title: Improvement of Microstomia in Scleroderma after Carbon Dioxide Laser Treatment.
abstract: Limited mouth opening (LMO) is a frequent complication of systemic sclerosis (SS). Its management is complex and there are limited treatment options. We report four patients with SS and severe LMO [interincisal distance (IID) <30 mm] treated with pulsed carbon dioxide (CO2) laser. Pulsed CO2 laser treatment of the white lips was performed after all patients had signed a written informed consent in the absence of alternative treatment. Treatment was carried out under locoregional anaesthesia using a Sharplan 30C CO2 laser in the Silk Touch® resurfacing mode. One to three laser sessions were performed at intervals of 8-12 months between sessions. Assessments were performed at 3 and 12 months with measurement of the IID using a ruler, calculation of the Mouth Handicap in Systemic Sclerosis (MHISS) scale and global evaluation by the patients. Adverse events were also reported. In all four patients, an improvement in IID occurred 3 months after the first session with a mean gain of +5 mm (range: 2-7). At 12 months, a mean gain of +8.5 mm (range: 7-10) in IID was observed. The MHISS score decreased by a mean of •14 (range: 11-17). All patients showed improvement of lip flexibility or mouth opening, allowing better phonation and mastication and easier dental care. Adverse effects were transient erythema and/or dyschromia. CO2 laser appears to be effective and well tolerated in the improvement of LMO in SS.
authors.affiliation: Department of Dermatology, Paul Sabatier University, Toulouse, France.
authors.forename: Imane
authors.initials: I
authors.lastname: Bennani
authors.affiliation: Departments of Oral and Maxillofacial Surgery, Toulouse University Hospital, Toulouse, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Departments of Internal Medicine, Toulouse University Hospital, Toulouse, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Bonnet
authors.affiliation: Departments of Pulmonology, Toulouse University Hospital, Toulouse, France.
authors.forename: Gregoire
authors.initials: G
authors.lastname: Prevot
authors.affiliation: Departments of Rheumatology, Toulouse University Hospital, Toulouse, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Constantin
authors.affiliation: Departments of Nephrology, Toulouse University Hospital, Toulouse, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Chauveau
authors.affiliation: Department of Dermatology, Paul Sabatier University, Toulouse, France.
authors.forename: Carle
authors.initials: C
authors.lastname: Paul
authors.affiliation: Department of Dermatology, Paul Sabatier University, Toulouse, France.
authors.forename: Cristina
authors.initials: C
authors.lastname: Bulai Livideanu
keywords: Carbon dioxide laser; Interincisal distance; Limited mouth opening; Microstomia; Mouth Handicap in Systemic Sclerosis scale; Systemic sclerosis