofacial tumor surgery will be the CO2 laser, the Er:YAG laser beam, the Nd:YAG laser beam and the KTM laser. The use of lasers in tumor surgery has several advantages: remote control application, precise slicing, hemostasis, low cicatrization, reduced postoperative pain and swelling, can be combined with endoscopic, microscopic and robotic surgery. Here we report a case of erythroplakia in smooth palate region cared for with diode laser beam.
CASE REPORT-
A, 63 years old, male patient (Fig 1), came to the department of oral and maxillofacial surgery, with the principle complain of red patches at the hard and soft palate region. Patient gave the history of pan, tobacco chewing and smoking since 20 yrs. Medical history was negative for any findings and everything the vitals were under the normal limit. No significant studies were discovered on extra oral evaluation. (Fig-1). On intraoral assessment, multiple red areas were seen at the mucosal surface of the palate. Those patches were less than 1. 5 cm in diameter. (Fig- 2). On palpation it was delicate and velvety on touch. A provisional analysis of Erythroplakia, with differential identification Lichen planus, Erythematous candidiasis, Early squamous cell carcinoma were made. All necessary blood vessels analysis done, and were found under normal limit. To determine a definitive prognosis, a biopsy was performed using a local anaesthesia. The biopsy specimen was extracted from hard and soft palate, and directed for histopathological exam (Fig 3) which confirmed the final examination of Erythroplakia. The red appearance is because of the slender atrophic epithelium with dominant subepithelial vascularity and infection. Almost all erythroplakic lesions contain dysplastic cells. The histopathology may be gentle or moderate epithelial dysplasia, severe dysplasia or carcinoma in-situ. Carcinoma in-situ is seen as a a total disorganization of cells throughout all levels of the epithelium, with no keratin pearls. Laser ablation was planned as the treatment modality under local anaesthesia. (Fig-4) Diode laser was used at 2. 5watts (Fig 5). Post operative instructions given and patient was recalled after a day. Patient emerged for follow-up, reported with slight pain. Curing was uneventful. After that patient was asked to survey at weekly period. Healing was sufficient after 3 weeks. (Fig 6)
DISCUSSION-
Erythroplakia and speckled leukoplakia are unusual lesions of the mouth. Erythroplakia of the mouth is a particular disease entity which must be differentiated from other specific or nonspecific inflammatory dental lesions, although this may only be done generally by biopsy. The term "erythroplakia" of the mouth as found in this report and as accepted by most writers describes the scientific appearance of your red patch of the mucous membrane which does not stand for some specific or nonspecific inflammatory lesion. However, in most cases the clinician cannot recognize with certainty the true erythroplakia as reviewed here and the more innocuous inflammatory lesions, thus mandating biopsy. Most, and probably all, cases of true scientific erythroplakia symbolize some epithelial atypia, ranging from mild epithelial dysplasia to invasive carcinoma. 7 Furthermore; there is absolutely no correlation between your medical appearance of erythroplakia and the histologic results. Erythroplakia is the leukoplakia like term used to describe clinically red and well demarcated macules of the dental mucosa which can't be attributed to inflammatory or distressing factors, and which have a higher propensity for development to carcinoma than leukoplakia8. The histopathological9 feature of erythroplakia includes a designated epithelial atrophy associated with epithelial dysplasia. A member of family reduction in keratin development and increase in vascularity makes up about the specialized medical color of the lesion. Cellular infiltration and capillary distention were extraordinary. Nowadays laser surgery has turned into a reliable treatment6 option for precancerous lesions. Widely used lasers in dental and maxillofacial tumor surgery are the CO2 laser beam, diode laser, the Er:YAG laser beam, the Nd:YAG laser beam and the KTM laser. In our circumstance we use diode laser in erythroplakia. Laser has many distinctive advantages, including the ability to minimize, coagulate, ablate or vaporize goal tissue elements, permitting dry-field surgery through the closing of small arteries (haemostasis) disinfection of the muscle, reduced post-operative edema (through the closing of small lymphatic vessels) lowered amount of scarring. It plays a part in faster and far better treatment leading to improved treatment results and increased patient comfort and satisfaction.
CONCLUSION-
Oral tumor is one of the 4 major non communicable diseases resulting in Death10. Soft muscle health in the mouth is essential for overall dental care and medical health insurance and a successful maintenance of any recovery. The scientific and pathological features of the lesions examined in our study support the data in other posted studies. Although their prevalence is low, histopathological features which range from epithelial dysplasia to invasive carcinoma. This justifies positioning these lesions among the list of dental lesions with the highest malignant potential. Also, no matter histopathology and remedy, periodic monitoring of these patients and cessation of risk factors are crucial measures.
