Common benign oral soft tissue masses

Surgical Excision of Localized Gingival Overgrowth Using Laser: A Case Report

Gingival overgrowth, localized or generalized, is one of the leading causes of poor maintenance of oral hygiene. Excision of growth using laser should be the choice of treatment because laser helps maintain a blood-free surgical site during treatment and provides more patient comfort during and after the procedure. Lasers are commonly employed in many different applications, including scaling, root planning, cavity preparation, and excision of soft tissue growths in surgery. Laser therapy offers numerous benefits over traditional methods of treatment. These benefits have led to the growing use of lasers as dental treatment options in a variety of dental fields. In this case report, we are presenting a case of excision of localized gingival growth using a laser. Postoperative healing and maintenance of oral health were satisfied after laser surgery.

Electro-surgical management of a traumatic fibroma with clinical assessment of re-epithelialization using methylene blue assay: A clinico-histopathological case report

This article addresses the clinical presentation, diagnosis, histological features, and management of a case of fibroma. Fibroma is proliferative fibrotic lesions of the gingiva and oral mucosa, which may cause aesthetic and functional problems. Fibrous hyperplasia and fibroepithelial hyperplasia are histological alternates of these nonneoplastic lesions. The case demonstrated an overgrowth in the lower back tooth region. The growth was pale in color, sessile, painless, and firm in consistency. The lesion caused discomfort when chewing food, the lesion was excised using dental electrocautery and sent for histopathological assessment. This lesion was caused by trauma or persistent irritation, and histological examination indicates that the cells in the lesion are from the oral mucous membrane. This case demonstrates the need for proper diagnosis, the role of biopsy, and histologic evaluation in the management of fibrotic lesions.

A Rare Case of Lipomatous Variant Mammary-Type Myofibroblastoma of the Lateral Tongue

Mammary-type myofibroblastoma (MTMF) is an unusual and rare benign tumor that typically presents in older men or post-menopausal females. A 53-year-old female presented with a 6-month history of an asymptomatic pink/white submucosal nodule involving the left lateral tongue. Clinical examination showed a 5 mm × 5 mm × 5 mm firm submucosal nodule with intact overlying mucosa. Differential diagnoses focused on benign nodular connective tissue tumors. An excisional biopsy was performed and submitted for histopathological examination. The patient underwent conservative local excision. Histopathology and immunocytochemistry revealed a lipomatous variant of MTMF. Hematoxylin and eosin sections revealed an unencapsulated soft tissue lesion with a lobular growth pattern. The neoplasm was biphasic, comprising adipose tissue and cellular fibrous components. By immunohistochemistry, tumor cells were positive for desmin, estrogen receptor, and CD34. In summary, we presented an unusual case of a lipomatous variant of myofibroblastoma on the tongue. MTMF rarely occurs in the head and neck and its accurate diagnosis necessitates awareness of its histomorphological spectrum and application of appropriate immunohistochemical stains.

Unusual clinical presentation of oral pyogenic granuloma with severe alveolar bone loss: A case report and review of literature

BACKGROUND

Pyogenic granuloma (PG) is a localized, reddish and vascularized hyperplastic lesion of the connective tissue which occurs in the oral cavity. In most cases, the presence of this lesion does not show alveolar bone resorption. The pathology is diagnosed clinically with some caution. However, the diagnosis and treatment are usually corroborated with histopathological evidence.

CASE SUMMARY

Three clinical cases of PG associated with bone loss were described in this study. The three patients presented tumor-like growth which bled on touch, and were associated with local irritant factors. Radiographs showed bone loss. All cases were treated with conservative surgical excision. The scarring was satisfactory, and there was no case of recurrence. The diagnoses were based on clinical findings, and were confirmed histopathologically.

CONCLUSION

The occurrence of oral PG with bone loss is unusual. Therefore, clinical and radiographic evaluations are important for the diagnosis.

Excision of Traumatic Fibroma of the Tongue in a Pediatric Patient: A Case Report

Traumatic fibroma is a benign reactive exophytic oral lesion in response to local trauma in the oral cavity. The article presents the case of an 11-year-old boy patient with a month-long proliferation on the left lateral margin of the tongue. Upon detailed history and clinical examination, it was determined that the sharp cusps of the mandibular posterior were the etiological component. Here a soft tissue laser was used for the complete excision of the lesion. The main advantages of using a soft tissue laser in pediatric patients are effective hemostasis that can be achieved in a short span, is less invasive, and better postoperative phase. It is a safe and fast procedure that allows easy manipulation of the tissue without scarring. The excised lesion was then sent to histopathology for analysis. After clinical and histological examinations, the case was diagnosed as a traumatic fibroma.

How to cite this article

Asundaria RR, Tavargeri A. Excision of Traumatic Fibroma of the Tongue in a Pediatric Patient: A Case Report. Int J Clin Pediatr Dent 2023;16(1):166-169.

A Rare Gingival Lesion in Children: Fibroepithelial Hyperplasia

Aim and objective

This case report aims to describe the management of a case of rare gingival lesion in a young pediatric patient.

Background

An increase in the size of the gingival tissue is known as gingival hyperplasia. This can cause esthetic as well as functional problems, and interfere with normal functions like mastication and speech. A histological form of fibroma, fibroepithelial hyperplasia is a proliferative fibrous lesion of the gingival tissue. These lesions can be caused by trauma or persistent irritation, or they can develop from the periodontal, periodontal ligament, or periosteum cells.

Case description

This paper discusses a situation in which the parents of a 4-year-old girl presented to the department with a major complaint of swelling in the upper front tooth region, who was diagnosed with fibroepithelial hyperplasia with the help of a biopsy and histologic evaluation.

Conclusion

In this case surgical excision was performed under local anesthesia with no postoperative complications, and a 2-year follow-up was made with a positive outcome.

Clinical significance

When these type of gingival lesions are present, they should be investigated and diagnosed properly. They should be managed as soon as possible without causing any further complications to permanent dentition.

How to cite this article

Niranjan B, Shashikiran ND, Dubey A, et al. A Rare Gingival Lesion in Children: Fibroepithelial Hyperplasia. Int J Clin Pediatr Dent 2022;15(4):468-471.

Dental MRI of Oral Soft-Tissue Tumors—Optimized Use of Black Bone MRI Sequences and a 15-Channel Mandibular Coil

Soft-tissue lesions in the oral cavity, one of the most common sites for tumors and tumor-like lesions, can be challenging to diagnose and treat due to the wide spectrum from benign indolent to invasive malignant lesions. We report an abnormally large, rapidly growing hyperplastic lesion originating from the buccal mucosa in a 28-year-old male patient. Clinical examination revealed a well-circumscribed, smooth-surfaced, pinkish nodular lesion measuring 2.3 × 2 cm, which suggested the differential diagnosis of irritation fibroma, pyogenic granuloma, oral lipoma, and other benign or malignant neoplasms such as hemangioma, non-Hodgkin’s lymphoma, or metastases to the oral cavity. Dental MRI using a 15-channel mandibular coil was performed to improve perioperative radiological and surgical management, avoiding adverse intraoperative events and misdiagnosis of vascular malformations, especially hemangiomas. Black bone MRI protocols such as STIR (short-tau inversion recovery) and DESS (double-echo steady-state) were used for high-resolution radiation-free imaging. Radiologic findings supported the suspected diagnosis of an irritation fibroma and ruled out any further head and neck lesions, therefore complete surgical resection was performed. Histology confirmed the tentative diagnosis. This article evaluates the use of this novel technique for MR diagnosis in the perioperative management of soft-tissue tumors in oral and maxillofacial surgery.

Use of Diode Laser for Surgical Removal of Pyogenic Granuloma of the Lower Lip in a Pediatric Patient: A Case Report

BACKGROUND A pyogenic granuloma is an inflammatory exophytic lesion that can occur in the oral cavity. Numerous factors are involved in the etiology of the lesion and can lead to the tissue proliferation underlying the lesion's characteristic appearance. The main treatment is surgical excision with careful curettage of the surrounding tissues. The use of a laser has been proposed because it enables performing deep and precise incisions with better hemostasis and less invasive procedures with less discomfort to patients. The aim of this study was to evaluate the possible advantages of using a diode laser in the surgical treatment of pyogenic granuloma, particularly in the management of a pediatric patient. CASE REPORT A swelling in the lower lip of an 11-year-old female patient was analyzed. After several evaluations, a 980-nm diode laser in continuous wave mode was chosen for excision of the lesion. The lesion was excised successfully with a diode laser as a conservative method that was nonstressful for the pediatric patient. CONCLUSIONS Among the techniques for surgical excision of a lesion, the use of a diode laser has the following advantages: less invasiveness, absence of intra- and postoperative discomfort and pain, effective hemostasis with better control of bleeding, absence of scarring, better postoperative management, and greater patient compliance.

A puzzling pregnancy epulis with aggressive bone loss mimicking malignant neoplasm: A case report

Epulis is a benign tumor, rarely involves aggressive alveolar bone resorption. This study reported a rare case of rapid growth of pregnancy epulis with extensive alveolar bone destruction and the management of this case. A 24-year old pregnant woman at 35 weeks and 1 day of gestation presented a large asymptomatic nodular mass with severe teeth loosening at the anterior mandibular region for 4 weeks. Radiographic examination showed extensive alveolar bone resorption around the affected teeth to the apical area. After delivery, the patient received an extended resection under general anesthesia. The final histopathological analysis revealed the diagnosis of epulis. In conclusion, the rapid growth of epulis during pregnancy mimicking malignant neoplasm with aggressive alveolar bone destruction was rare and puzzling. In such cases, the histopathological and immunohistochemical examinations are the only effective method to reach the correct diagnosis and clinician should proceed with high precaution.

Pattern of distribution of reactive localised hyperplasia of the oral cavity in patients at a tertiary health institution in Nigeria

Background

Reactive localized hyperplastic lesions of the oral cavity (RHLs) are relatively common peripheral lesions which present as a range of clinically similar lesions at dental centers. Diagnosis can be challenging if dentists are unfamiliar with their clinicopathological across various populations.

Objective

This study reviews the pattern of distribution of RHLs of the oral mucosa in a hospital- the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife.

Materials and methods

We reviewed 10 years data from the archives of the Department of Oral Maxillofacial Surgery and Oral Pathology, Obafemi Awolowo University, Nigeria. Information on RHLs were extracted and recorded on standardized data forms and analyzed using STATA.

Results

The most common lesions were pyogenic granuloma (43.7%) and focal fibrous hyperplasia (39.7%), respectively. RHLs were found to be more frequent in women (66.7%) than men (33.3%). The most common locations of involvement was the gingivae (84.6%), and lesions were more common in the 9–29 year age group and the mean age was 37.7 (±21.1) years. The relationship between age group and reactive lesions was however not statistically significant.

Conclusion

The major benefit of this study is an improved knowledge of the frequency and distribution of oral reactive lesions in sub-Saharan Africa which may be highly beneficial when establishing a diagnosis and treatment plan in clinical practice.

HPV-Related Papillary Lesions of the Oral Mucosa: A Review

Human papillomaviruses (HPVs) are causative of a group of clinically papillary lesions. The HPV-related lesions of the oral cavity include squamous papilloma, condyloma acuminatum, verruca vulgaris, and multifocal epithelial hyperplasia. Benign entities, such as verruciform xanthoma or giant cell fibroma, as well as malignancies, such as papillary squamous cell carcinoma and verrucous carcinoma, may be considered in the clinical and/or histologic differential diagnoses of these lesions. Mechanisms of infection, epidemiology, clinical presentations, histologic features, and differential diagnoses of the HPV-related oral pathologies are discussed. Current concepts of viral transmission, especially as pertaining to lesions in pediatric patients, and the impacts of HPV vaccination are reviewed.

Osteopontin expression and clinicopathologic correlation of oral hyperplastic reactive lesions: An institutional 6-year retrospective study

Background and Objective

Reactive proliferations of oral cavity comprise pyogenic granuloma (PG), fibrous hyperplasia (FH), peripheral ossifying fibroma (POF), and peripheral giant-cell granuloma (PGCG). They often pose diagnostic challenges due to their overlapping clinical and histopathological features. This study was conducted to determine the frequency and clinicopathological correlation of reactive hyperplastic lesions in the oral cavity reported in our institute and compared it with other previous studies. Further evaluation of osteopontin (OPN) expression in normal gingival tissue and different types of focal reactive lesions was also done.

Materials and Methods

Data of all reactive hyperplasias were retrieved, reviewed, and analyzed for age, gender, clinical presentation, and site of location. Presence and distribution of OPN were assessed using immunohistochemistry in these reactive lesions.

Results

Two hundred and forty-eight reactive lesions were comprised of FH (38%), PG (23%), POF (13%), and PGCG (7%). FH was more common in males (55%) whereas other reactive lesions were more in females (68%-73%). The most frequently involved site was gingiva (59%), and most common clinical presentation was sessile growth on gingiva. OPN expression was minimal in normal gingiva. Few cases of FH, PG, and all cases of POF showed positivity for OPN in inflammatory cells, stromal cells, extracellular matrix, and in calcifications.

Conclusion

Reactive hyperplastic lesions of oral cavity are mucosal responses to chronic low-grade irritation caused by plaque, calculus, and any other irritant. It is helpful to know their frequency and presentation as their early identification enables accurate patient evaluation and management.

Prospective study of the 532 nm laser (KTP) versus diode laser 980 nm in the resection of hyperplastic lesions of the oral cavity

Background

The aim of this study is to evaluate the resection of hyperplastic lesions on the buccal mucosa comparing the 532nm laser (KTP), versus diode 980nm laser, considering pain, scarring, inflammation and drug consumption that occurred postoperatively with each lasers.

Material and Methods

A prospective study of consecutive series of 20 patients in two groups that presents hyperplastic lesions on the buccal mucosa. The choice of the KTP laser or diode 980nm laser for the surgery was made randomly. The power used was 1.5W in both groups in a continuous wave mode with a 320 μm optical fiber. Parameters of pain, scarring, inflammation and consumption of drugs were recorded by a Numerical Rating Scale and evaluated postoperatively. These recordings were made the day of the surgery, 24 hours after, 14 and 28 days after.

Results

Pain and inflammation was light - moderate. The consumption of paracetamol was somewhat higher in the diode 980nm laser versus the KTP laser after 24 hours, although data was not statistically significant; significant differences were found after 28 days in regards to pain (p = 0.023) and inflammation (p = 0.023), but always in the absence parameter so we find no pain in both lasers. Scarring in the two types of laser showed no differences along the visits, with not detected scar retractable.

Conclusions

Although there is a slight histological difference regarding the KTP laser in the oral soft tissues for clinical use, both wavelengths are very suitable for excision of oral fibroma.

Key words:Laser surgery, Laser therapy, oral surgery, soft tissue, 980 nm diode laser, 532 nm KTP laser.

Angioleiomyoma (Vascular Leiomyoma) of the Oral Cavity

A 70-year-old male presented with a slow growing, dome shaped and painless mass of the hard palate. The mass was excised. Histopathological examination confirmed the diagnosis of a angioleiomyoma (vascular leiomyoma). A leiomyoma is an uncommon benign tumor of smooth muscle differentiation. True leiomyomas of the oral cavity are rare and most oral tumors are derived from the smooth muscle of walls of blood vessels. Therefore, they are called vascular leiomyomas or angioleiomyomas. Clinically, they may resemble a myriad other conditions both benign and malignant. A definitive diagnosis depends upon histopathological examination of the biopsied tissue in correlation with the tumor cell immunohistochemistry. Tumors are excised and recurrence is rare. The histopathological findings and differential diagnosis of a case of a palatal angioleiomyoma are discussed.

Retrospective analysis of benign orofacial tumors at a tertiary referral center in Saudi Arabia

AIM

The aim of the present study was to analyze the prevalence of benign tumors of the orofacial region at a tertiary referral center in the south-western region of Saudi Arabia.

METHODS

Cases from 2009 to 2014 were retrieved from October 2014 to June 2015 from the archives of the histopathology department of the center. Demographic and clinical details of the patients were recorded.

RESULTS

Of the 714 oral and maxillofacial biopsy specimens, 78 (10.9%) were benign tumors. The mean age and range were 34.6±19.8 and 3-85 year, respectively. Sex distribution was equal. Most tumors were mesenchymal (34.6%), followed by epithelial (26.9%), odontogenic (20.5%), and salivary gland tumors (17.9%). Squamous cell papilloma (20.5%) was the most common, followed by pleomorphic adenoma (15.4%) and fibrous tumors (15.4%).

CONCLUSIONS

The low prevalence of benign orofacial tumors found in this study indicates a lack of awareness of the importance of taking biopsy for such lesions. The information reported here emphasizes the need for biopsy investigation for all oral lesions to ascertain appropriate diagnosis.

Management of a Recurrent Pyogenic Granuloma of the Hard Palate with Diode Laser: A Case Report

INTRODUCTION

Pyogenic granuloma (PG) is a prevalent inflammatory hyperplasia of skin and oral mucosa which is often caused by constant low-grade local irritation, traumatic injury or hormonal factors. In many cases, gingival irritation and inflammation due to poor oral hygiene are precipitating factors. Oral PG occurs predominantly on the gingiva, but it is also encountered on the lips, tongue, buccal mucosa and rarely on the hard palate. Although surgical excision is the first choice of treatment, many other treatment modalities could be counted such as cryosurgery, sodium tetradecyl sulfate sclerotherapy, intralesional steroids, flash lamp pulsed dye laser, neodymium-doped yttrium aluminium garnet (Nd:YAG) laser, carbon dioxide (CO2) laser, erbium-doped yttrium aluminum garnet (Er:YAG) lasers and diode laser have been suggested. After surgical excision recurrence occurs up to 16% of these lesions. It is believed that recurrence ensues as a result of incomplete excision, failure to eliminate etiologic factors or repeated trauma.

CASE REPORT

A 50-year-old female was referred to the Department of Oral Surgery, Gazi University, School of Dentistry, complaining of a swelling and growth on the right side of the hard palate for four months. Patient reported a similar growth in the same area about two years earlier, which had turned out to be a PG by histopathology. The treatment plan included surgical excision of the lesion using diode laser.

RESULTS

The patient reported no pain after the surgery. She was discharged with a prescription of chlorhexidine mouthwash and necessary post-operative instructions. At 7 days follow up visit, immediate recurrence of the lesion was observed, and it was excised by diode laser with 2 mm margins at its clinical periphery, to a depth up to the periosteum, by the same operator. No recurrence or scarring was observed in 14 months follow-up.

CONCLUSION

Although diode laser is a secure and efficient technique for the treatment of intraoral PG, in order to minimize its recurrence, the lesion should be excised with a wider margin down to the periosteum or to the causing agent. Also due to its high recurrence rate, long-term follow-up is recommended.

Mucocele and fibroma: treatment and clinical features for differential diagnosis

Mucocele is a benign lesion occurring in the buccal mucosa as a result of the rupture of a salivary gland duct and consequent outpouring of mucin into soft tissue. It is usually caused by a local trauma, although in many cases the etiology is uncertain. Mucocele is more commonly found in children and young adults, and the most frequent site is the lower inner portion of the lips. Fibroma, on the other hand, is a benign tumor of fibrous connective tissue that can be considered a reactionary connective tissue hyperplasia in response to trauma and irritation. They usually present hard consistency, are nodular and asymptomatic, with a similar color to the mucosa, sessile base, smooth surface, located in the buccal mucosa along the line of occlusion, tongue and lip mucosa. Conventional treatment for both lesions is conservative surgical excision. Recurrence rate is low for fibroma and high for oral mucoceles. This report presents a series of cases of mucocele and fibroma treated by surgical excision or enucleation and the respective follow-up routine in the dental clinic and discusses the features to be considered in order to distinguish these lesions from each other.

Pyogenic granuloma in relation to dental implants: Clinical and histopathological findings

Background

The occurrence of pyogenic granuloma in association to dental implants is rare and only five cases have been reported in the literature.

Material and Methods

Patients charts were analyzed to select patients who had been diagnosed for pyogenic granuloma and its association with dental implants had been evaluated. The clinical status of the dental implants and the prosthesis had also been assessed.

Results

Clinical and histopathological diagnosis of pyogenic granuloma had been reached for soft mass growth in association with dental implants in 10 patients. Histological analysis of all samples was performed to obtain a firm diagnosis of finding against pyogenic granuloma lesions. Accumulation of dental plaque due to poor oral hygiene and improper design of the prosthesis had been related to the occurrence of pyogenic granuoloma. This lesion showed no predilection to specific surface type and had no significant association with marginal bone loss.

Conclusions

Pyogenic granuloma should be included in the differential diagnosis of soft mass growth around dental implants.

Key words:Reactive lesion, soft mass, pyogenic granuloma, dental implant, titanium.

Diode Laser in Minor Oral Surgery: A Case Series of Laser Removal of Different Benign Exophytic Lesions

INTRODUCTION

The role of laser in conservative management of oral disease is well established. Laser procedures are common in the fields of oral surgery, implant dentistry, endodontic, and periodontic therapy.

CASE

This case series describes the use of diode laser for the excision of oral exophytic lesions. All the patients attended the oral medicine department of Shahid Beheshti University of Medical Sciences, Tehran, Iran. Criteria in patient selection were accessibility to lesions, patient fear from blade surgery, aesthetics, and probability of bleeding. An informed consent was filled by every patient. All of the lesions were completely excised under local anaesthesia by diode laser with 300 μm-fibre tip, 808 nm continuous wavelength and 3-3.5 W power for 3×60 seconds (Dr Smile, Italia). During surgery, the fibre tip was in contact with lesions. No analgesics were prescribed to the patients. The patients were followed for the first, second, and forth week after treatment.

CONCLUSION

The lesions could be excised using the diode laser. This procedure was a quick clinical technique without bleeding.

Retrospective analysis of the histopathologic features of 288 cases of reactional lesions in gingiva and alveolar ridge

INTRODUCTION

The aim of this study was to perform a retrospective study of histopathologic features of a series of cases of pyogenic granuloma (PG), peripheral giant cell lesion (PGCL), and peripheral ossifying fibromas (POF) that constitutes the group called reactional lesions, located in gingiva and alveolar ridge.

STUDY DESIGN

Cases of PG, PGCL, and POF were selected for this study. The morphological analysis of the lesions constituted the following: intensity of inflammatory infiltrate (IF), presence of vascular proliferation (VP), fibroblastic proliferation (FP), areas of ulceration (AU), bacterial colony (BC), presence of mineralization (PM), multinucleated giant cells (MGC), hemosiderin deposition (HD), hemorrhage area (HA).

RESULTS

Of the 288 cases analyzed, 162 (56.3%) were PG, 72 (25%) were PGCL, and 54 (18.8%) were POF. The IF, VP, AU, and BC were more prominent in PG (85.8%, 98.8%, 91.4%, and 46.9%, respectively) and PM in POFs (98.1%). FP was more frequent in POF (98.1%) and PGCL (100%) and MGC in PGCL (100%), although some cases of POF (7.4%) and PG (0.6%) exhibited MGC. HD was more frequent in PGCL (40.3%) and HA in PG (53.1%).

CONCLUSIONS

This study demonstrated that IF, VP, AU, BC, and HA are the common features in PG, MGC, FP, and HD are the most common in PGCL, and PM associated with FP are the most common in POF, which can help in the histopathologic differential diagnosis between these lesions. In addition, it may suggest a possible development and maturation of the PG in POF with reduction in the inflammatory component and increase in the fibrous component.

Palatal pyogenic granulomaa

Pyogenic granuloma (PG) is a kind of inflammatory hyperplasia seen in the oral cavity. This term is a misnomer because the lesion is unrelated to infection. In reality it arises in response to various stimuli such as low-grade local irritation, traumatic injury or hormonal factors. It predominantly occurs in the second decade of life in young females possibly because of the vascular effects of female hormones. It is also called as pregnancy tumor because of its high frequency of occurrence during the early part of pregnancy. Even though, this lesion is non-neoplastic and treatment procedure is simple, it should be diagnosed correctly before proceeding with the treatment. The most common site for PGs is gingiva (75%) and rarely in the palate. In this case report, we are going to present very rare occurrence of pregnancy tumor in the hard palate.

Management of unusual case of Crocker and Hartzell's disease in a young patient with a 1 year follow-up

Soft tissue enlargements of the oral cavity often present a diagnostic challenge because a diverse group of pathological processes can produce such lesions. Crocker and Hartzell's disease is one of the most common entities responsible for causing soft tissue enlargements. It is a relatively common benign mucocutaneous lesion. Crocker and Hartzell's disease has been referred to by other names such as pregnancy tumour, pyogenic granuloma, granuloma pediculatum benignum, benign vascular tumour and vascular epulis. The incidence is 26.8-32% of all reactive lesions. It is seen mostly in second or third decade of life and commonly seen in women. The most frequently involved site is the maxillary gingiva; other sites are lip, tongue, buccal mucosa and palate. This paper presents a rare case of Crocker and Hartzell's disease found on mandibular anterior gingiva of an 8-year-old male patient.

Reactive lesions of oral cavity: A survey of 100 cases in Eluru, West Godavari district

Aim:

Reactive lesions of the oral cavity are associated with injuries of soft tissue and have high prevalence rates and different involvement patterns in different parts of the world. This study reviews the pathogenesis and analyzes demographic data, histopathological features and compares the clinico-pathologic profiles of the diseases to those previously reported.

Materials and Methods:

Patient records of the Department of Oral Pathology during one and half year period were reviewed for diagnosis of oral connective tissue reactive hyperplastic lesion. Data including the area involved and the type of lesion were collected and analyzed using descriptive statistical methods and ANOVA test.

Results:

100 cases (mean age 36 years, male:female ratio 1:2) matched study criterion. The most common affected site was mandibular anterior region and buccal mucosa and the most common lesion was pyogenic granuloma and focal fibrous hyperplasia. All the lesions were more common in the mandible than in the maxilla. PGCG was seen to be equally distributed in males and females.

Conclusion:

Reactive hyperplastic lesions of the oral connective tissue are more common in females and the majority of the lesions occur in gingiva. This study supports previous assertions that PG and FFH may occur on any oral mucosal site with special preference for the mandibular anterior gingiva and buccal mucosa while PGCG and POF occur exclusively on the mandibular gingiva.

Oral pyogenic granuloma: Various concepts of etiopathogenesis

Pyogenic granuloma or granuloma pyogenicum is a well-known oral lesion. The name pyogenic granuloma is a misnomer since the condition is not associated with pus and does not represent a granuloma histologically. Pyogenic granuloma of the oral cavity is known to involve the gingiva commonly. Extragingivally, it can occur on the lips, tongue, buccal mucosa, palate, and the like. A history of trauma is common in such sites. The etiology of the lesion is not known, though it was originally believed to be a botryomycotic infection. It is theorized that pyogenic granuloma possibly originates as a response of tissues to minor trauma and/or chronic irritation, thus opening a pathway for invasion of nonspecific microorganisms, although microorganisms are seldom demonstrated within the lesion. Pathogenesis of pyogenic granuloma is still debatable. Medline and PubMed databases were searched under the following key terms: Pathogenesis of oral pyogenic granuloma, pyogenic granuloma, and oral pyogenic granuloma. This search was limited to articles on human/animal studies which were published in English language. After reviewing the searched articles, the relevant articles were selected for the present review. Through this article, we have tried to summarize and present all the concepts of pathogenesis related to this most common and most mysterious oral lesion.

Micro-marsupialization as an alternative treatment for mucocele in pediatric dentistry

BACKGROUND

Mucocele is a common oral lesion in children and adolescents. Different techniques have been described for the treatment; however, all of them are invasive.

AIM

This work studied the efficacy of micro-marsupialization for the treatment for mucoceles in paediatric patients.

DESIGN

A retrospective review was performed using the clinical records of patients aged between 0 and 18 years with a clinical diagnosis of mucocele. The following data were obtained: age, gender, location and size of the lesion, duration of mucocele development, and type of treatment and its results.

RESULTS

The mean age of the patients was 11.1 ± 3.95 years. Mucoceles were found in the lower lip (83.7%), buccal mucosa (11.6%), and tongue (4.7%). From the overall cohort of 86 cases, 33 were treated by micro-marsupialization, of which five developed a recurrence that required surgical excision. The other 53 cases were treated by surgical excision, and three of these had recurrent disease. No statistically significant difference was found between the treatment methods.

CONCLUSIONS

Micro-marsupialization can be used to treat mucoceles in paediatric dentistry. It is simpler to perform, minimally invasive, requires no local infiltration of anaesthesia, has a lower postoperative complications rate, and is well-tolerated by patients.

A giant cell fibroma and focal fibrous hyperplasia in a young child: a case report

A case of two fibrotic lesions of the oral mucosa in a 17-month-old African-American female is reported. Both lesions occurred on the anterior maxilla, one lesion pedunculated on the buccal attached gingiva and the other lesion sessile on the palate. Histological examination characterized the buccal lesion as focal fibrous hyperplasia (FFH) and the palatal lesion as a giant cell fibroma (GCF). A case is made for continuing the consideration of GCF as a histologically distinct entity from FFH but that no difference in clinical impact between the two lesions exists.

Nasal papilloma, a rare late complication of tongue flap repair of palatal fistula

The use of a tongue flap for treatment of palatal fistulae is a well-established procedure, but it is not without complication. We report on a patient who underwent palatal fistula closure with tongue flap as a child, who then developed a nasal papilloma from the mucosa of the tongue flap 40 years later. This case is the first of its kind to be reported and emphasizes the need for long-term follow-up because the tongue mucosa is vulnerable to many diseases.

Benign fibrous histiocytoma of the lower lip

Benign fibrous histiocytoma (BFH) is one of the most common tumors of the superficial and deep soft tissues; it is commonly localized on the skin of the extremities and presents as a slow growing solitary nodule, made up of a mixture of fibroblastic and histiocytic cells. To our knowledge, involvement of the soft tissue of the oral cavity is rare. We present a case of BFH of the lower lip in a 61-year-old white woman who presented with a painless, slow-growing lump inside the lower lip. The lesion was surgically removed. Histologically, it was characterized by uniform spindle-shaped cells arranged in a prominent whorled or storiform pattern. Scattered xanthomatous cells, multinucleated giants cells, lymphocytes, and deposits of hemosiderin were noted throughout the lesion. This rare tumor should be considered in the differential diagnosis of the oral soft-tissue neoplasms.

CO2 laser-assisted treatment of a giant pyogenic granuloma of the gingiva

BACKGROUND

Pyogenic granuloma (PG) may develop in the oral cavity of pregnant women. The periodontal treatment outcomes during and after pregnancy are described.

METHODS

A 34-year-old woman in the 39th week of pregnancy presented for surgical treatment with a mass on the lingual mandibular gingiva. She had been surgically treated alio loco in the 37th week, but this failed. The patient was reassured and an individual oral hygiene programme was initiated in our department. The tumour was about 20 mm in diameter. A CO(2) laser-assisted surgical excision was performed 4 weeks after delivery. The lesion was analysed histopathologically using a von Willebrand Factor immunoreactivity staining. The highly vascularized tissue with a dense inflammatory infiltrate was in accordance with the diagnosis of a PG.

RESULTS

The initial wound healing was uneventful. A 12-month follow-up revealed no recurrence of the mass and healthy periodontal tissues.

CONCLUSION

This report describes an oral complication during pregnancy for which surgical excision of a PG after delivery seemed the best treatment. It is possible that gender-specific periodontal disease risk factors contributed to the development of the lesion. This is another reason why pregnant women should be encouraged to be assessed by oral health professionals before late pregnancy.

Benign lip lesions. A 10-year retrospective study

OBJECTIVES

This paper aims to present a retrospective analysis of a cohort of patients with benign lip lesions managed over the last decade at the Department of Maxillofacial Surgical Oncology of Theagenio Cancer Hospital of Thessaloniki. It aims to highlight the substantial clinical and histological diversity of the lesions, as well as to present an epidemiological analysis for the specific cohort/population.

STUDY DESIGN

During the period 1995-2004 a total of 420 patients were managed for lip lesions. Of these, 280 were malignant and 116 benign. A total of 24 cases of actinic keratosis were added in the latter group.

RESULTS

Of the benign lesions, the commonest were haemangiomas (19.28%), actinic keratosis (17.14%), intradermal naevus (14.28%), fibroma (9.28%), papilloma (7.85%), mild and moderate dysplasia (7.85%) and mucocele (7.14%). The group included 17 different histological types of benign lesions. The most frequent site of presentation was the lower lip (56.42%). Post-operative follow-up ranged from 6 months to 2 years (average 15.5 months). There was a single case of recurrence during follow-up.

CONCLUSIONS

Benign lip lesions do not usually pose a problem for the clinician and their surgical management is straightforward. Accurate auditing and detailed statistical analysis aid in disease prevention and help avoid errors in diagnosis and management.

Oral pyogenic granuloma: a retrospective analysis of 293 cases in a Brazilian population

PURPOSE

The purpose of this study was to retrospectively analyze the clinical, demographic, and pathologic properties of oral pyogenic granuloma occurring in a Brazilian population.

PATIENTS AND METHODS

We retrieved an archival number of 293 cases that were diagnosed as having oral pyogenic granuloma at the Service of Pathological Anatomy, Discipline of Oral Pathology, Department of Dentistry, Federal University of Rio Grande do Norte, Natal, Brazil, during a 38-year period, from 1970 to 2008. The records were reviewed, and information on gender, age, race, lesion site, predisposing factors, clinical features, and clinical diagnosis, treatment, and recurrence was collected.

RESULTS

There was a female predilection, and the female-to-male ratio was 2.38:1. The mean age of the patients was 27 years. A high degree of occurrence was observed in the second decade of life. White patients were most commonly affected (44.7%). The most frequently involved site was the gingiva (83%), with a higher prevalence in the maxilla. The majority of cases were symptomatic and showed bleeding; the lesions were described as nodules (71.9%) with a soft consistency (62.3%) and a red surface (73.2%). The base was pedunculated in 61.1% of cases, and the mean size was 1.3 cm. The recurrence rate was 8.2% of cases.

CONCLUSION

The clinical, demographic, and pathologic features of oral pyogenic granuloma in the Brazilian population in this study were similar to those in studies of populations from other countries.

Giant intramuscular lipoma of the tongue: a case report and literature review

We herein report a rare case of giant intramuscular lipoma of the tongue. A 75-year-old Italian male presented at our department with a large tumor at the tip of the tongue that had been present for over 30 years. Clinical examination revealed a yellowish lesion, measuring 10 cm in maximum diameter, protruding from lingual surface. Histological examination showed an unencapsulated lipomatous tumor composed of mature adipocytes, uniform in size and shape, diffusely infiltrating striated muscle fibers of the tongue. The patient is well with no local recurrence after a 15-month follow-up period.

Giant intramuscular lipoma of the tongue: a case report and literature review

We herein report a rare case of giant intramuscular lipoma of the tongue. A 75-year-old Italian male presented at our department with a large tumor at the tip of the tongue that had been present for over 30 years. Clinical examination revealed a yellowish lesion, measuring 10 cm in maximum diameter, protruding from lingual surface. Histological examination showed an unencapsulated lipomatous tumor composed of mature adipocytes, uniform in size and shape, diffusely infiltrating striated muscle fibers of the tongue. The patient is well with no local recurrence after a 15-month follow-up period.

Oral viral infections and the therapeutic use of antiviral agents in dentistry

This paper reviews the current concepts of viral classification, infection and replication. The clinical presentation of common oral viral infections encountered in the dental practice are discussed, including: herpes simplex virus types 1 and 2; Epstein-Barr virus; varicella-zoster virus; Coxsackie virus; human papilloma virus; and human immunodeficiency virus. The diagnosis, principles of management and pharmacological agents available for the treatment of oral viral infections are also discussed.

Oral pyogenic granuloma: a review

Pyogenic granuloma is one of the inflammatory hyperplasias seen in the oral cavity. This term is a misnomer because the lesion is unrelated to infection and in reality arises in response to various stimuli such as low-grade local irritation, traumatic injury or hormonal factors. It predominantly occurs in the second decade of life in young females, possibly because of the vascular effects of female hormones. Clinically, oral pyogenic granuloma is a smooth or lobulated exophytic lesion manifesting as small, red erythematous papules on a pedunculated or sometimes sessile base, which is usually hemorrhagic. The surface ranges from pink to red to purple, depending on the age of the lesion. Although excisional surgery is the treatment of choice for it, some other treatment protocols such as the use of Nd:YAG laser, flash lamp pulsed dye laser, cryosurgery, intralesional injection of ethanol or corticosteroid and sodium tetradecyl sulfate sclerotherapy have been proposed. Because of the high frequency of pyogenic granuloma in the oral cavity, especially during pregnancy, and necessity for proper diagnosis and treatment, a complete review of published information and investigations about this lesion, in addition to knowledge about new approaches for its treatment is presented.