1. Oral Medicine Case
Presentation
by
Waad Khayat

2. Personal Data:
• Age: 49 years.
• Sex: female.
• Status: married.
• Nationality: Egyptian.
• Occupation: housewife.

3. Patient’s History:
• Chief Complaint:
The patient wants orthodontic treatment.
An exophytic lesion was shown on examination.
• Medical History:
Insignificant.
• Family History:
Insignificant.
• Dental History:
History of car accident 15 years ago
Injury to buccal mucosa Suturing.

4. Clinical Examination:
Extra Oral Examination:
• General Appearance:
• Face:
• Hair:
• Eyes:
• Nose: Insignificant for
• Ears: any abnormality
• Lip:
• Lymph nodes:
• Salivary glands:
• TMJ: clicking.

5. Clinical Examination:
Intra Oral Examination:
• Buccal mucosa:
1-scar on.
2-exophytic lesion.
• Teeth:
1- large diastema.
2- over erupted #11.
3- RCT #17, 27.
4- caries #18, 47.
5- Amalgam restoration # 37.
• Hard palate:
• Soft palate: insignificant
• Floor of the mouth:
• Tongue:

6. Radiographic examination:

7. The Exophytic Lesion:
• History:
-Painless ,present more
than 10 years.
-No size changes, no
bleeding or ulceration.
• Site: solitary, anterior
area of left buccal mucosa.
• Size: 8 mm.
• Shape: sessile.
• Texture: smooth.
• Color: pale pink.
• Consistency: firm.

8. Diagnosis:
Differential Diagnosis:
• Irritational fibroma.
• Fibroepithelial polyp.
• Pyogenic granuloma.
• Firm minor salivary gland tumor.
Prognosis:
• good.

9. Pale pink
Small
Smooth
Firm
Painless
Buccal mucosa
Female 4th
decade
Irritational
fibroma
Fibroepithelial
polyp
Pyogenic
granuloma
)late stage(
Firm minor
Salivary gland
tumor
-High incidence
in oral cavity.
-Most common site
is buccal mucosa
)biting line(.
-Most common site
is gingiva.
-history of trauma
for extragingival.
-Ulcerated surface.
-local irritation.
-most common site
is palate.
-dome shape.
-size changes
or ulceration.
-clinically similar to
irritational fibroma.
-in buccal mucosa.

10. Treatment plan:
1. Identify the source of irritation.
2. Excisional biopsy.
• Surgical removal.
• microscopical examination.
3. Caries excavation and restoration.
4. Orthodontic treatment.

11. Management:
Excisional biopsy.
• Perilesional
anasthesia.
• Surgical excision.
• Suturing.
• Post operative
instructions
• Fixation.

12. Follow up:
After 1 week:
• Suture removal.
After 2 weeks:

13. Final diagnosis:

14. Fibroepithelial polyp
• One of the most common oral mucosal
lesions.
• It is a reactive focal fibrous and epithelial
hyperplasia.
• 66% female predilection.
• 4th
_ 6th
decade.
• 70% Buccal mucosa
Etiology:
• Local irritation.
• Cheek biting.
• Trauma.

15. Fibroepithelial polyp
shape Round, ovoid,leaf
shape,sessile or
pedinculated.
size Less than 1 cm
Color Normal color of the
mucosa
texture Smooth, may become
ulcerated.
consiste
ncy
firm
growth slow
mobility immovable
number Usually single

16. Fibroepithelial polyp
Histopathological feature:
Epithelium:
keratinized stratified
squamous epithelium.
Elongation of rete ridges.
Connective tissue:
Dense mature collagen
bundles.
Chronic inflammatory
cells.

17. Fibroepithelial polyp:
Management:
• Eleminate the irritation.
• Conservative surgical or laser
removal.
Prognosis:
• Excellent if the irritation is eleminated.
• No risk of malignant transformation.

18. Related Topic:
Aim:
Evaluate the indications and the
advantages of resection of oral
hyperplastic lesion using CO2 laser
versus surgical scalpel.

19. Related Topic:
Method:
Oral
hyperplastic
lesions
)128(
Gingival
hyperplasia
)77(
Fibromatous
hyperplasia
)51(
CO2 laser
)43(
Surgical scalpel
)7(
CO2 laser
)65(
Surgical scalpel
)11(

20. Related Topic:
Results:
CO2 laser was the treatment of choise for most cases for the
following reasons:
• less pain and edema: Sectioning and sealing of nerve endings
and lymphatic vessles.
• less bleeding: Coagulate vessles less than 0.5 mm diameter.
• Isolation: Formation of thin denaturalized collagen layer.
• less malignant cells and germ spreading: Sterile incision.
• Limited penetration capacity: soft lesions removal.

21. References:
• Neville: Oral and Maxillofacial Pathology , 2nd
edition, page 438-442.
• Tamarit M, Dolgado E. Removal of hyperplastic lesions of the oral
cavity.Med Oral Patol Oral Cir Bucal.2005;10:151-162.
• www.maxillofacialcenter. com

22. Thank You