IJCRR - Vol 09 Issue 06, March
Date of Publication: 31-Mar-2017
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A Rare Occurrence of Traumatic Fibroma with Secondary Ulceration in a Two Year Old Child: A Case Report
Author: Tanvi Sethi Sahani, Umesh Chandra Chaudhary, Nitin Singh, Archana Malviya, Mobeen Khan, Nazish Akhter
Abstract:Reactive overgrowths are relatively common lesions that occur in response to irritation in the oral cavity but have been reported to be extremely rare in the first decade of life. Here we report an uncommon interesting case of Irritation fibroma occurring in a 2-year-old male child following a traumatic injury to maxillary anterior region.
Keywords: Irritational fibroma, Traumatic irritants, Sessile growth, Surgical excision
Inflammatory hyperplastic lesion may be defined as “an increase in the size of an organ or tissue due to an increase in the number of constituent cells, as a local response of tissue to injury”. The traumatic irritants include calculi, overhanging margins, restorations, foreign bodies, chronic biting, margins of caries, and sharp spicules of bones and overextended borders of appliances. Fibrous hyperplasia (Traumatic or Irritation fibroma) is the healed end product of the inflammatory hyperplastic lesion1. Clinically they appear either as pedunculated or sessile growth on any surface of the mucous membrane and smaller than 1.5 cm at its largest diameter, though there have been reports of a 4-6 cm injury. Its occurrence is reported to the anterior maxillary, more precisely in the interdental papilla. Other common sites are the buccal mucosa along the bite line, labial mucosa, tongue and gingiva. They do not have malignant potential and recurrences are mostly as a result of failure to eliminate the chronic irritation involved.2
There are relatively few reports in the literature regarding oral mucosal conditions in children.3 Short-term institutional studies by Mathew et al have shown no incidence of irritation fibroma in the age group of 2-20 years.4 It is extremely rare during the first decade of life.5
Herein, we report an uncommon interesting case of Fibroma occurrence in the Maxillary Anterior region associated with trauma to the same region in a 2 year old child. The patient had fallen down while playing about three weeks back and fractured his Deciduous maxillary anterior teeth. Subsequently a growth engulfing the left maxillary incisor developed which was painful and was interfering in the feeding of the child. On Intra oral examination a rounded, sessile, well-demarcated mass of diameter 1.5×1.5 cm completely enclosing fractured Maxillary Left Deciduous Incisor was found. Its surface was smooth and it had normal mucosa colour with secondary ulceration from recurring trauma (from the mandibular deciduous teeth) visible. It was tender on palpation. (Fig 1) The case was planned under general anaesthesia as the child was in pre-cooperative stage. The lesion was completely excised using scalpel. (Fig 2) Maxillary left Deciduous Incisor was extracted as fracture line extended subgingivally and the remaining tooth structure was not sufficient to support a coronal restoration. Also in the present case, the ragged margins of the fractured tooth was the probable causative irritant which enabled the lesion to grow.Suturing of the region was done with 3-0 black silk suture and Partial Pulpectomy was done for the Maxillary Right Central Incisor followed by composite build up. (Fig 3) The tissue was sent for histological examination, and was diagnosed as irritation fibroma. Histologically, Fibroblasts were scattered in a dense, collagenous matrix. A mild chronic, inflammatory infiltrate was present but this was not a consistent finding.(Fig 4) Follow up of the patient was done at regular intervals and at the end of one year the area present with fibroma had healed without any recurrences.
The clinical features of Irritation Fibroma are not unique and the differentiation of these lesions should be made from Peripheral ossifying fibroma, Pyogenic granuloma or Peripheral giant cell granuloma. When treatment is required, the only option is surgical excision of the fibroma with narrow margins. Overall prognosis of Irritation Fibroma is usually good; they commonly do not recur when the source of irritation is removed. It is therefore important to manage the source of the irritation. These lesions although benign are usually excised to rule out the fear of malignancies in the patients.
Inflammatory hyperplastic lesion is an increase in the size of an organ or tissue. This is mainly due to an increase in the number of constituent cells. They mainly occur in the local response of tissue to injury. The common traumatic irritants are calculi, overhanging restorations, foreign bodies and chronic biting. They appear either as pedunculated or sessile growth. The main line of treatment is removal of irritants along with the surgical excision of the fibroma. Overall prognosis is good.
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
- Wood NK, Goaz PW (5th ed) Differential diagnosis of oral and maxillofacial lesions. Missouri: Mosby, 2006:136-8.
- Delaney JE, Keels MA. Pediatric Oral Pathology: Soft Tissue and Periodontal Conditions. Paediatr Clin North Am 2000;47(5):1125-47.
- Majorana A, Bardellini E, Flocchini P, Amadori F, Conti G, Campus G. Oral mucosal lesions in children from 0 to 12 years old: ten years’ experience. Oral Surg Oral Med Oral Pathol Oral Radiol Endod2010;110:13-18.
- Mathew AL, Pai KM, Sholapurkar AA, Vengal M. The prevalence of oral mucosal lesions in patients visiting a dental school in southern India. Indian J Dent Res 2008;19:99-103.
- Barker DS, Lucas RB. Localized fibrous overgrowth of the oral mucosa. Br J Oral Surg 1967;5:86-92.