EPULIS FISSURATUM

By: Aleia S. Guzman

WHAT IS EPULIS FISSURATUM?

is a benign hyperplasia of fibrous connective tissue which develops as a reactive lesion to chronic mechanical irritation produced by the flange of a poorly fitting denture

OTHER TERMS

inflammatory fibrous hyperplasia

denture-induced fibrous inflammatory hyperplasia

denture epulis

denture injury tumor

denture induced granuloma

granuloma fissuratum

DEFINITION OF TERMS

Epulis- is a general term for any gingival or alveolar tumor

Granuloma- a mass of granulation tissue, typically produced in response to infection, inflammation, or the presence of a foreign substance.

Tumor- a swelling of a part of the body, generally without inflammation, caused by an abnormal growth of tissue, whether benign or malignant.

er cr ysgg laser – erbium laser.

Excisional biopsy- procedure where the entire abnormality or area of interest is removed

ETIOLOGY

Prolonged use of ill fitting denture (removable partial denture/complete denture.

Continued use of broken denture.

DIFFERENTIAL DIAGNOSISpain bleedi

ngcolor Fast

growing

Pyogenic Granuloma

Red/pink- purple

Metastatic Neoplasms to the Oral Cavity

Reddish

Squamous Cell Carcinoma

Reddish

Epulis fissuratum pink /red

RELATED LITERATURE

. This report presents a case of a 68-year old male patient with two soft tissue hyperplastic growths seen in the buccal vestibule in the lower anterior region. These lesions were removed using an Er,Cr:YSGG laser. The healing was uneventful and no suture or analgesic was required. The histopathological report confirmed the presurgical diagnosis. No relapse was observed till one year after surgery.

RELATED LITERATURE

CASE PRESENTATION

PERSONAL DATA

Name: Lorna Gines

Address: Cabubugan, Guimbal, Iloilo City

Sex: Female

Age: 57 years old

Occupation: Massage therapist

CHIEF COMPLAINT

“ Nabudlayan ko magkaon kai naguba akon pustiso”

HISTORY OF PRESENT ILLNESS

20 years ago she visited a dentist because she can’t eat well due to she is partially edentulous and was fabricated a set of denture. 3 years prior to consultation her denture was destroyed while she was eating, according to her she ate something hard that cause the damaged to her denture. Despite the incident she continuously wears her denture because she can’t afford to pay a private dentist.

MEDICAL HISTORY

The patient was admitted to the hospital in 1993 due to child birth. She has no serious illness or systemic disease and is healthy.

PAST DENTAL HISTORY

She had her first tooth extraction year 1984 and had her last tooth extracted 3 years ago due to severe caries.

PERSONAL AND SOCIAL HISTORY

The patient does not smoke and drink alcoholic beverages.

X-RAY

TREATMENT PLAN

Surgical excision on lesion

Fabrication of complete denture

SURGICAL APPROACH

Excisional biopsy

Using:• Removal by scalpel• Electrocautery

PRINCIPLES OF SURGERYAsepsis - Is a state of being free from disease-causing contaminants, or preventing contact with microorganism.

Attained by:Proper hand washing

Sterilizing of instruments and equipmentssss

Reusing of used equipment is contraindicated

Proper gear is needed (gloves, mask, lab gowns, head cap)

Proper infection control before and after any procedure

 

PRINCIPLES OF SURGERY

Atraumatic InjuryMaintenance of patient airwayGood AnesthesiaControl of Infection

ADVANTAGES

Tissue separation is clean with little or no bleeding.

The technique is less pressure and precise.

Planning of soft tissue is possible.

Healing discomfort and scar formation is minimal.

Access to difficult to reach area is increased.

Chair time and operator fatigue are reduced

No need to suture.

Short healing period.

DISADVANTAGES

Cannot be used on patients with poorly shielded pacemaker

Cannot be used near flammable gasses.

Odor of burning tissue is present if high volume suction is not used.

ARMAMENTARIUM

ARMAMENTARIUM

ARMAMENTARIUM

• Mouth mirror• Cheek retractor

(minesotta)• Allis forceps• Hemostat• 1% betadine• Tissue forceps• Cotton gauze• Disposable syringe• Syringe• Needle• Mask

• Gloves • Anesthetic cartridge• Topical anesthesia• Normal saline solution• Suction tip• scalpel• Kidney basin • Electrocautery• Scalpel holder • Specimen cup• Head cap and gauze

PRE-OP INSTRUCTIONS

Get enough sleep the night before the procedure.

Take amoxicillin 500mg 1 capsule every 8hours for 7days.

Eat before the procedure.

PROCEDURETake blood pressure

Let the patient gargle 1% betadine.

Put betadine around the patients’ mouth.

Retract.

Dry the surgical area and apply topical anesthesia.

Perform local infiltration.

Use Allis forcep to grip the lesion and slightly pull.

Using scalpel, remove the lesion with 2-3mm of normal appearing surrounding tissue and clean the area with NSS.

Put the lesion in a specimen cup with NSS for biopsy.

After removing the lesion use electrocautery to close the wound and to stop bleeding.

Recall after 7 days.

PROCEDURE

PROCEDURE

PROCEDURE

PROCEDURE

MEDICATION

Mefenamic acid 500mg

28 caps

Sig: take 1 capsule every 6 hours for 7 days for pain or as needed.

Amoxicillin 500mg

21 caps

Sig. take 1 capsule every 8 hours for 7 days.

POST-OP INSTRUCTIONS

Take all medications religiously 30 mins. after meal

Gargle chlorhexatedine 15 ml for 30 seconds twice a day for 2 weeks.

Avoid stressful activities.

Do not wear the denture.

Avoid touching the affected.

Avoid sipping beverages.

Soft diet for 7 days.

RECALL

AFTER 14 DAYS

BIOPSY

CONCLUSION

Surgical wound healing using electrocautery is faster compared to other techniques and the chance of epulis fissuratum recurrence is very low if new denture is fabricated.