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Table of Contents   
SHORT COMMUNICATION  
Year : 2012  |  Volume : 23  |  Issue : 5  |  Page : 677-679
Peripheral fibroma obstructing the eruption pathway


1 Department of Prosthodontics, Triveni Institute of Dental Sciences and Research Centre, Bilaspur, Chhattisgarh, India
2 Department of Pediatric and Preventive Children Dentistry, Triveni Institute of Dental Sciences and Research Centre, Bilaspur, Chhattisgarh, India
3 Department of Orthodontics and Dentofacial Orthopedics, Triveni Institute of Dental Sciences and Research Centre, Bilaspur, Chhattisgarh, India
4 Department of Oral and Maxillofacial Surgery, Bhavnagar Dental College and Hospital, Bhavnagar, Gujurat, India

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Date of Submission01-Jun-2010
Date of Decision23-Sep-2011
Date of Acceptance23-Mar-2012
Date of Web Publication19-Feb-2013
 

   Abstract 

Reactive hyperplasias comprise a group of fibrous connective tissue lesions that commonly occur in oral mucosa secondary to injury. Peripheral fibroma is also a type of reactive hyperplasia. Peripheral fibroma is a reactive hyperplastic mass that occurs on the gingiva and is derived from connective tissue of the submucosa or periodontal ligament. It may occur at any age, although it does have a predilection for young adults. Females develop these lesions more commonly than do males. Here, we are presenting a case report of a child who is 6 years old and presented to us with a swelling in the lower anterior region which was providing discomfort to the child and also was obstructing the eruption pathway of the permanent central incisor in the region. The lesion was surgically excised.

Keywords: Gingiva, hyperplasias, peripheral fibroma

How to cite this article:
Shetty P, Padmanabhan V, Kavitha P R, Thomas H. Peripheral fibroma obstructing the eruption pathway. Indian J Dent Res 2012;23:677-9

How to cite this URL:
Shetty P, Padmanabhan V, Kavitha P R, Thomas H. Peripheral fibroma obstructing the eruption pathway. Indian J Dent Res [serial online] 2012 [cited 2019 Jul 19];23:677-9. Available from: http://www.ijdr.in/text.asp?2012/23/5/677/107397
Reactive hyperplasias comprise a group of fibrous connective tissue lesions that commonly occur in oral mucosa secondary to injury. [1] Peripheral fibroma is also a type of reactive hyperplasia. As a group, reactive hyperplasias present as submucosal masses that may become secondarily ulcerated when traumatized during mastication. Their color ranges from lighter than the surrounding tissue (because of a relative increase in collagen) to red (because of an abundance of well-vascularized granulation tissue). Because nerve tissue does not proliferate with the reactive hyperplastic tissue, these lesions are painless. Treatment is generally surgical excision and removal of the irritating factor(s). [2],[3],[4]

Very rarely, literature has reported on the presence of hyperplastic lesions like peripheral fibromas in children and especially associated with the primary dentition. In this article, we present a case of peripheral fibroma, a type of reactive hyperplasia in a 6-year-old female child.


   Case Report Top


A 6-year-old girl, along with her parents, reported to our department for treatment, with the chief complaint, as presented by the parents, being discomfort to the child in the lower anterior region since some months. A swelling was seen in the mandibular anterior gingival area in relation to the 81, 82 and 83 region [Figure 1]a and b. The history of the swelling was as follows. It was present for 2-3 years; it began as a small nodule and was constantly growing in size though no proper etiology could be derived, except that it was a swelling which came in the path of mastication and it had reached the present size may be due to repeated trauma. The parents did not consult anywhere else as the lesion was painless and small in size; it was only since a year that it was gaining in size and reached these dimensions.
Figure 1: The patient with certain disfigurement on her right side of the face

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On extraoral examination, there was a definite disfigurement of the face on the right side. The lips were also incompetent owing to the large size of the lesion [Figure 1]a

On intraoral examination, the swelling was seen to extend from 81 to 83 region, both labially and lingually [Figure 1]b. It was a pedunculated lesion with a color similar to the surrounding tissue. The swelling had an irregular surface and showed no ulcerations and was not tender but was definitely causing discomfort in terms of mastication, esthetics and speech to the child due to its large size. The intraoral periapical radiograph (IOPA) [Figure 2] showed radiolucency over the 81 region.
Figure 2: The figure shows the peripheral fibroma on the anterior mandibular region

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Treatment plan

Though the lesion was asymptomatic, considering its size and the discomfort the child was going through, we decided to surgically excise the lesion with the consent of the parents.

The procedure of surgical excision was carried out in our department under local anesthesia after getting the consent of the Pediatrician and the Hematologist. The mass was excised uneventfully. The size of the mass was around 20 mm [Figure 3]. The soft tissue mass was also found to contain the deciduous central incisor inside it; the deciduous lateral incisor fell off the mass during the excision [Figure 4]. The site was sutured and the patient was recalled after a week. The healing was uneventful and no complications were reported. In the first week postoperative recall visit [Figure 5], we could see the erupted permanent central incisor, the eruption pathway of which was otherwise blocked by the lesion [Figure 6]. The child is kept on periodic follow-up and is taken up for other preventive oral hygiene procedures.
Figure 3: The IOPA showing the presence of the erupting central and lateral incisor covered by the soft tissue radiolucency but there is no evidence of the presence of the deciduous central and lateral incisorsj

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Figure 4: The excised lesion measured approximately 20mms in size

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Figure 5: 1 week postoperative. The permanent central has erupted; the adjacent central incisor is yet to erupt

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Figure 6: The excised lesion showed the embedded deciduous central incisor

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   Discussion Top


Fibroma is the most common tumor of the oral cavity. However, it is doubtful whether it represents a true neoplasm in most instances; rather, it is a reactive hyperplasia of fibrous connective tissue in response to local irritation or trauma. [5],[6]

Peripheral fibroma presents clinically as either a pedunculated or a sessile mass that is similar in color to the surrounding tissue. Ulceration may be noted at times over the summit of the lesion. It rarely causes erosion of the subjacent alveolar bone. [4]

In this case also, the condition looks like to have risen from some kind of chronic irritation at the site. Neither the lesion showed any ulceration nor was any erosion of the subjacent bone present.

The histological features of the lesion reported are typical of any fibroma, consisting of bundles of interlacing collagenous fibers interspersed with varying numbers of fibroblasts or fibrocytes and small blood vessels.

The management of peripheral fibroma or, for that matter, any kind of reactive hyperplasia should be local surgical excision. Also, any identifiable etiological agent, such as calculus or other foreign material, should be removed. Recurrence may occur if the etiologic agent is not removed completely. [6] In our case, with the eruption of the central incisor already having taken place, the chances of recurrence if any look obsolete.

 
   References Top

1.Barker DS, Lucas RB. Localized fibrous overgrowths of the oral mucosa. Br J Oral Surg 1967;5:86-92.  Back to cited text no. 1
[PUBMED]    
2.Barnes L. Tumors and tumor like lesions of the soft tissues. In: Barnes L, Surgical pathology of the head and neck. New York: Marcel Dekker; 1985. p. 725-80.  Back to cited text no. 2
    
3.Alawi F, Stratton D, Freedman PD. Solitary fibrous tumor of the oral soft tissues: A clinicopathologic and immunohistochemical study of 16 cases. Am J Surg Pathology 2001;25:900-10.  Back to cited text no. 3
[PUBMED]    
4.Regezi JA, Sciubba JJ, Jordan RC. Oral pathology: Clinical Pathologic Correlations. 4 th ed. St Louis, Missouri: Saunders Publications; 2003. p. 158-9.  Back to cited text no. 4
    
5.Cuisia ZE, Brannon RB. Peripheral Ossifying fibroma- A clinical evaluation of 134 Pediatric Cases. Pediatr Dent 2001;23:245-8.  Back to cited text no. 5
[PUBMED]    
6.Kendrick F, Waggoner WF. Managing a peripheral ossifying fibroma. ASDC J Dent Child 1996;63:135-8.  Back to cited text no. 6
[PUBMED]    

Top
Correspondence Address:
Vivek Padmanabhan
Department of Pediatric and Preventive Children Dentistry, Triveni Institute of Dental Sciences and Research Centre, Bilaspur, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.107397

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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