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Materials and methods. A 66 year old woman was referred to our observation, since the presence of a painless swelling located on the right cheek mucosa. A surgical approach with KTP laser was performed with the mucosal preservation technique. Results. Follow up after seven days, sixty days and four months did not showed any complication and the histological examination reported the diagnosis of AL.
Discussion. AL is a relatively rare tumor of the head and neck region, although it occurs more commonly in the extremities and the trunk. This tumor has been rarely reported in the oral cavity and when seen in this area, it involves in the lip, cheek, tongue, mandible, and palate. ALs are also intraosseous in the mandible and intramuscular in the pterygoid fossa. KTP laser excision showed to be resolutive and avoid of complications.
Conclusions. AL of the cheek is a very rare patology, but when it appears, it requires a surgical excision.
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Annali di stomatologia
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Excision of an oral angiolipoma by KTP laser: a case report
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Excision of an oral angiolipoma by KTP laser: a case report
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                                                                                                                  Original article



    Excision of an oral angiolipoma by KTP laser:
    a case report




                                                                                                                li
                                                                                                             na
    Gaspare Palaia, DDS, PhD                                       When angiolipomas occur in the oral cavity, they re-
    Gianfranco Gaimari, DDS                                        quire a surgical excision: the treatment can be per-
    Rossella Lo Giudice, DDS                                       formed with surgical blade or laser, like KTP (Potassium




                                                                                                          io
    Alexandros Galanakis, DDS                                      Titanium Phosphate) laser (1,2,3).
    Gianluca Tenore, DDS, PhD                                      The KTP laser has a wavelength of 532 nm and emits a
    Umberto Romeo, DDS                                             green visible radiation. Light is produced, as in the




                                                                                az
                                                                   Nd:YAG laser, by a solid active material (Yttrium, Aluminium
                                                                   Garnet crystal doped with Neodymium). The resulting ra-
                                                                   diation is filtered by a system of mirrors of Potassium, Ti-
    "Sapienza" University of Rome, Rome, Italy                     tanium and Phosphate, that halves the initial wavelength.
    Department Oral and Maxillofacial Science                      The wavelength of the KTP laser is more strongly absorbed




                                                                              rn
                                                                   by oxyhaemoglobin than any other wavelength, so lower
                                                                   levels of energy and fluence can be used to cut vascu-
                                                                   larized tissues (4,5,6).
    Corresponding author:                                          In this report, the authors present a case of non-infiltrat-




                                                                   te
    Gaspare Palaia                                                 ing angiolipoma excised from the cheek with KTP laser.
    Via Feronia, 148
    00157 Rome, Italy
    Mobile +39 339 4522515, fax +39 06 7806974
    E-mail: gaspare.palaia@uniroma1.it
                                                          In       Case report

                                                                   A 66 year old woman with no history of systemic dis-
                                                                   eases, in drug therapy for hypertension, which was referred
                                                                   to our observation, since the presence of swelling three
                                             ni
    Summary
    Excision of an oral angiolipoma by KTP laser: a case re-       months ago, located on the right cheek mucosa, corre-
    port.                                                          sponding to the second premolar and the first molar. The
                                                                   patient reported no pain.
                                    io


    Materials and methods. A 66 year old woman was re-             Clinical examination showed a soft, mobile and rilevate
    ferred to our observation, since the presence of a pain-       mass, of about 2 x 1,5 cm, covered with normal mucosa
    less swelling located on the right cheek mucosa. A             (Fig. 1). Not ulcerated and necrotic areas were found.
                           iz



    surgical approach with KTP laser was performed with            Surgery was performed with the mucosal preservation te-
    the mucosal preservation technique.                            chnique. After local anesthesia without adrenaline, because
    Results. Follow up after seven days, sixty days and four       the wavelength of the KTP laser is absorbed by oxyhae-
    months did not showed any complication and the his-            moglobin, the lesion was immobilized and highlighted by
            Ed




    tological examination reported the diagnosis of AL.            Collin clamp. Then, it was performed a longitudinal incision
    Discussion. AL is a relatively rare tumor of the head and      by laser with optical fiber of 300 micron at parameters 2
    neck region, although it occurs more commonly in the           watt in continuos wave and a fluence of 2830 J/cm2 (Fig.
    extremities and the trunk. This tumor has been rarely re-      2). In a second phase, it was possible to separate the le-
    ported in the oral cavity and when seen in this area, it in-
    volves in the lip, cheek, tongue, mandible, and palate.
 IC




    ALs are also intraosseous in the mandible and intra-
    muscular in the pterygoid fossa. KTP laser excision
    showed to be resolutive and avoid of complications.
    Conclusions. AL of the cheek is a very rare patology, but
    when it appears, it requires a surgical excision.
C




    Key words: angiolipoma, KTP laser, oral biopsy.
©




    Introduction

    Lipomas are the most common neoplasms arising from fat
    tissues. They are usually slow-growing, soft and asymp-
    tomatic masses. Angiolipomas represent 6-17% of all lipo-
    mas. 13% of all lipomas occur in the head and neck, in-
    cluding cheek, tongue, palate, parotid gland, neck and lar-
    ynx (1, 2).                                                    Figure 1 - Clinical featuring of the lesion.


    28                                                                                    Annali di Stomatologia 2011; II (1-2): 28-31
    Excision of an oral angiolipoma by KTP laser: a case report




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    Figure 2 - Incision by laser KTP, emitting a green visible light.      Figure 5 - Surgical sample.




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    Figure 3 - Dissection of the lesion with Metzenbaum scissors.          Figure 6 - Resorbable suture.
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    Figure 4 - Taking the lesion with Kelly clamp, being careful to pre-   Figure 7 - Follow up after 7 days, showing the absence of inflam-
    serve the oral mucosa was carried to enucleated of the lesion.         matory process.
C




    sion from tissue below by Metzenbaum scissors (Fig. 3).                Discussion
    Then the lesion was excised at 2 watt in pulsed wave (T-
    on 100 ms, T-off 100 ms) and a fluence of 283 J/cm2 (Figs              Lipomas represent about 1 to 5% of all neoplasms of the
©




    4,5).                                                                  oral cavity (1). They are painless, soft, round and mobile.
    Finally, resorbable suture point were applied (Fig.                    Angiolipomas, histologic variants of lipoma, are benign
    6).This surgical technique was permit to preserve the oral             mesenchymal tumours made up of mature lipocytes and
    mucosa overlying the tumor providing an excellent soft tis-            blood vessels. Multiple lesions are seen in approximate-
    sues healing. Follow up after seven days (Fig.7), sixty days           ly 70-80% of cases. 5% of these cases are familial but the
    (Fig. 8) and four months (Fig. 9) did not showed any com-              genetic pattern is unclear (2). It has been suggested that
    plication and the histological examination reported the di-            the etiology of AL is from a hamartomatous origin. Histo-
    agnosis of AL (Fig.10).                                                ry of trauma, lipomatous differentiation by hormones dur-

    Annali di Stomatologia 2011; II (1-2): 28-31                                                                                         29
    G. Palaia et al.


                                                                            Table 1 - Histologic guidelines for diagnosis of non-infiltrating
                                                                            angiolipoma (2).




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    Figure 8 - Follow up after 60 days, complete recovery.




                                                                                        az
                                                                            tures and the difficulty in separating the cancer from sur-
                                                                            rounding tissues. Other investigators proposed that the dif-
                                                                            ferentiation between non infiltrating and infiltrating form was
                                                                            based on the presence of a complete capsule and rare re-




                                                                                      rn
                                                                            currences in the former, and partial or no capsule with re-
                                                                            currences in the latter (7,11). The non-infiltrating type is
                                                                            the most common. It presents as painless or tender sub-




                                                                            te
                                                                            cutaneous nodules, generally in young patients and its rare
                                                                            before puberty (12,13,14,15). Histologically it is encap-
                                                                            sulated, and is a mixture of mature adipocytes and a pro-
                                                                            liferation of thin-walled vascular channels.[12] The diagno-
                                                                  In        sis is based on both the clinical and histologic features
                                                                            (Table 1) (12). Microscopically, AL is characterized by ma-
                                                                            ture adipocytes, interspersed in connective tissues with vas-
                                                                            cular vessels containing fibrin thrombi and mast cells in-
                                                                            filtrations. This features distinct it from usual lipoma
                                                   ni
    Figure 9 - Follow up after 4 months. There are no scars or signs of
    recurrence and the surgical site appears to be covered by nor-          (2,13,14,16,17).
    motrofic mucosa.                                                        As differential diagnosis, lipoma, liposarcoma, heman-
                                                                            gioma, leiomyoma, neurilemmoma, lymphangioma and Ka-
                                        io


                                                                            posi’s sarcoma can be considered. Lipomas have no pre-
                                                                            dominant vascular component. When CT scan demonstrate
                                                                            the presence of soft tissue or bony infiltration, liposarco-
                              iz



                                                                            ma must be included in the differential diagnosis. Surgi-
                                                                            cal excision is the treatment for both infiltrating and non-
                                                                            infiltrating angiolipomas (1,9,10).
             Ed




                                                                            Conclusions

                                                                            Angiolipomas are rarely seen in the head and neck region.
                                                                            This case report, showed the typical clinical and histological
                                                                            findings of a non-infiltrating angiolipoma.
 IC




                                                                            The advantages of the employment of the KTP laser in oral
                                                                            soft tissue surgery are its high cutting ability, the bloodless
    Figure 10 - Histological examination (E.E.,10x). The tumor is com-      operative field, its relative ease and rapidity of use, and the
    posed of a diffuse proliferation of mature fat cells mixed with thick   reduced use of infiltrative anaesthesia. The KTP laser is
C




    fibrous connective tissues containing many small blood vessels.         an effective instrument for performing oral soft tissue ex-
                                                                            cision, because of its excellent surgical properties and the
                                                                            almost total lack of thermal damage. However, these in-
    ing puberty, fatty degeneration of a central hemangioma                 disputable advantages cannot replace the ability and knowl-
©




    and vascular proliferation of a congenital lipoma (congenital           edge of the oral surgeon (4).
    origin) have been reported as possible etiologic factors (1).           The KTP laser demonstrated surgical effectiveness and
    Hemangioma, leiomyoma, neurilemmoma, myxolipoma                         caused little peripheral damage to the cut edges, and
    and Kaposi’s sarcoma must be considered in differential                 therefore would always allow a safe histological diagno-
    diagnosis (8,9). Based on studies by Gonzales-Crussi et                 sis to be obtained. Complete surgical excision with a clear
    al. (1,10), angiolipoma has two histologic types: infiltrat-            surgical margin is the treatment of choice to avoid re-
    ing and non-infiltrating. Infiltrating ALs have been diagnosed          currence; KTP laser in this sense represents a very valu-
    in the head and neck by their invasion of adjacent struc-               able surgical aid.

    30                                                                                           Annali di Stomatologia 2011; II (1-2): 28-31
    Excision of an oral angiolipoma by KTP laser: a case report


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