Diode Laser for the Use of Lingual Venous Malformations

Journal Pre-proof Diode Laser for the Use of Lingual Venous Malformations Melissa J. Danesh, MD, Aria Vazirnia, MD MAS, Richard R. Anderson, MD PII:

S0190-9622(19)33135-4

DOI:

https://doi.org/10.1016/j.jaad.2019.11.043

Reference:

YMJD 14026

To appear in:

Journal of the American Academy of Dermatology

Received Date: 20 November 2019 Accepted Date: 22 November 2019

Please cite this article as: Danesh MJ, Vazirnia A, Anderson RR, Diode Laser for the Use of Lingual Venous Malformations, Journal of the American Academy of Dermatology (2020), doi: https:// doi.org/10.1016/j.jaad.2019.11.043. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier on behalf of the American Academy of Dermatology, Inc.

Diode Laser for the Use of Lingual Venous Malformations Melissa J Danesh MD,1 Aria Vazirnia MD MAS 2,3 Richard R Anderson MD 2,3

1

Harvard Combined Dermatology Residency Program, Harvard Medical School, Boston, MA 2 Department of Dermatology, Massachusetts General Hospital, Boston, MA, 3 Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA Abstract word count: N/A Manuscript word count: 163

Number of tables: 0 Number of figures: 0

Number of references: 2 *Corresponding author: Name: Melissa Danesh MD Department of Dermatology Massachusetts General Hospital 50 Staniford St. Boston, MA, 02114 Phone: 617-726-0149 Fax: 617-726-7768 Email: [email protected]

Funding sources: none IRB approval not applicable. Declaration of Interest: none There have been no prior presentations of this material.

Clinical Challenge Venous malformations of the tongue can cause significant functional impairment and bleeding. Often, patients are referred for surgical excision and sclerotherapy, which can have pronounced side effects. Solution We have found that the 810-nanometer wavelength diode laser, best known for its application in laser hair removal, is a highly effective but less invasive therapeutic option for treating lingual venous malformations. This wavelength is sufficiently penetrating to target deeper lesions while still possessing excellent absorption in hemoglobin.1 Delivery through a cold sapphire window, with a 9-15 millimeter aperture, fluence of 40-60 J/cm2 at 30-60 millisecond pulse duration is typically used. The cold window is held with gentle pressure against the lesion for several seconds before each pulse. The therapeutic endpoint is a dull “thud” due to intravascular steam formation.2 Several treatments may be required, but often one or two yield a very good result. For large lesions, we recommend observation for at least 6 hours following the procedure to monitor for edema.

1. 2.

Fan CM, Rox-Anderson R. Endovenous laser ablation: mechanism of action. Phlebology. 2008;23(5):206-213. Suthamjariya K, Farinelli WA, Koh W, Anderson RR. Mechanisms of microvascular response to laser pulses. The Journal of investigative dermatology. 2004;122(2):518-525.