Scalpel Surgery Research Articles

The impact of 0.24% hyaluronic acid gel on pain level and periodontal status following labial frenectomy

Aim: The labial frenum is a mucosal fold that connects the upper lip to the alveolar ridge. Frenectomy involves the surgical removal of a mucosal fold. The traditional surgical technique utilizing a scalpel remains popular for performing a frenectomy. The study aims to examine the effectiveness of applying Hyaluronic Acid (HA) Gel after conventional frenectomy. Methods: This research comprised 48 young patients (25 girls and 23 boys) aged 8 to 14. Participants were randomly divided into two groups. Group 1: Conventional Scalpel Surgery and Sterile Saline (SS) (n=24) and Group 2: Conventional Scalpel Surgery+HA (Aftamed, Child Gel 24% HA) (n=24). After measuring the participants’ periodontal parameters, the frenectomy was performed. Postoperative pain levels were evaluated daily for one week utilizing a 10-point Visual Analog Scale. Before frenectomy, Plaque Index (PI), Gingival Index (GI), Pocket Depth (PD), Bleeding On Probing (BOP), Keratinized Gingival Width (KGW), Attached Gingival Thickness (AGT) values were measured and recorded. The periodontal parameters were assessed and analyzed after a 3-month follow-up period. Results: VAS (Visual Analogue Scale) was assessed. The application of Although 0.24% HA gel caused less pain from days 1-3.6, there was no significant difference in pain levels between the HA gel and control groups (p>0.05). Pain levels were equal between groups on day 7. No significant changes in PI, GI, PD, BOP, KGW, or AGT values after three months of follow-up (p>0.05). Conclusions: During the first week after a frenectomy performed with classic scalpel surgery, the application of 0.24% HA gel did not significantly reduce pain levels. It did not result in significant changes in other measured periodontal parameters after three months of follow-up.

CO2 Laser Frenuloplasty: Advancing Minimally Invasive Techniques for Rapid Healing and Improved Patient Outcomes

This study explores the innovative use of CO2 laser technology in frenuloplasty, a significant shift from classic methods like scalpel surgery or electrocautery towards a minimally invasive approach. The research involved 15 patients aged 25 to 50, undergoing frenuloplasty with a CO2 laser system equipped with a 7-inch defocused handpiece, set at 20 Hz and 0.3 W. This method diverges from conventional laser techniques, focusing on controlled laser passes combined with manual traction to elongate the fibrous tissue of the frenulum. The results demonstrated that the CO2 laser technique allowed for a precise and progressive modification of the frenulum, significantly reducing the risks of hemorrhage and secondary intention fibrosis. The healing process was notably expedited, with patients reporting satisfactory outcomes within a two-week period. Statistically significant improvements were observed in patient-reported outcomes, as evidenced by the increases in the Short Form Health Survey (SF-12) scores, with the mean Physical Component Summary (PCS) score rising from 32.5 to 47.5 and the mean Mental Component Summary (MCS) score from 39.3 to 52.3 (p < 0.001 for both). The study concludes that CO2 laser frenuloplasty is an effective and safe technique, offering substantial benefits in terms of reduced healing time and enhanced patient satisfaction. The significant improvements in SF-12 scores underscore the positive impact on patient quality of life, advocating for the broader application of this technique in clinical practice. Further research is warranted to explore its potential in a wider clinical context.

Fine scalpel surgery: preserving the dartos muscle in apatient with scrotal and perigenital giant Buschke-Löwenstein tumors.

Giant condyloma acuminatum (GCA), alternatively referred to as aBuschke-Löwenstein tumor (BLT), is an uncommon, benign, but locally aggressive form of verrucous carcinoma. The condition usually affects the male population under the age of50years; however, there have been rare reports of pediatric cases. Various risk factors such as smoking, diabetes, promiscuous behavior, poor hygiene, immunosuppression, and others are linked to the development of this condition. We present the case of a26-year-old male patient who came to the dermatology department with primary complaints of 10-year-old verrucous tumor formations located in the perigenital and perianal areas. Serological tests for AIDS, hepatitisB, hepatitisC, Chlamydia trachomatis, and syphilis were negative. The routine blood tests were slightly abnormal. Histological verification of condylomata acuminata of Buschke-Löwenstein was made. Given the sensitive areas, surgery was advised. With several fine undermining scalpel excisions, the lesions in the scrotal and perigenital areas were removed and the dartos muscle was preserved. Electrodissection and shave curettage were not performed. The postoperative period passed without complications and no recurrences in the perigenital area were reported. We believe that our case report represents the first documented surgical approach for scrotal Buschke-Löwenstein tumor using exclusively fine undermining scalpel surgery. Abrief literature review of the condition is presented, focusing on the currently available treatment options and highlighting the potential effectiveness of the surgical approach.

Management of Gingival Hyperpigmentation – A Case Report

Gingival hyperpigmentation, characterized by darkening of the gums due to melanin deposition, can affect the aesthetic appearance of the smile, particularly in patients with excessive gingival display. Various techniques, including scalpel surgery, have been employed for cosmetic depigmentation. This case report describes a simple and cost-effective scalpel depigmentation procedure performed on a 23-year-old female patient with Dummet's score 3 pigmentation. The procedure involved meticulous removal of pigmented epithelium and a thin layer of connective tissue, followed by post-operative care and monitoring. While initial results are promising, repigmentation remains a potential challenge, necessitating long-term follow-up. Scalpel depigmentation offers reliable results, enhances smile aesthetics, and can be a preferred choice considering equipment constraints and healing times.

Evaluation of diode laser efficacy in treating benign oral soft tissue masses: A case series

Introduction and importanceThe diode laser, with a wavelength ranging from 810 to 980 nm, is a modern treatment modality that offers significant advantages in the management of benign oral soft tissue masses. Therefore, this report aimed to assess the efficacy of diode laser application for excisional biopsy of such masses. Case presentationThree female patients, aged 9, 39, and 45 years, visited the Oral Medicine Clinic with complaints of painless masses in the oral cavity persisting for two to three months. Their intraoral examination showed the presence of pedunculated or sessile exophytic lesions with a smooth surface. The lesions appeared as single, pink to red protrusions located in various sites, including the left buccal mucosa, right lateral border of the tongue, and lower gingiva. Clinical discussionExcisional biopsy of the masses was carried out in the patients using the diode laser. The surgical procedures ranged from 10 to 20 min, with minimal intraoperative bleeding and precise cutting, while no pain was reported. Postoperatively, at two weeks and four months follow-up, the intraoral wounds exhibited excellent healing without complications such as pain, bleeding, swelling, scarring, infection, or mass recurrence. The clinical diagnosis of irritational fibroma (two cases) and fibrous epulis were confirmed by histopathological examination. ConclusionDiode laser emerges as a highly efficacious method for the excisional biopsy of benign oral soft tissue masses, providing intraoperative and postoperative advantages over scalpel surgery.

Histological evaluation of mouse tongue incisions after Er:YAG laser surgery with different pulse energies versus after conventional scalpel surgery.

To identify the surgical instrument that allows for optimal healing of tongue incisions. An Er:YAG laser was compared with different pulse energies to a conventional scalpel for the incision of mouse tongue tissues. Mice were sacrificed through cervical dislocation at 24, 48, and 72 h postoperatively, followed by extraction of their tongues for incision experiments. The healing of the incisions and expression of inflammation- and pain-related factors in the tongues were compared between the surgical procedure groups. In laser-treated mice, tongue incisions healed the fastest when the laser output energy was 60 MJ per pulse. Macrophage chemotaxis toward the incisional area was triggered on the first postoperative day for the 60-MJ group, while the time for macrophage chemotaxis to the surgical area was later in the 80-MJ group. Tumor necrosis factor-alpha expression increased and then decreased in the 80-MJ group; however, it gradually decreased in the 60-MJ and conventional scalpel groups. Prostaglandin E2 expression increased and then decreased in the 80-MJ and conventional scalpel groups but gradually decreased in the 60-MJ group. The expression of transforming growth factor beta 1 gradually decreased in the 60-MJ and 80-MJ groups but gradually increased in the conventional scalpel group. Compared with surgical procedures using conventional scalpels, those using an Er:YAG laser with appropriate pulse energies can inhibit inflammation in the incisional area and promote incision healing. The use of an Er:YAG laser with appropriate pulse energies can alleviate intraoperative and postoperative pain in the incisional area.

Depigmentasi Gingiva Menggunakan Teknik Bedah Scalpel pada Pasien dengan Hiperpigmentasi Gingiva : Sebuah Laporan Kasus

Background: Gingival hyperpigmentation is a physiological pigmentation genetically, appearing with brown to black pigment on the gingiva and oral mucosa which is an aesthetic problem for patients. Purpose: This case report aims to discuss gingival depigmentation procedure using scalpel surgical techniques in patients with gingival hyperpigmentation. Case presentation: A 27-year-old female patient reported brown discoloration on the gums of her upper and lower front teeth which she had noticed ten years ago. Gingival depigmentation using scalpel surgical technique is performed to remove the pigment. Conclusion: Gingival hyperpigmentation is an aesthetic problem that is of concern to patients and requires surgical intervention to remove the pigment, one of them are gingival depigmentation with a scalpel surgery.
 Keywords: gingival depigmentation, gingival hyperpigmentation, scalpel surgery

Evaluating surgical excision to prevent progression of oral precancerous lesions: Highlighting randomized controlled trials and cohort studies

Currently, surgical excision remains a common intervention for oral precancerous lesions (OPL). However, the studies focusing on conventional surgery by scalpel for OPL are not analyzed collectively in detail. Therefore, the objective of this short communication is to summarize and evaluate the evidence on scalpel surgery in preventing the progression of OPL patients. There are 16 eligible studies on surgery management of the recurrence (13 studies) or malignant transformation (13 studies) of OPL. The pooled recurrence rate (95% confidence interval) of OPL patients received scalpel surgery and laser therapy is 29.5% (26.3–33.0%) and 32.2% (26.1–38.9%), respectively. The pooled rate of malignant transformation of OPL patients received scalpel surgery, laser therapy, and clinical observation is 8.9% (7.3–10.9%), 6.0% (3.5–10.1%), and 10.2% (8.6–12.1%), respectively. The important limitation of current evidence available for prognosis of dysplastic OPL is based on retrospective observational studies. It highlights that surgical management of OPL needs more randomized controlled trials and cohort studies to explore more reliable methods for routine clinical use to facilitate high- or low-risk stratification and further select more appropriate treatment option.

Managing leukoplakia with diode laser: A report of two cases

Oral leukoplakia is the most common precancerous lesion of the oral mucosa. WHO defined it as a lesion which has a white patch or plaque on the oral mucosa that cannot be removed by scraping and cannot be classified clinically or microscopically as another disease process. Management of oral leukoplakia should begin with elimination of predisposing habit. There are currently different approaches in the management of Leukoplakia such as scalpel surgery, systemic carotenoids and antioxidants, electro cauterization, cryotherapy and Lasers. Even though on-surgical options are preferred choice of treatment, it takes time to achieve complete regression of lesion and sometimes may not achieve complete resolution. On the other hand, conventional surgical techniques are invasive and cause trauma to the patient. Excision of precancerous oral lesions using LASER offers comparative advantages over traditional scalpel excision. Laser is an acronym for Light Amplification by stimulated emission of radiation. It is surgical technique which excises the targeted tissue using emission of a monochromatic light of specific wavelength. Because of this property, laser excision of the tissue results in complete bloodless field of surgery, reduced chances of post-surgical inflammation and infections and hence better treatment compliance of the patients towards the surgery. This is one of the important goals for management of oral potentially malignant disorders. We present two case reports of homogeneous leukoplakia treated using diode lasers of wavelength 810nm with follow-up. Both cases did not report any post-operative discomfort or inflammation. The aim of this case report is to highlight the importance of laser excision with minimal complications and better treatment outcomes.

Diode laser therapy for peripheral ossifying fibroma: A 2 years follow up

In daily practice we can come across many growths in oral cavity, mostly reactive rather than neoplastic, which are difficult to differentiate from one another posing a challenge to dentist. Peripheral ossifying fibroma (POF) is a single benign fibro osseous origin growth of gingiva which occurs due to long standing irritation by plaque, calculus, trauma, restorations, and orthodontic appliances, however the precise etiopathogenesis of POF is unclear. The standard treatment protocol involves surgical excision followed by the biopsy of the lesion. Proper follow up of the lesion is necessary due to its high recurrence. The present case report managed with diode laser excision did not showed any signs of recurrence during the follow up period of 2 years. Minimum bleeding, less postoperative pain, ease of operation and absence of recurrence makes diode laser assisted excision is the better treatment option over conventional scalpel surgery.

Assessment of treatment outcomes after using electrocautery and scalpel blade in separate patients for minor oral surgical procedure

Context: Conventionally minor oral surgical treatments are done with the use of Bard Parker handle for incising the tissues. The favourability of B.P. handle is its low cost and no extra equipments. Electro surgery has many applications in oral surgery , but it is not widely used. The presence of varying information on electro surgical wound healing might be the reason. Aims: This study aimed to assess and compare the treatment outcomes in minor oral surgery done by electrocautery and scalpel blade using clinical parameters: Bleeding intraoperatively, Time taken for incision intraoperatively, Pain postoperatively, Healing of the surgical site postoperatively. Methods and Material: Sixty patients between age group ranging 15 to 65 years who reported to Dept of Oral & Maxillofacial surgery, M.G.S. Dental college underwent electrosurgery or scalpel surgery for minor oral surgical procedures under local anaesthesia, were the study subjects. They were randomly and equally divided into two groups. Statistical analysis used: Mann Whitney U test.

Comparative frenectomy with conventional scalpel and dual-waved laser in labial frenulum

AimThe purpose of the study is to compare the labial frenectomy between the laser surgery (erbium yttrium aluminum garnet and neodymium-doped yttrium aluminum garnet (Er:YAG and Nd:YAG)) and the scalpel...

Gingival depigmentation with scalpel and diode laser

Melanin, a nonhemoglobin-derived brown pigment, is the most common of the endogenous pigments and is produced by melanocytes present in the basal layer of the epithelium. Gingival hyperpigmentation is caused by excessive deposition of melanin located in the basal and suprabasal cell layers of the epithelium. Pigmentation of gingiva not just has an impact on esthetics but also creates psychological negativity. Though a wide range of techniques are available to manage this condition. Depigmentation procedures such as scalpel surgery, gingivectomy with free gingival autografting, electrosurgery, cryosurgery, chemical agents such as 90% phenol and 95% alcohol, abrasion with diamond bur, Nd: YAG laser, semiconductor diode laser, and CO laser have been employed for removal of melanin hyper pigmentation. The following case report describes two different surgical depigmentation techniques scalpel technique and lasers. Better results of depigmentation were achieved with diode laser than conventional scalpel with respect to esthetics and less postoperative discomfort.

Post-skin incision scar tissue assessment using patient and observer scar assessment scales: A randomised controlled trial

BackgroundThe scalpel was once the gold standard for surgical incisions. Electrosurgery has started to supplant scalpels but is not yet acceptable for skin incisions due to the risk of burns and deeper injury relative to the scalpels' neat incision with less tissue damage. The unnecessary burden of excessive scar formation makes comparing these two methods challenging. Therefore, this study aims to compare post-incision skin scarring created after monopolar electrosurgery and scalpel surgery, and evaluate the Patient and Observer Scar Assessment Scale (POSAS) suitability for assessing skin incision scars by comparing patients' and observers’ scores. MethodsThis self-controlled study involved patients undergoing elective and emergency skin surgery procedures. A singular wound site was created using two incision methods (monopolar electrosurgery and scalpel) simultaneously. Post-incision scar tissue formation was evaluated using the POSAS, a subjective scar assessment tool that involved patients self-reporting on pain, itching, color, thickness flexibility, and surface relief. Observer-rated vascularity, pigmentation, thickness, flexibility, and surface relief both using a 5-point Likert-type scale. We performed this assessment three months post-surgery, and the results were analyzed by a battery of statistical tests and linear mixed models. ResultsTwenty patients were included in this study. Data analyzed using the paired t-test or Wilcoxon rank-sum test indicated no statistically significant differences between the scar tissue created by monopolar electrosurgery and scalpels according to both the patients and the observers. Correlation analyses between the patients' and observers’ total POSAS scores indicated these followed a moderate linear relationship (r = 0.51; p < 0.001). Linear mixed models further supported the agreement of POSAS total scores between patients and observers. They also confirmed that electrosurgery was not inferior to the scalpel technique. ConclusionScar tissue from skin incisions made by monopolar electrosurgery were indistinguishable from those created with a scalpel. The POSAS instrument is an acceptable means of assessing scar formation on the skin.

EVALUATION OF DIFFERENT TREATMENT MODALITIES FOR THE EXCISION OF IRRITATIONAL FIBROMA: A CASE SERIES

INTRODUCTION: Fibroma is the most common benign tumor-like lesion of the oral cavity. They are non-neoplastic brous overgrowths; usually reactive or irritational in nature. Different kinds of surgical treatments have been employed for the removal of bromas, which include simple excision using scalpel, laser technology, electrical surgery, and cryotherapy. This report aimed at comparing two different treatment modalities for excision of broma- laser and scalpel. METHODS: Two cases of irritational broma, one using a diode laser and another using scalpel, were undertaken for comparison. RESULTS: Parameters like time taken for the procedure, intra-operative bleeding, ease of surgery for the surgeon, and the post-operative wound healing were evaluated with both the techniques. Excision with laser was an easier procedure for the surgeon and the time taken was less than excision with scalpel. Additionally, bleeding was controlled better and a signicantly faster healing period was observed with laser as compared to excision with scalpel. CONCLUSION: Excision with laser provides better working conditions and has a quicker and superior post-operative healing over the scalpel surgery

High-level laser therapy versus scalpel surgery in the treatment of oral lichen planus: a randomized control trial

ObjectiveTo compare the clinical effectiveness of various types of high-level laser therapy (HLLT) toward scalpel excision for the surgical treatment of erosive oral lichen planus (OLP).Materials and methodsThe total number of 128 individuals were enrolled in the study. The 35 did not meet the inclusion criteria due to malignancy signs and presence of diabetes mellitus. In total, 8 were lost to follow-up, and 10 were excluded from the analysis, due to analgesics intake. This way 75 patients with the erosive form of OLP were analyzed in three intervention groups (Er:YAG, n = 19; Nd:YAG, n = 15; Er:YAG + Nd:YAG combination, n = 20) and one control group with scalpel excision (n = 21). The therapy effectiveness has been assessed based on the comparison of salivary interleukin (IL)-1β, IL-6 and interferon (IFN)-γ preoperative levels to 14, 30 days, and 2 years postoperation, as well as pain level and time of epithelization.ResultsAll HLLT groups demonstrated a significantly (p > 0.05) higher IL-1β, IL-6, IFNγ and pain level reduction and quicker epithelization toward the control group on the 30th day, except Nd:YAG in case of IFNγ level. The highest IL-1β, IFNγ and pain level reduction and quicker epithelization on the 30th day was observed in Er:YAG group, followed by Er:YAG + Nd:YAG combination, Nd:YAG respectively. However no significant difference was observed between the HLLT groups with regard to IL-6 level reduction. After a 2-year follow-up, no significant difference was observed between all study groups with regard to all variables.ConclusionHLLT yields a superior clinical outcome compared to the scalpel excision for the surgical treatment of oral lichen planus, whereby the Er:YAG has been proposed as the most effective laser type at the end of the first postoperative month.Clinical relevanceFor the surgical treatment of erosive OLP the Er:YAG laser may be a preferable treatment option compared to Nd:YAG and scalpel surgery.Trial registrationThe present trial was registered retrospectively in the German Clinical Trials Register, as a member of WHO international clinical trials registry platform, on the 18.03.2020 with the following number: DRKS00020986

Correlation between temperature rise and auto-fluorescence: ex vivo study with Er:YAG laser, Quantum Molecular Resonance scalpel and Nd:YAG laser on hard and soft tissues.

Surgical techniques of soft and hard oral tissues highly benefited from new technologies such as the Quantic Molecular Resonance (QMR) lancet, the Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) laser and the Erbium-doped Yttrium Aluminum Garnet (Er:YAG) laser. Increasingly, these technologies replace scalpel, conventional electrosurgery and traditional rotary surgery instruments due to their proven advantages. Features such as reduction of the surgical time, more efficient bleeding control resulting in higher intra-operative visibility and improvement of postoperative course with better Quality of Life score (QoL) are highlighted in numerous studies published in the literature. The thermal rise of tissues during surgical incision, performed with other instruments rather than traditional cold blade scalpels, is not to be ignored by the operator and it must take into consideration first when choosing the surgical instrument and then throughout all the surgical act. Auto-fluorescence (AF) is a property possessed by every cell that exposed to a specific wavelength can absorbance or reflect with peculiar characteristics and its direct examination has been proposed as a non-invasive visual tool for investigation of suspicious changes in oral mucosa. At the limit of our knowledge, few studies have been published in the literature regarding tissue's temperature variations and the interest in Infra-Red temperature detection has been shown in various medicine fields and none of published studies investigated the possible correlation between temperature raise and AF variations. This ex vivo study aims to analyse and compare through the use of a thermal imaging camera and simultaneous detection of AF, the possible correlation between temperature increase and auto-fluorescence.

Ligation-free single scrotal incision orchiectomy with ultrasonic scalpel: Xinhua Zhang Procedure

Background: To explore the efficacy and safety of a new type of testicular excision with ultrasonic dissector. Methods: A retrospective analysis was performed on 69 patients with advanced prostate cancer undergoing orchiectomy in our hospital between June 2017 and June 2019. All patients were divided into a traditional surgery group (n = 27) and an ultrasonic scalpel surgery group (n = 42). The operation time, intraoperative blood loss, postoperative hospital stay and postoperative complication rates were compared. Results: The ultrasonic scalpel surgery group had significantly shorter operation times and less intraoperative blood loss than the traditional surgery group (each P &lt; 0.01). Moreover, the incidence of postoperative complication differed significantly between the traditional surgery group (18.52%) and the ultrasonic scalpel surgery group (0%) (P &lt; 0.01). However, there was no significant difference in postoperative hospital stay between the two groups (P &gt; 0.05). Conclusions: The surgery time for testicular excision using the ultrasonic knife is short, the operation is simple and the complications are few and thus it may become a form of replacement for traditional testicular excision.

Evaluation of upper labial frenectomy: A randomized, controlled comparative study of conventional scalpel technique and Er:YAG laser technique.

ObjectivesAbnormalities in the maxillary frenum may lead to esthetic or functional limitations and need to be corrected with a surgical intervention called frenectomy. The aim of the study was to compare frenectomies performed using Er:YAG laser technology with those using a conventional scalpel technique. Comparisons were of patients' experiences, treatment times, bleeding during treatment and wound healing.Material and methodsThe trial was performed as a prospective, randomized and controlled, single‐blind investigation. A total of 40 patients requiring frenectomy were randomly assigned to groups which underwent either conventional or Er:YAG laser treatment. Patients' experiences, treatment time, bleeding and wound healing were evaluated immediately after surgery and 5 days, 12 days and 3 months after surgery.ResultsSignificant increase in time spent in surgery and bleeding was seen with conventional scalpel surgery. Directly after surgery the wound area was significantly larger in the laser group but at the 5‐day evaluation no difference could be observed between the groups. Finally, patients were satisfied with both methods, giving them the same assessments.ConclusionIn the frenectomy procedure, laser surgery is faster and causes less bleeding and may be advantageous in frenectomies.

GINGIVAL DEPIGMENTATION AND PINK AESTHETICS: A CASE REPORT

The colour of gingiva has a tremendous impact on the overall aesthetics of an individual. Clini­cally, gingival melanin hyperpigmentation is presented as ‘black gum’, which is a common aesthetic problem especially for those who have a gummy smile. It mainly affects the self-esteem, appear­ance, and confidence of an individual, and it can also have a psychological impact on many pa­tients. Gingival depigmentation can be carried out as part of its treatment using various methods. A case is reported here where scalpel surgery was performed.