PDF: Cryosurgery as an Effective Alternative for Treatment of Oral Lesions in Children

Children can exhibit a wide variety of oral pathologies, such as oral lesions, bone lesions, tumors, cysts and cutaneous lesions. 

Different techniques have been described for the treatment of these lesions, but all of them are invasive.

This paper presents a series of cases that demonstrate the clinical efficacy of cryosurgery as an alternative to invasive surgical treatments of the most common oral lesions in children. This technique has been well tolerated by patients due to the absence of anesthesia, rapid healing and minimal bleeding. Cryotherapy has many applications in oral medicine and is an extremely useful alternative in patients to whom surgery is contraindicated due to age or medical history. It is a simple procedure to perform, minimally invasive, low-cost and very effective in pediatric dentistry clinic.

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Cryosurgery, a method based on the cytotoxic effects of cold, consists of the therapeutic application of extremely low temperatures to living tissues to obtain their destruction. Many cell types have different sensitivities to freezing temperature. Experiments have shown that the temperatures at which the differences in cell sensitivity can be identified are in the range of 0 to 30 °C.

The cryosurgical site is characterized by two zones: a central zone of total coagulative necrosis and a peripheral zone characterized by varying degrees of cellular death and injury. The mechanisms by which acute, direct cellular death occurs in the central zone are quite well established. Both the involved mechanisms include intracellular ice crystal formation resulting in mechanical trauma, and cellular dehydration with associated osmotic damage. Subsequent cell death is mediated by ischemia and apoptosis.

The mechanisms for cell destruction after cryosurgery are complex, involving a combination of direct and indirect effects (5). Direct effects consist of extracellular and intracellular formation of ice crystals that, in turn, disrupt cell membranes. Cellular dehydration, toxic intracellular electrolyte concentration, inhibition of enzymes, protein damage are thawing effects that cause the cell to vacuolate, swell and rupture, producing thermal shock injury to cells.

Indirect effects include vascular changes that lead to ischemic necrosis of the treated tissue and immunologic responses that cause cell damage by a cytotoxic immune mechanism.

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