A Gray-purple Mass on the Floor of the Mouth: Gigantic Mucogingival Pyogenic Granuloma in a Teenage Patient

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.

Expansive Oral Giant Cell Granuloma in a Pediatric Patient

Aim

This article describes a peripheral oral giant cell granuloma (POGCG) in a pediatric patient and its surgical management and histological characteristics.

Background

Peripheral oral giant cell granuloma (POGCG) is a hyperplastic reactive lesion formed by a proliferation of mononuclear cells and osteoclast-type giant cells in vascular tissue, occasionally with bone formation. Generally found in women and adults, POGCG has rarely been described in children.

Case description

An 8-year-old girl was consulted for an exophytic lesion in the anterior area of the upper jaw, which had increased in volume in the preceding weeks. An excisional biopsy of the tumor was performed with an electrosurgical pencil. The pathological diagnosis was POGCG.

Conclusion

Excision followed by additional therapy, such as scaling and curettage, should be the first option in the treatment of POGCG.

Clinical significance

Early detection of these lesions involving the periodontium is important in order to reduce bone loss and avoid pathological dental migration.

How to cite this article

Cahuana-Bartra P, Brunet-Llobet L, Suñol-Capella M, et al. Expansive Oral Giant cell Granuloma in a Pediatric Patient. Int J Clin Pediatr Dent 2023;16(2):405-408.

Extragingival pyogenic granuloma of the lower lip masquerading as a vascular lesion

Pyogenic granuloma (PG) is a benign nonneoplastic mucocutaneous lesion. It occurs as a result of chronic irritation or due to hormonal changes. The most favorable site for this fairly common lesion is gingiva, but rarely, it can occur outside the oral cavity, later often difficult to diagnose, as a diverse group of the pathologic process can produce such lesions outside the oral cavity. The diagnosis is also challenging as the lesions appear as smooth or lobulated red nodules with easy bleeding, occasionally ulcerated mimicking malignancies. The purpose of this article is to report a rare case of extragingival PG of the lower lip simulating as a vascular lesion in young male of 30 years old diagnosed by ultrasound followed by histopathological examination.

Pyogenic granuloma of the upper lip: A common lesion in an uncommon location

Pyogenic granuloma is a non-neoplastic reactive lesion that commonly occurs in gingiva. It is rarely found in other locations such as the lips, tongue, palate and buccal mucosa. Lesions affecting the upper lip are even rarer and very few cases have been reported in the literature. In such situations, the lesion may mimic other conditions such as minor salivary gland tumours, mesenchymal tumours, and infectious lesions, which may create diagnostic difficulty. This case report describes an uncommon location of pyogenic granuloma occurring on the upper lip in a 49-year-old male patient.

The Periodontium as a Potential Cause of Orofacial Pain: A Comprehensive Review

Introduction:

Orofacial pain of periodontal origin has a wide range of causes, and its high prevalence and negative effect on patients' quality of life make intervention mandatory. This review provides a periodontological overview of the field of orofacial pain, focusing on the entities which involve the periodontal tissues and may be the cause of this pain or discomfort.

Methods:

The study comprised a literature search of these pathologies conducted in the MEDLINE/PubMed Database. Acute infectious entities such as gingival and periodontal abscesses are emergencies that require a rapid response. Periodontitis associated with endodontic processes, necrotizing periodontal disorders, desquamative gingivitis, gingival recession, and mucogingival herpetic lesions, cause mild to severe pain due to tissue destruction and loss. Other lesions that lead to periodontal discomfort include gingival enlargement and periodontal ligament strains associated with occlusal trauma, parafunctional habit and the impaction of food or foreign bodies.

Conclusion:

A range of therapeutic, pharmacological and surgical alternatives are available for the management of these injuries. However, the wide variety of causes of orofacial pain or periodontal discomfort may confuse the clinician during diagnosis and may lead to the wrong choice of treatment.

Cystic mass of the floor of the mouth

Background

Epidermoid and dermoid cysts in the oral cavity are relatively uncommon lesions of developmental origin. They often remain asymptomatic for years until they grow enough to interfere with speech, deglutition and less often with breathing which can pose a critical risk to the airway and require immediate surgery.

Case description

A case of an epidermoid cyst of the floor of the mouth affecting a 37-year-old man is presented; this lesion was surgically enucleated with an intraoral approach. Patient did well postoperatively and there was no evidence of recurrence up to 2 years of follow up.

Clinical implications

Floor of the mouth is a challenging site for the diagnosis of a broad variety of lesions which the surgeon should be aware. Depending on the anatomical relation to the muscles of the floor of the mouth dermoid cysts are classified as supramylohyoid or inframylohyoid, and they will both have different clinical and radiological features. This article also includes literature review about the etiopathological, clinical, radiological and histological features, the differential diagnosis and its treatment.

Key words:Epidermoid cyst, dermoid cyst, floor of mouth.

Correlation of Age, Sex, and Location With Recurrence of Oral Giant Pyogenic Granuloma After Surgical Excision

OBJECTIVES

This study was carried out to correlate age and sex of the patient as well as location of the oral giant pyogenic granuloma (PG) with the recurrence rate after surgical excision.

METHODS

Seventy-two patients having oral giant PGs were treated by a conservative surgical excision. Information on sex, age, lesion site, and recurrence was collected. Data were reviewed and analyzed to correlate the recurrence rate with sex and age of the patient as well as the location of the lesion.

RESULTS

Recurrence of the oral giant PG was occurred in 22.2% of patients. The highest rates of recurrence were observed in the third (33.3%) and fourth (19%) decades of life. The recurrence rate was more common in females (24%) than males (18.2%) and it was predominant in mandibular lesions (25%) than maxillary one (8.3%).

CONCLUSIONS

On the basis of their results the authors concluded that recurrence of oral giant PG has an obvious correlation with age and sex of the patient as well as location of the lesion.

Dental root elevator embedded into a subgingival caries: a case report

Background

Breakage of surgical instruments is a rare complication. A mistake in operator technique or sub-standard/aged tools could lead to this type of accident. A tooth elevator is an instrument used in minor oral surgical procedures to luxate the tooth or fractured root from its socket. The authors have not found any previously published cases reporting the breakage of a tooth elevator tip which then remained as a foreign body in a hidden caries cavity.

Case presentation

A 28-year-old African black male was referred to a hospital in Tanzania for an intraoral radiography. The patient explained that six months previously his mandibular left third molar had been extracted. Whilst the healing process had been satisfactory, he had recently experienced acute oral pain in this region. The dental X-ray showed an image consistent with a piece of broken metal embedded in a distal subgingival caries at the mandibular left second molar.

Conclusion

Oral and dental surgeons should take particular care when employing metal instruments with strong force in poorly visible areas. A radiographic study should be carried out when instrument breakage occurs. If an unexpected accident takes place during a surgical procedure, the patient must be informed in accordance with ethical codes, and suitable measures adopted to resolve the issue.