Case Report An Unusually Large Irritation Fibroma ... · Case Report An Unusually Large Irritation...

Case ReportAn Unusually Large Irritation Fibroma Associated with Gingivaof Lower Left Posterior Teeth Region

Ashish Lanjekar, Sunita Kulkarni, Sonali Akhade, Sonal Sonule, and Usha Rathod

Department of Oral Medicine and Radiology, Swargiya Dadasaheb Kalmegh Smruti Dental College & Hospital, Nagpur, India

Correspondence should be addressed to Sonali Akhade; [email protected]

Received 30 July 2016; Accepted 16 October 2016

Academic Editor: Paolo Giacomo Arduino

Copyright © 2016 Ashish Lanjekar et al.This is an open access article distributed under theCreativeCommonsAttribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Fibroma is a benign tumor of oral cavity, with usually the tongue, gingiva, and buccalmucosa being themost common sites. Femalesare twice more likely to develop fibroma than males. The intraoral fibroma typically is well demarcated; and its size can vary frommillimeter to few centimeters. Intraorally the growth is attached to the mucosa by means of a peduncle. Fibroma is generally slowgrowing, painless, smooth surface lesion and the color is slightly paler than the adjacent healthy tissue. Treatment usually requirestotal excision and recurrence is rare. Here we present a case of 37-year-old female patient reported to the Department of OralMedicine and Radiology with the chief complaint of a growth in the lower left posterior teeth region 3 months earlier.

1. Introduction

Intraoral localized reactive lesions occurring on the gingivaare common which include irritation/traumatic fibroma,peripheral ossifying fibroma, focal fibrous hyperplasia, pyo-genic granuloma, inflammatory hyperplasia, and peripheralgiant cell granuloma [1]. Irritation fibroma is the mostcommon response of submucosa secondary to trauma fromteeth or dental prosthesis. First case of intraoral fibromawas reported in 1846 called fibrous polyp and polypus [2].Fibroma of gingiva is clinically presented as slow grow-ing, well-demarcated growth, usually with normal coloredmucosa and smooth surface, sessile or pedunculated base,and hard consistency [3], causing difficulty in masticationand speech. The size of the growth is generally smaller than1.5 cm [4], although there are few reports of 4–6 cm [5].Irritation fibroma is most commonly prevalent in anteriorregion and usually associated with interdental papilla. Casesin the posterior teeth region are rare in the literature. Thispaper reports the case of irritation fibroma of 37-year-oldfemale associated with gingiva of lower left posterior teethregion.

2. Case Report

2.1. Clinical Examination. A 37-year-old female patient wasreported to the Department of Oral Medicine and Radiologywith the chief complaint of a growth in the lower left posteriorteeth region 3 months earlier. She was apparently alright3 months back when she experienced food lodgment andpain in the area of chief complaint when she was usingtooth pick to remove the lodged food particles. She noticedsometimes bleeding after using toothpick. After few days shenoticed a small pea sized growth in the region. The growthprogressively increased to present size with no history of painbleeding and paresthesia. She gives exfoliation of one toothduring the period of enlargement of the growth.The medicalhistory was not contributory.

Intraoral clinical examination revealed a well-defined,exophytic, multilobulated growth over themandibular alveo-lar ridge in region of lower left first molar, measuring approx-imately 5 cm × 4 cm × 3 cm in size, extending mesiodistallyfrom mesial surface left lower canine up to the distal surfaceof lower left second molar. Surface of the lesion was smooth,shiny, andwith normal color of oralmucosa (Figures 1 and 2).

Hindawi Publishing CorporationCase Reports in DentistryVolume 2016, Article ID 5202181, 4 pageshttp://dx.doi.org/10.1155/2016/5202181

2 Case Reports in Dentistry

Figure 1: Intraoral preoperative lesion.


Small ulcerative lesion was seen on the buccal aspect of thegrowthmeasures approximately 1 cm× 2 cm in diameter (Fig-ure 3).Thegrowthwas firm in consistency,with pedunculatedbase, nontender, and noncompressible on palpation, no bruitor pulse was felt, temperature was not raised, and it wasmovable over the peduncle. On the basis of history clinicalpresentation a provisional diagnosis of irritation fibroma wasgiven.

2.2. Investigations. Orthopantomograph was obtained. Theradiographic examination shows the missing left lower firstmolar, mesially displaced, and floating tooth appearance withlower left first and second premolars. There is generalizedbone loss in interdental region suggestive of generalizedmoderate periodontitis. No radiographic abnormality wasdetected in the bone related to the region associated with thelesion (Figure 4).

Routine hematological examinations including hemo-gram, blood sugar level, HBsAg, and HIV screening testswere found to be within normal physiological limits. Thehistopathological report of incisional biopsy (Figure 5) showsconnective tissue mass lined by parakeratinized stratifiedsquamous epithelium of variable thickness. Some parts of tis-sue showmyxoid areas with delicate fibers and stellate shapedcells; multinucleated giant cells are also visible (Figure 6).


Figure 4: Orthopantomograph.

Figure 5: Incisional biopsy.

Case Reports in Dentistry 3

Figure 6: Histopathology.

2.3. Diagnosis. The differential diagnosis consisted of pyo-genic granuloma, periapical giant cell granuloma, aggres-sive gingival fibromatoses, odontogenic myxoma, periapicalodontogenic fibroma, and giant cell fibroma.These outcomeswere discussed with the patient in an attempt to alleviate fearof carcinoma. Thus, a final diagnosis was considered as anirritation fibroma.

2.4. Treatment. The lower first and second molars were ex-tracted. Total surgical excision of the lesion under localanesthesia and aseptic conditions was done. It was followedup after 8 days showing healing at surgical site of excision(Figure 7).

3. Discussion

Inflammatory hyperplasia is different from irritation fibromathat histologically represents inflamed fibrous tissue alongwith granulation tissue [6, 7]. Reactive hyperplastic massesvary in size and depend upon the inflammatory components.Similar gingival lesions are often referred to as an epulis[6, 8]. Irritation fibroma developsmore commonly in femalesthan in males. It develops frequently between second andfourth decades of life.Thehigh female predilection and a peak

Figure 7: Eight-day postoperative photograph.

occurrence in the second decade of life suggested hormonalinfluences.

Approximately 60% of irritation fibromas occur in themaxilla and they are found more often in the anterior region,with 55–60% presenting in the incisor-cuspid region, rare inposterior region [9], but in our case the fibroma is presentin posterior region of mandible. It is usually reported withthe diameter of 1.5 rarely reaching 3 cm; very few case reportsare present in the literature with the lesion measures about6–9 cm [10]. The present case was of 5 cm × 4 cm × 3 cm indiameter with ulcerated surface.

Histopathologically, irritation fibroma can appear as anintact or ulcerated stratified squamous epithelium along withshortening and flattening of rete pegs. Treatment of irritationfibroma consists of elimination of etiological factors, scalingof adjacent teeth, and total aggressive surgical excisionalong with involved periodontal ligament and periosteumto minimize the possibility of recurrence. Any identifiableirritant such as an ill-fitting dental appliance and roughrestoration should be removed [10]. Long-term postoperativefollow-up is extremely important because of the high rate ofreoccurrence of incompletely removed lesion.

Competing Interests

The authors declare that they have no competing interests.

References

[1] L. R. Eversole and S. Rovin, “Reactive lesions of the gingiva,”Journal of oral pathology, vol. 1, no. 1, pp. 30–38, 1972.

[2] J. Tomes, “A course of lectures on dental physiology and surgery(lectures I–XV),” American Journal of Dental Science, vol. 7, pp.1–68, 1846.

[3] J. C. Baumgartner, H. R. Stanley, and J. L. Salomone, “Zebra VI,part 2,” Journal of Endodontics, vol. 17, no. 4, pp. 182–185, 1991.

[4] Y. Kfir, A. Buchner, and L. S. Hansen, “Reactive lesions of thegingiva: a clinicopathological study of 741 cases,” Journal ofPeriodontology, vol. 51, no. 11, pp. 655–661, 1980.

4 Case Reports in Dentistry

[5] F. Kendrick and W. F. Waggoner, “Managing a peripheralossifying fibroma,” Journal of Dentistry for Children, vol. 63, no.2, pp. 135–138, 1996.

[6] L. K. Mathur, A. P. Bhalodi, B. Manohar, A. Bhatia, N. Rai,and A. Mathur, “Focal fibrous hyperplasia: a case report,” Inter-national Journal of Dental Clinics, vol. 2, no. 4, 2010.

[7] H. Jafarzadeh, M. Sanatkhani, and N. Mohtasham, “Oral pyo-genic granuloma: a review,” Journal of Oral Science, vol. 48, no.4, pp. 167–175, 2006.

[8] R. I. Macleod and J. V. Soames, “Epulides: a clinicopathologicalstudy of a series of 200 consecutive lesions,” British DentalJournal, vol. 163, no. 2, pp. 51–53, 1987.

[9] U. M. Das and U. Azher, “Peripheral ossifying fibroma,” Journalof Indian Society of Pedodontics and Preventive Dentistry, vol. 27,no. 1, pp. 49–51, 2009.

[10] H. Bagde, A. Waghmare, B. Savitha, and P. Vhanmane, “Irri-tation fibroma—a case report,” International Journal of DentalClinics, vol. 5, no. 1, pp. 39–40, 2013.

Submit your manuscripts athttp://www.hindawi.com

Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014

Oral OncologyJournal of

DentistryInternational Journal of



International Journal of

Biomaterials


BioMed Research International


Case Reports in Dentistry


Oral ImplantsJournal of


Anesthesiology Research and Practice


Radiology Research and Practice

Environmental and Public Health

Journal of


The Scientific World JournalHindawi Publishing Corporation http://www.hindawi.com Volume 2014


Dental SurgeryJournal of

Drug DeliveryJournal of



Oral DiseasesJournal of


Computational and Mathematical Methods in Medicine

ScientificaHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014

PainResearch and TreatmentHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014

Preventive MedicineAdvances in


EndocrinologyInternational Journal of



OrthopedicsAdvances in

Case Report An Unusually Large Irritation Fibroma ... · Case Report An Unusually Large Irritation...

Documents

Transcript of Case Report An Unusually Large Irritation Fibroma ... · Case Report An Unusually Large Irritation...