Download Excision of Focal Fibrous Hyperplasia using a Diode Laser

JDSOR
Sana Khan et al
10.5005/jp-journals-10039-1113
CASE REPORT
Excision of Focal Fibrous Hyperplasia using a Diode Laser
1
Sana Khan, 2Hirak S Bhattacharya, 3Upasana Singh, 4Bimmi Tripathi, 5Abhinav Rastogi, 6Pooja Mittal
ABSTRACT
Laser can be used for the excision of soft tissue growth.
They provide bloodless field of surgery and allow complete
removal. This is a case report of a 50-year-old female patient
who underwent diode laser-assisted excision of focal fibrous
hyperplasia.
Keywords: Betel nut, Diode laser, Focal fibrous hyperplasia.
How to cite this article: Khan S, Bhattacharya HS, Singh U,
Tripathi B, Rastogi A, Mittal P. Excision of Focal Fibrous
Hyperplasia using a Diode Laser. J Dent Sci Oral Rehab
2016;7(2):78-80.
Source of support: Nil
Conflict of interest: None
INTRODUCTION
Laser is the latest treatment modality which is available
for any dental soft tissue growth. They have many
advantages over the conventional techniques like
allowing complete removal of growth without excessive
bleeding and scarring. They are much better in terms of
healing and postoperative pain. The advantage of laser
excision is that they provide bloodless field and thus
make visibility better.
Different types of localized reactive lesions may occur
on the gingiva, which include focal fibrous hyperplasia,
pyogenic granuloma, peripheral giant cell granuloma,
and peripheral ossifying fibroma (POF). The causative
etiology for these types of lesions can be attributed to the
local irritants like plaque, calculus, trauma, overhanging
margins, and dental appliances.1,2
The patient reported that a growth developed on the
gingiva in the upper front region 2 years back which
gradually increased in size for 1 year. Patient complained
of discomfort, difficulty in eating, and inability to carry
out routine oral hygiene procedures. The general health
of the patient was normal.
Patient gave history of betel nut chewing for the past
20 years.
Upon clinical examination, a 2.5 × 1.8 cm localized
sessile exophytic growth involving the maxillary anterior
labial gingiva which extended from the right lateral
incisor to the left central incisor was seen. The lesion was
pinkish red in color with scattered white patches, had illdefined margins, and had a smooth surface. There was
no bleeding from the lesion and there was no regional
lymphadenopathy. The oral hygiene of the patient was
poor (Fig. 1).
The hemogram was normal. The radiographic evaluation including the periapical radiograph showed no
significant changes.
Considering the history, presence of local irritants,
age, and social background of the patient, a provisional
diagnosis of traumatic fibroma was made. Phase 1 therapy
including scaling and root planing was done. Diode laserassisted excisional biopsy was planned after 21 days,
under local anesthesia.
The etiology of the lesion could be attributed to the
prolonged use of betel nut for the past 20 years and poor
oral hygiene which had led to the chronic irritation of
the labial gingiva.
CASE REPORT
A 50-year-old female patient reported to the Department
of Periodontology and Implantology, Institute of Dental
Sciences, Bareilly, in December 2015 with a chief complaint
of growth in the upper front tooth region.
1,3-6
Postgraduate Student, 2Professor
1-6
Department of Periodontology and Implantology, Institute of
Dental Sciences, Bareilly, Uttar Pradesh, India
Corresponding Author: Sana Khan, Postgraduate Student
Department of Periodontics and Implantology, Institute of
Dental Sciences, Bareilly, Uttar Pradesh, India, Phone:
+919084007514, e-mail: [email protected]
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Fig. 1: Preoperative photograph 21 days prior to surgery
JDSOR
Excision of Focal Fibrous Hyperplasia using a Diode Laser
Fig. 2: Preoperative photograph immediately before surgery
Fig. 3: Growth excision using diode laser
Fig. 4: Postoperative photograph immediately after surgery
Fig. 5: Photograph of excised growth
Patient was told about the procedure and written
informed consent was taken. She was administered 2%
lignocaine with adrenaline (1:80,000). Infiltration was
given on the area surrounding the lesion. The lesion was
removed using a diode laser with 810 nm wavelength
in contact mode and pulse of 30 ms duration and 30 ms
interval with initiated tip at 1.5 W power. The excised
lesion was then put in 10% formalin and sent to the
Department of Oral Pathology for histopathological
evaluation (Figs 2 to 5).
The operated field was irrigated using sterile normal
saline. No sutures or periodontal dressing was given.
The patient was advised to avoid hot and spicy food
for a week. No medications were prescribed. Healing was
assessed after a week and was found to be uneventful
(Fig. 6).
Histopathological Evaluation
Hematoxylin and eosin–stained section showed the
following:
Fig. 6: Postoperative 7 days photograph
Under scanner view: Two pieces of tissue with epithelium overlying fibrous connective tissue stroma.
Under low power and higher magnification:
Epithelium is stratified squamous hyperparakeratinized
type showing slender rete pegs. In few areas, spongiosis is
Journal of Dental Sciences and Oral Rehabilitation, April-June 2016;7(2):78-80
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Sana Khan et al
evident, connective tissue stroma comprises loose dense
bundles of collagen fibers with plump to spindle-shaped
fibroblasts. Few endothelial lined blood vessels with red
blood corpuscles are seen. Mild chronic inflammatory
infiltrate predominantly comprising of lymphocytes is
evident in some areas.
Final Diagnosis
Clinical and histopathological evaluation was suggestive
of fibrous hyperplasia.
DISCUSSION
A laser is a device that produces coherent electromagnetic radiation. Laser radiation is characterized by a low
divergence of the radiation beam and, with few exceptions, it has a well-defined wavelength. The term laser
is well known as the acronym for light amplification by
stimulated emission of radiation.
Because of the photophysical characteristics of lasers,
laser irradiation exhibits strong ablation, hemostasis,
detoxification, and bactericidal effects on the human
body. These effects could be beneficial during periodontal
treatment, especially for the fine cutting of soft tissue as
well as in the debridement of diseased tissues. Thus, in
periodontal therapy, laser treatment may serve as an alternative or adjunctive therapy to mechanical approaches.3
Compared with the use of a conventional scalpel,
lasers can cut, ablate, and reshape the oral soft tissue more
easily, with no or minimal bleeding and little pain as well
as no or only a few sutures. Laser surgery occasionally
requires no local anesthetic, or only a topical anesthetic.4
Fibrous nodules are the most common soft-tissue
swellings of the mouth. They are not neoplasms but
hyperplastic swellings that develop in sites subject to
chronic minor injury and/or a low-grade infection.
Fibromas are not recognized as an entity and in any case
they cannot be distinguished from fibrous hyperplasia.
Irritation of the gingival margin by the sharp edge of a
carious cavity or by calculus may lead to the formation of
a fibrous epulis; irritation of alveolar or palatal mucosa by
a rough area on a denture may provoke the development
of a denture granuloma. Though different names are given
to these lesions, they are similar in origin and structure.5
The differential diagnosis of fibrous inflammatory
hyperplasia should include consideration of the possibility
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that the lesion is a true papilloma (a cauliflower-like mass
made up of multiple fingerlike projections of stratified
squamous epithelium with a central core of vascular
connective tissue) or a small verrucous carcinoma.6
Other differential diagnosis of focal fibrous hyperplasia includes giant cell fibroma, neurofibroma, peripheral
giant cell granuloma, mucocele, benign and malignant
salivary gland tumor. Areas of diffuse or focal calcification or even ossification are found in some fibromas,
chiefly those occurring on gingival, and these lesions are
sometimes called POF, ossifying fibroid epulis, peripheral cementifying fibroma, or peripheral odontogenic
fibroma.7
Sometimes, similar type of lesion is referred to as
pregnancy epulis or pyogenic granuloma when associated with pregnancy.8
CONCLUSION
Lasers are the latest treatment modality for excision of soft
tissue growth, such as fibrous hyperplasia as they provide
complete removal with minimal bleeding and scarring.
Many cases may progress for long periods before the
patients seek treatment. Proper diagnosis and treatment
planning are essential.
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