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High-power diode laser use on Fordyce granule excision: A case report

Article  in  Journal of Cosmetic Dermatology · December 2010

DOI: 10.1111/j.1473-2165.2010.00531.x

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 Research Letter

High-power diode laser use on Fordyce granule excision:

a case report
Fernando M Baeder, DDS, MS,1 Jose E P Pelino, DDS, MS, PhD,2 Eliete R de Almeida, DDS, MS, PhD,2
Danilo A Duarte, DDS, MS, PhD,2 & Maria T B R Santos, DDS, MS, PhD2
1
Reabiliation Center Lar Escola São Francisco Lar Escola São Francisco, Centro de Reabilitação, São Paulo, SP, Brazil
2
Universidade Cruzeiro do Sul, São Paulo, Brazil

Summary Background Fordyce granules are conventionally considered to be a developmental oral

lesion with a higher incidence in men.
Objective To report a clinical case of surgical lip Fordyce granule excision in a 19-year-
old male.
Methods Fordyce granules were excised using a high-power diode laser (gallium arsenide
[GaAs], Diode Vision, MDL, 10 Dental Laser Unit, GmbH, Lower Saxony, Germany)
with wavelength emission at 980 ± 10 nm, in a continuous wave mode, pulse width of
0.5 ls, fiber optic delivery system of 400 lm in diameter, at 2.5 W. Subsequently, low-
intensity laser therapy was applied (gallium-aluminum-arsenide [GaAlAs], at 670 nm,
50 mW, at 4 J ⁄ cm2; Dentoflex, São Paulo, Brazil] in order to stimulate a faster wound
tissue–healing process and less postoperative pain and inflammation.
Conclusion The excellent esthetic result demonstrated the effectiveness of both high- and
low-intensity laser therapy on the excision of Fordyce granules.
Keywords: laser ablation, laser surgery, laser treatment

the molar teeth, gingival, and palate, and are rarely

Introduction
Fordyce granules are ectopic sebaceous glands that
occur on the lips. They are a normal developmental
variation and can best be categorized as a benign
hamartoma of sebaceous origin.1 These lesions may be
present at birth or become evident later in life. They may
be discovered during routine dental examinations and
vary depending on age, sex, or race.2 Clinically they are
small in size, creamy-yellow dots in appearance, with no
hair follicle association.3 They are symmetrically located
on the vermilion border of the lips. They can also occur
on buccal mucosa, in the line with the occlusal planes of
Correspondence: M T B R Santos, Full Professor of the Discipline of Dentistry,
Persons with Disabilities Division, Post Graduation Professor, Universidade
Cruzeiro do Sul, Rua Constantino de Souza, 454, apto 141, São Paulo,
SP 04605-001, Brazil. E-mail: drsantosmt@yahoo.com.br
Accepted for publication September 3, 2010
observed on the tongue.4
The incidence of Fordyce granules increases from
childhood to adulthood, being more common in
adults.5,6 This condition is twice as prevalent in men
than in women, as the granules are the target of
androgenic hormones and receptors in dermal sebaceous
glands.7 Fordyce granules usually have the same histo-
logic features as cutaneous sebaceous glands and
pathological alterations are rare. There is no significant
correlation between Fordyce granules and systemic
diseases.5
The complications of conventional oral surgeries are
related to the bleeding control, consequently compro-
mising the visualization of the operative surgical field,
and causing delay in the postoperative outcome. The
benefit of lasers, such as diode lasers at 980 ± 10 nm,
includes homogenous tissue ablation and excellent
hemostasis, enabling a much better surgical site view

 2010 Wiley Periodicals, Inc. • Journal of Cosmetic Dermatology, 9, 321–324 321

Fordyce granule excision with diode laser • F M Baeder et al.
and control, thus promoting a faster, safer, and more
precise procedure. Because of their tissue vaporization
capability, high-power lasers reduce the possibility of
bacteremia (sepsis), with a comfortable and safer post-
operative period.8
To our knowledge, there are no studies in the
literature describing Fordyce granule excision using
lasers. Therefore, the aim of this case report was to
outline the surgical excision of Fordyce granules on the
left vermilion of the upper lip with the use of a high-
power diode laser.
Case report
The patient read, agreed to, and signed the terms of the
informed consent and was willing to participate in the
clinical case protocol. The treatment alternatives as well
as risks and benefits were also explained.
A Caucasian male patient aged 19 was referred to the
Laser Center at the University Cruzeiro do Sul (UNIC-
SUL), São Paulo, Brazil, and complained of dissatisfac-
tion with his upper lip. He was a healthy, nonsmoking
student without any previous medical history or med-
ication use. The clinical examination revealed the
presence of variably sized Fordyce granules on the
vermilion border of the upper lip (Fig. 1). The treatment
plan consisted of excision of the Fordyce granules on the
left upper lip margin using a diode laser.
The laser used was a high-power diode laser (gallium
arsenide [GaAs], Diode Vision, MDL – 10 Dental
Laser Unit, GmbH, Berlin, Germany, Lower Saxony,
Germany). The laser parameters were wavelength emis-
sion at 980 ± 10 nm in a continuous wave mode, pulse
Figure 1 Aspects of the upper lip with Fordyce granules.
322
width of 0.5 ls, and a fiber optic delivery system of
400 lm in diameter set at 2.5 W. (Fig. 2).
Intraoral antisepsis was performed with 0.12% glu-
conate chlorhexidine containing mouthwash (Perioxi-
dim; Glaxo Welcome SA, Rio de Janeiro, Brazil) for 45 s
and extraoral antisepsis with 2% gluconate chlorhexi-
dine (Methiolate; Dm Pharmaceutical Industry Ltda,
Barueri, Brazil).
After local anesthesia with Mepivacaine with
1:100 000 epinephrine, the peeling of the Fordyce
granules was initiated with the laser at 2.5 W. During
this process, the fiber was in direct contact with the
tissue at a 45 angle. This enabled complete control of
the excision and helped to avoid heat transmission to
the deep tissue layers and consequently collateral
injury.
After total excision of the lesion, a low-intensity laser
therapy (LILT) was applied (gallium -aluminum- arse-
nide a [GaAlAs], at 670 nm, 50 mW, at 4 J ⁄ cm2 –
Dentoflex, São Paulo, Brazil) in order to stimulate a
faster wound tissue–healing process and prevent post-
operative pain and inflammation (Fig. 3).9 Within the
first 24 h, a good lesion recovery was observed, with the
presence of re-epithelialization (pseudo membrane). LILT
was applied with the same parameters as the first
application (immediate post-op) during all the postoper-
ative visits. This protocol was repeated after 48 and
72 h. A solar protection factor (Sun Protection Factor
30) lip balm was also indicated for patient use through-
out the wound tissue–healing process.
The patient reported no pain or discomfort during the
first 72 h. After 20 days, the wound tissue–healing
process revealed no signs of inflammation, infection or
Figure 2 Aspects of the tissue during surgical removal with a
high-power diode laser.
 2010 Wiley Periodicals, Inc. • Journal of Cosmetic Dermatology, 9, 321–324

Figure 3 Low-intensity laser therapy irradiation in the injured
area.
Figure 4 Thirty-day postoperative assessment.
scaring, while anatomy reestablishment, esthetics, and
recovery of the functions of the mouth occurred without
any trauma of the excised area (Fig. 4).
Discussion
This is the first published case report on the use of high-
power diode laser in surgical procedures as a result of
the photocoagulation effects on Fordyce granules.
Although Fordyce granules usually do not present
pathologic alterations,5 ‘‘the patient was self-conscious
and very distressed by the presence of unsightly lesions
on his face.’’
Currently, the therapeutic use of lasers on various
types of oral lesions is considered a technological
 2010 Wiley Periodicals, Inc. • Journal of Cosmetic Dermatology, 9, 321–324
Fordyce granule excision with diode laser • F M Baeder et al.
advance in dentistry. Their absorption, diffusion, and
transmission properties, in addition to their vaporizing,
coagulation, and tissue cutting capacity make lasers an
asset for surgical treatment of oral lesions.10
Compared to conventional surgery, high-power lasers
permit homogenous tissue ablation and excellent hemo-
stasis, thus facilitating visualization of the surgical site,
providing greater surgical precision and leading to a
faster and safer procedure. Because of their tissue
vaporization properties, these lasers reduce the risk of
bacteremia (sepsis), making the postsurgical period more
comfortable and safer.11
The specific choice of the high-power diode laser was
based on its properties, similar to that of the argon
laser,12 because its wavelength is well absorbed by
pigmented tissues. Given this fact, it is highly recom-
mended for performing soft-tissue surgeries because of its
cutting capacity and coagulation properties.13 The fiber
optic delivery system used is 400 lm in diameter, which
permits better control when cutting the lesion with a
safety margin, without affecting the underlying tis-
sues;14 thus enabling the achievement of an esthetic
condition of considerably better quality regarding the
wound tissue–healing process.
The therapeutic use of LILT is a useful adjunct in
promoting a better wound tissue–healing process. LILT
use in animal models suggests that it may have potential
as an alternative therapy to anti-inflammatory
drugs.15,16 In a previous experiment, Albertini et al.16
reported that red LILT, with a wavelength of 650 nm,
reduced rat paw edema similar to a 1 mg ⁄ kg dose of
sodium diclofenac, an NSAID, and a nonselective COX-
inhibitor. They also showed that wavelengths of 660 and
684 nm, red diode lasers, are similarly effective at
reducing edema formation during the first four hours of
inflammation.17,18 A reduction in the density of inflam-
matory cells in injured tissue has previously been reported
after LILT on the wound healing of diabetic rats19 and
mouse pleurisy.20 For these patients, the use of LILT was
beneficial, as an improvement was observed at the lesion
site without the use of NSAID or analgesic drugs.
The patient was very satisfied with treatment to his
right upper lip and showed a keen interest in removing
the other hamartomas present in the left upper lip with
the same technique.
Conclusions
The excellent esthetic outcome observed in this case
report demonstrated the efficacy and safety of high-
power diode laser use and LILT therapy on the excision
of Fordyce granules.
323
 Fordyce granule excision with diode laser • F M Baeder et al.
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