tobacco in the form of smoking , and smokeless is a prime etiological agent in the causation of oral leukoplakia .
its incidence ranges from 0.2% to 4.9% in indian subcontinent , with range of malignant transformation reported to be 420% .
neodymium : yttrium aluminum garnet ( nd : yag ) laser due to its low intra - operative and postoperative complication rates gives it a leading edge over other conventional treatment modalities .
forty - two patients ( 36 males and 6 females ) with clinically diagnosed and histopathologically correlated leukoplakic lesions [ figure 1 ] were selected for the treatment .
all patients were informed about the disease , and written consents were taken for the same .
the study was conducted following clearance from an ethical committee of the university . only patients with mild or moderate dysplasia
patients with severe dysplasia and definable white lesions such as linea alba , lichen planus , white sponge nevus , and biopsy - proven severe dysplasia including carcinoma in situ or squamous cell carcinoma were excluded from the study .
leukoplakic patch over left lateral surface of the tongue the 1064 nm nd : yag laser ( fotona d.d .
stegne 7 , 1000 ljubljana , slovenia , eu ) with a power range of 115 w was used for the study .
the operating surgeon , assistant and the patients eyes were protected with laser protection glasses .
nd : yag laser was set at an average power of 2.53.5 w in free running pulsed mode in most of the cases .
the power is slightly raised up to a maximum of 5 w ( n = 10 ) in cases of lesions involving the palatal mucosa , attached gingiva or lesions classified as verrucous leukoplakia .
the power should always be customized for each patient based on the tissue characteristics of the lesional site .
the beam was directed as perpendicular as possible onto the tissue with a suitable clearance margin of 56 mm [ figure 2 ] .
once the surgical outline is defined , parallel lines of application of laser was placed within marginal outline , using a process known as  rastering .
 constant speed was maintained to create uniform depth and to prevent heat accumulation at a single site .
wet gauze was used to mop the surgical site and also cleansing of the fiberoptic tip containing charred tissue . a pale pink base that does not bleed indicates removal of the epithelium at the level of basement membrane .
all patients postoperatively were prescribed analgesics ( tablet aceclofenac 100 mg ) twice daily till 3 postoperative day .
all patients were followed 24 h , 72 h , 1-week and successively for 1 , 3 , and 6 months , 1 year and 2 postoperative year [ figures 4 and 5 ] .
neodymium : yttrium aluminum garnet laser application to the lesional site one week follow - up of the lesional site six months postoperative follow - up showing complete eradication of the lesion two years postoperative follow - up shows healed site with no recurrence of the lesion
the age of patients included in the study ranged from 25 to 60 years ( mean : 45.7 years ) with the disease showing a male predominance . of 42 patients included in the study ,
22 patients had lesions in buccal mucosa , eight patients had lesions in lateral border of tongue , six patients over gingival mucosa , two patients over palate and 2 each over labial mucosa and commissure of lip .
76.2% patients ( n = 36 ) had a history of consumption of tobacco in smoking or smokeless form . during postoperative assessment ,
all patients reported of mild pain in the surgical site after 24 h which gradually decreased during 72 h and 1-week postoperatively and became nil in subsequent follow - ups up to 2 years ( wilcoxon rank test p = 0.0001 statistically significant ) .
none of the patients in the study group reported burning sensation , anesthesia or paresthesia .
there was recurrence of the lesion in two patients during the 1 month follow - up period ( mcnemar 's test p = 0.001 statistically significant ) .
following reapplication of laser , there were no recurrences over the period of 2 years follow - up period .
no patients developed carcinoma adjacent to the site of laser application during the follow - up period .
leukoplakia has a higher incidence in south east asian countries with india as no exception .
being termed by who in 2004 as  potentially malignant disorder ,  malignant transformation of this disease ranges from as low as 4% to as high as 20% .
though several studies have evaluated the role of nd : yag laser and its role in oral mucosal lesions , the powers used were in a higher range of 1015 w. our study aims at management of oral leukoplakic lesions with lesser power ( 2.5 w3.5 w ) .
this is mainly aimed to lessen postoperative swelling and pain along with the inherent property of higher penetration of nd : yag laser compared to carbon dioxide laser .
focusing of the laser beam in a small area results into a higher concentration of effective power to the lesional site .
hence , minimal tissue damage leading to less inflammation is the cause of mild pain following ablative therapy to the lesional site . in our study
, all patients were managed with nonsteroidal anti - inflammatory drugs with total relief of pain by 1 postoperative week .
similar results were also seen for slough , which is a slimy layer covering the surgical site .
there was complete remission of it by 1 month which corresponds to complete healing of the lesion .
but vivek et al . reported complete healing of lesions by 5 weeks at a power of 15 w. this could be due to delayed healing at higher power due to more inflammation to the surgical site .
damage of small lymphatic vessels in surgical site is the cause of postoperative swelling . but
sealing of such vessels by laser is the cause of decreased swelling postoperatively in our patients .
none of the patients reported of postoperative infection and anesthesia or paresthesia in our study .
recurrences were also reported by previous researchers in their study but schoelch et al . reported it as high as 38.1% .
the first case of recurrence occurred in a patient with a lesion over left lateral border of the tongue with diffused margin .
the lesion was treated , and recurrence was observed in 1-month follow - up . following second application of laser , there was no recurrence in subsequent follow - ups till 2 year
. kardos et al . suggested that the lateral surface of the tongue is characterized by marked proportion of dysplastic changes and high recurrence rate , suggesting that the lesion occurs widely in field cancerization .
the second case of recurrence occurred in a patient with previously treated verrucous leukoplakia with a well - defined margin .
the lesion was retreated , and no recurrence was observed in subsequent follow - ups . finally concluding the results of our study we found that nd : yag laser in low power is an effective treatment modality for the management of mild to moderate dysplastic oral leukoplakia with lesser duration of pain and discomfort .
there is excellent wound healing by 4 weeks with no scarring , minimal postoperative pain , and no infections .
hence , we suggest 23 sittings for larger lesions with close postoperative follow - up . although a single cohort of patients was used in our study , the study might benefit from continued longitudinal assessment of future patients .
 objectives : oral leukoplakia is a nonscrappable whitish patch described as a potentially malignant disorder with high prevalence in india . besides medicinal treatment , neodymium : yttrium aluminum garnet ( nd : yag ) laser 
 is also used for the management of oral leukoplakia . 
 this study evaluated the role of nd : yag laser in the management of oral leukoplakia and also investigated postoperative complications along with long - term prognosis of the disease.settings and designs : the study is a prospective cohort study conducted for 24 months ( june 2011 to may 2013 ) in lucknow.materials and methods : the study comprised of 42 patients , both male and female of indian origin and diagnosed with oral leukoplakic lesions . 
 patients with biopsy proven squamous cell carcinoma and medically compromised are excluded from the study . 
 all patients has undergone ablation of lesion by pulsed nd : yag laser and were followed after 24 h , 72 h , 1-week and then successively for 1 , 3 , 6 months and then 1st and 2nd postoperative years.results:pain and slough were evaluated by wicoxon rank test ( p = 0.0001 statistically significant ) which decreased from 24 h to 1-week and became nil in subsequent follow - ups . 
 similarly , mcnemar 's test ( p = 0.001 statistically significant ) was used for evaluation of burning sensation , paresthesia , infection and recurrences . 
 recurrence was noted in 2 patients but following the second application , there were no recurrences over the period of further follow - up . 
 none of the patient suffered from an infection , paresthesia or anesthesia.conclusion:hence , nd : yag laser was found to be effective in ablating leukoplakia . 
 it is convenient , economical with minimum complications and morbidities . 
Introduction
Materials and Methods
Results
Discussion