Oral Medicine CasePresentation

byWaad Khayat

Oral Medicine CasePresentation

byWaad Khayat

Personal Data:Personal Data:

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

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

Patient’s History: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.

• 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.

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

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

Clinical Examination: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:

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:

Radiographic examination:Radiographic examination:

The Exophytic Lesion: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.

• 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.

Diagnosis:Diagnosis:

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

Prognosis:• good.

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

Prognosis:• good.

Pale pinkSmall

SmoothFirm

PainlessBuccal mucosa

Female 4th decade

Irritational fibroma

Fibroepithelial polyp

Pyogenic granuloma(late stage)

Firm minorSalivary 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 siteis palate.

-dome shape.-size changes or ulceration.

-clinically similar to irritational fibroma.

-in buccal mucosa.

Treatment plan: Treatment plan:

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

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

Management:Management:

Excisional biopsy.• Perilesional

anasthesia.• Surgical excision.• Suturing.• Post operative

instructions • Fixation.

Excisional biopsy.• Perilesional

anasthesia.• Surgical excision.• Suturing.• Post operative

instructions • Fixation.

Follow up:Follow up:

After 1 week:• Suture removal.

After 2 weeks:

Final diagnosis:Final diagnosis:

Fibroepithelial polypFibroepithelial 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.

• 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.

Fibroepithelial polypFibroepithelial polypshapeRound, ovoid,leaf

shape,sessile or pedinculated.

sizeLess than 1 cm

ColorNormal color of the mucosa

textureSmooth, may become ulcerated.

consistency

firm

growthslow

mobilityimmovable

numberUsually single

Fibroepithelial polypFibroepithelial polyp

Histopathological feature:

Epithelium: keratinized stratified

squamous epithelium.Elongation of rete

ridges.Connective tissue:Dense mature collagen

bundles. Chronic inflammatory

cells.

Histopathological feature:

Epithelium: keratinized stratified

squamous epithelium.Elongation of rete

ridges.Connective tissue:Dense mature collagen

bundles. Chronic inflammatory

cells.

Fibroepithelial polyp:Fibroepithelial polyp:

Management:• Eleminate the irritation.• Conservative surgical or laser

removal.Prognosis:• Excellent if the irritation is

eleminated.• No risk of malignant transformation.

Management:• Eleminate the irritation.• Conservative surgical or laser

removal.Prognosis:• Excellent if the irritation is

eleminated.• No risk of malignant transformation.

Related Topic:Related Topic:

Aim: Evaluate the indications and the advantages of resection of oral hyperplastic lesion using CO2 laserversus surgical scalpel.

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

Related Topic:Related Topic:

Method:Method:Oral

hyperplastic lesions

(128)

Gingival hyperplasia

(77)

Fibromatous hyperplasia

(51)

CO2 laser(43)

Surgical scalpel(7)

CO2 laser(65)

Surgical scalpel(11)

Related Topic:Related Topic:

Results: CO2 laser was the treatment of choise for most cases forthe 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

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.

References: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

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