A clinical and histological comparison of mucosal incisions produced by scalpel, electrocautery, and diode laser: A pilot study

Abstract

Aim: The aim of this study was to clinically and histologically compare mucosal incisions of oral tissues after surgical procedures with scalpel, electrocautery, and diode laser. Materials and Methods: Nine standardized incisions were performed in oral mucosa by scalpel, electrocautery, and diode laser. Specimens were classified into three groups according to tool used for surgical excision. Group A: Three specimens excised through a Bard-Parker (BP) scalpel blade no. 15c; Groups B and C included three specimens each excised through electrocautery and diode laser, respectively. Cut margins of biopsy specimens, adjacent peripheral mucosa were evaluated using light microscopy and histologic zones were identified, assessed: For epithelial changes, incision morphology, lateral tissue damage. Intra- and post-operative parameters assessed were the duration of surgery, bleeding, postoperative pain and healing. Results: Immediate hemostasis was seen with electrocautery and laser compared to scalpel (P < 0.011), mean time taken by electrocautery and laser was less compared to scalpel (P < 0.001). The analysis of regularity of incision and postoperative pain experienced by patients revealed a statistically significant difference (P < 0.01). Histologic damage was least with scalpel. The extent of degeneration was lowest with scalpel followed by laser or electrocautery (P < 0.05). Conclusion: Laser and electrocautery have upper hand over scalpel in relation to hemostasis, but have demerits such as lateral heat damage, tissue necrosis, delayed wound healing, and high cost. Even with advanced treatment modality, conventional scalpel treatment is better option in terms of precise incision, lower cost and faster reepithelization than laser and electrosurgery. Heat generating devices may not allow reliable histologic interpretations, particularly assessing margins of small biopsy specimens or malignant conditions.