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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 3  |  Issue : 2  |  Page : 118-121

Irritation fibroma: Report of a case


Department of Periodontology, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India

Date of Submission05-Sep-2017
Date of Acceptance14-Oct-2017
Date of Web Publication8-Jan-2018

Correspondence Address:
Dr. Ritika Arora
Department of Periodontology, Subharti Dental College, Meerut, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrsm.jcrsm_53_17

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  Abstract 

Traumatic or irritation fibroma is the healed end product of the inflammatory hyperplastic lesion which can occur at any age from almost any soft-tissue site, tongue, gingiva, and buccal mucosa being the most common. The aim of this case report is to present the clinical features and management of the benign lesion which was posteriorly positioned in the interdental papillary region of mandibular premolars. A female patient, 40 years old, reported to the department with a chief complaint of pain and swelling in the right lower back tooth region for the past 1 year. On examination, the lesion was found to be a well circumscribed, smooth, tender, firm and lobulated pink swelling measuring 2 cm × 2 cm in its greatest diameter in relation to right mandibular premolar region. Surgical therapy was carried out for the management of the same. There was no recurrence reported at the end of 2 months showing that treatment with electrocautery was highly effective as it was a relatively simple and safe method with easy handling of the electrodes without any bleeding or scarring. Irritation fibroma clinically resembles as pyogenic granuloma, peripheral giant cell granuloma, or odontogenic tumors, so radiographic and histopathological examination is essential for accurate diagnosis. Furthermore, complete excision is the choice of treatment as recurrence has been associated with incomplete removal of the lesion.

Keywords: Fibroma, granuloma, hyperplasia


How to cite this article:
Jain G, Arora R, Sharma A, Singh R, Agarwal M. Irritation fibroma: Report of a case. J Curr Res Sci Med 2017;3:118-21

How to cite this URL:
Jain G, Arora R, Sharma A, Singh R, Agarwal M. Irritation fibroma: Report of a case. J Curr Res Sci Med [serial online] 2017 [cited 2018 Jul 19];3:118-21. Available from: http://www.jcrsmed.org/text.asp?2017/3/2/118/222421


  Introduction Top


Inflammatory hyperplastic lesion may be defined as an increase in the size of an organ or tissue due to a local response of tissue to injury or an increase in the number of constituent cells. These traumatic irritants include calculi, foreign bodies, overhanging margins, restorations, margins of caries, chronic biting, sharp spicules of bones, and overextended borders of appliances. Fibroma, a benign neoplasm of fibroblastic origin, is reactive in nature and represents a reactive hyperplasia of fibrous connective tissue in response to local irritation or trauma rather than being a true neoplasm.[1]

Traumatic or irritation fibroma is the healed end product of the inflammatory hyperplastic lesion which can occur at any age from almost any soft-tissue site, tongue, gingiva, and buccal mucosa being the most common. It is usually characterized by a slow, painless growth accumulated over a period of months or years.[2] Clinically, the growth is localized, with a smooth surface and a hard consistency usually with normal colored mucosa, sessile, or pedunculated base, and is smaller than 1.5 cm at its largest diameter. Furthermore, it occurs commonly in the anterior maxilla, more precisely in the interdental papillary region.[3]

In the present case report, the benign lesion is posteriorly positioned in the interdental papillary region of mandibular premolars.


  Case Report Top


A 40-year-old female patient reported to the department of periodontology with the chief complaint of pain in the right lower back tooth region for 1 year. The ENT and general physical examination was normal. She had undergone surgery in the left eye 4 months back and extraction of root stumps in relation to 44.45 one week back which, according to the patient, were constantly impinging on her right buccal mucosa.

On intraoral examination, the patient was found to have a well circumscribed, smooth surface, tender and firm in consistency, and lobulated pink swelling measuring 2 × 2 cm in its greatest diameter in relation to 44.45 involving buccal mucosa [Figure 1]. Under local anesthesia, incisional biopsy of the growth was performed.
Figure 1: Preoperative view

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Histopathological report revealed hyperplastic edematous stratified squamous epithelium showing toto bodies. Furthermore, the underlying fibrocellular connective tissue stroma showed mixed inflammatory cell infiltrate mainly composed of lymphocytes and plasma cells. Dilated blood capillaries were evident at focal areas with the presence of microbial colonies [Figure 2]. These features were suggestive of irritational inflammatory fibroma/inflammatory fibroepithelial hyperplasia in relation to 44.45 on buccal mucosa.
Figure 2: Histopathological photograph

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After phase 1 therapy, surgical excision of the fibroma was planned with the use of electrocautery. After obtaining an informed consent, topical anesthetic agents (2% lignocaine hydrochloride and 1:80,000 adrenaline) was applied to the surgical site and local anesthetic infiltration was administered. After anesthesia was found to be effective, excision of fibroma was done with the needle and diamond-shaped electrodes and coagulation was achieved by ball electrode [Figure 3] and [Figure 4].
Figure 3: Preoperative incision given with electrocautery

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Figure 4: Intraoperative view

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The patient was recalled for re-evaluation after 15 days and 2 months, respectively [Figure 5]. Postsurgical instructions were given, and antibiotic capsule amoxicillin (500 mg) thrice a day for 5 days and nonsteroidal anti-inflammatory drug paracetamol thrice a day for 3 days were prescribed to prevent postoperative infection and pain. However, swelling and pain were present on the 1st postoperative day, which subsided with the continuation of medication. The postoperative period was uneventful with no delayed hemorrhage.
Figure 5: Two-month postoperative view

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  Discussion Top


Localized fibrous tissue overgrowths are very common in the oral mucosa. The etiology of an irritational fibroma is usually a source of irritation. Furthermore, the character of these lesions tells a story. According to Barker and Lucas, irritational fibromas exhibit a pattern of collagen arrangement depending on the site of the lesion and the amount of irritation. There are two types of patterns: (a) radiating pattern and (b) circular pattern. Thus, they hypothesized that when there is a greater degree of trauma, the former appears in sites which are immobile in nature (e.g., palate), while lesser trauma induces the latter and it occurs in sites that are flexible in nature (e.g., cheeks).[1] Similar such lesions, which may also arise as a result of irritation due to plaque microorganisms and other local irritants, include pyogenic granuloma, peripheral giant cell granuloma, and peripheral ossifying fibroma. All the lesions have a similar clinical appearance.[4] Traumatic fibroma associated with oral practices such as tongue piercings has also been reported.

Rare association of reactive hyperplasia with a natal tooth in a 4-year and 6-month-old infant has been reported, showing that local irritants are one of the major causes of these reactive hyperplastic lesions.[5] The treatment of irritation fibroma consists of elimination of etiological factors, scaling of adjacent teeth, and total aggressive surgical excision along with involved periodontal ligament and periosteum to minimize the possibility of recurrence. Any identifiable irritant such as an ill-fitting dental appliance, root stumps, and rough restoration should be removed.

Long-term postoperative follow-up is extremely important because of the high growth potential of incompletely removed lesion which is 8%–20%.[6] Recurrences are rare and may be caused by repetitive trauma at the same site. Furthermore, this lesion does not have a risk for malignancy.[7]

In a retrospective study by Martins et al., 193 cases of focal fibrous hyperplasia of the oral cavity were reviewed and it was observed that the most commonly affected site was the buccal mucosa (n = 119, 61.7%), almost two-thirds of the cases were concentrated from the second to the fifth decade of life, females were more affected than men, and a history of trauma was related by 90.7% of the patients.[8] Conservative excisional biopsy is curative and its findings are diagnostic; however, recurrence is possible if the exposure to the offending irritant persists.[9]


  Conclusion Top


The present case report showed that treatment with electrocautery was highly effective as it was a relatively simple and safe method with easy handling of the electrodes without bleeding or scarring.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Barker DS, Lucas RB. Localised fibrous overgrowths of the oral mucosa. Br J Oral Surg 1967;5:86-92.  Back to cited text no. 1
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2.
Wood NK, Goaz PW. Differential Diagnosis of Oral and Maxillofacial Lesions. 5th ed. Missouri: Mosby; 2006.p.136-8.  Back to cited text no. 2
    
3.
Kohli K, Christian A, Howell R. Peripheral ossifying fibroma associated with a neonatal tooth: Case report. Pediatr Dent 1998;20:428-9.  Back to cited text no. 3
[PUBMED]    
4.
Kolte AP, Kolte RA, Shrirao TS. Focal fibrous overgrowths: A case series and review of literature. Contemp Clin Dent 2010;1:271-4.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Rangeeth BN, Moses J, Reddy VK. A rare presentation of mucocele and irritation fibroma of the lower lip. Contemp Clin Dent 2010;1:111-4.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Eversole LR, Rovin S. Reactive lesions of the gingiva. J Oral Pathol 1972;1:30-8.  Back to cited text no. 6
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7.
Esmeili T, Lozada-Nur F, Epstein J. Common benign oral soft tissue masses. Dent Clin North Am 2005;49:223-40.  Back to cited text no. 7
[PUBMED]    
8.
de Santana Santos T, Martins-Filho PR, Piva MR, de Souza Andrade ES. Focal fibrous hyperplasia: A review of 193 cases. J Oral Maxillofac Pathol 2014;18:S86-9.  Back to cited text no. 8
[PUBMED]    
9.
Pai JB, Padma R, Divya, Malagi S, Kamath V, Shridhar A, et al. Excision of fibroma with diode laser: A case series. J Dent Lasers 2014;8:34-8.  Back to cited text no. 9
  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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