Treatment of Epulis Fissuratum with carbon dioxide laser in a patient with antithrombotic medication

Abstract

Epulis fissuratum is a pseudotumor growth located over the soft tissues of the vestibular sulcus caused by chronic irritation from poorly adapted dentures. Treatment indication for these lesions is surgical excision with appropriate prosthetic reconstruction. The hemostatic capacity of carbon dioxide (CO2) laser is well described in the literature as a useful tool in oral surgery, especially in patients with clotting disorders. This paper presents a case of a 72-year-old female patient referred to the 'Nossa Senhora da Conceição de Valongo Hospital' at Porto, Portugal, with a massive growth of vestibular oral mucosa in the mandible and maxilla associated with ill-fitting dentures, suggestive of epulis fissuratum. The patient was taking antithrombotic medication. The lesions were excised with CO2 laser, and no significant complications, such as hemorrhage, pain, swelling or infection, were recorded. Twenty days after surgery, both areas were completely reepithelizaded. Prosthetic rehabilitation and function were achieved with the fabrication of new maxillary and mandibular dentures. Follow-up 1 month and 1 year after treatment revealed the areas free of recurrence. The use of CO2 lasers is currently the gold standard in the excision of this type of lesion, especially in patients with hemorrhagic diathesis or under antithrombotic therapy.