Image-Guided Excision of Oral Leukoplakia Using Narrow-Band Imaging Illumination and Two-Stage Local Anesthesia

This study evaluated the use of narrow-band imaging (NBI) to assist in achieving adequate excision of oral leukoplakia with complete removal of lesions. Use of lidocaine combined with a vasoconstrictor for local anesthesia is standard practice in surgery. However, the blanching effect that follows injection can obscure the boundary between oral leukoplakia and the surrounding normal mucosa. A two-stage local anesthesia protocol was applied: plain lidocaine was first administered for anesthesia, after which the excision margin was defined under NBI illumination using a carbon dioxide laser, followed by lidocaine with epinephrine for resection. Twenty-one patients (18 men, 3 women) with 50 lesions were treated. All surgical margins were free of residual disease. During at least 12 months of follow-up, one recurrence occurred, and no malignant transformations were observed. In conclusion, NBI-guided excision with two-stage local anesthesia avoids the blanching effect and enhances visualization, facilitates precise margin delineation, and supports complete lesion removal.