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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 12  |  Issue : 2  |  Page : 67-69

Excision of traumatic fibroma by diode laser


1 Department of Dentistry, Chirayu Medical College and Hospital, Bhopal, Affiliated to Madhya Pradesh Medical Science University (Jabalpur), Madhya Pradesh, India
2 Department of Periodontology, People's Dental Academy, People's University, Bhopal, Madhya Pradesh, India
3 Department of Endodontics, Peoples College of Dental Sciences, People's University, Bhopal, Madhya Pradesh, India
4 Department of Conservatives and Endodontics, Dentz Hospital, Delhi, India

Date of Web Publication19-Dec-2018

Correspondence Address:
Dr. Praveen Raj Jain
Senior Resident, Department of Dentistry, Chirayu Medical College and Hospital, Bhopal, Affiliated to Madhya Pradesh Medical Science University (Jabalpur), Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdl.jdl_9_18

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  Abstract 

Irritation fibroma is the most common tumor-like and submucosal reactive lesion in the oral cavity that composed of fibrous or connective tissue causing by traumatic irritants such as calculi, foreign bodies, chronic biting, overhanging margin restoration, sharp spicules of bones, and overextended borders of appliances. It is a well-defined lesion, slow in growth, and can occur in any age group but is more prevalent in the third, fourth, and fifth decades with a female predilection. The tumor may be small or may increase to several centimeters in diameter. The tumor may become irritated and inflamed and sometimes may even show ulcers, which is superficial in nature. The lesions are nonsymptomatic, and the patient usually reports for treatment due to the problem and discomfort during mastication. The fibroma appears as a nodular growth mainly on the buccal mucosa along the occlusal plane. Other common sites are the gingiva, palate, lips, and the tongue. The management of this reactive lesion can be done through conservative surgical approach.

Keywords: Focal fibrous hyperplasia, oral polyp, traumatic fibroma


How to cite this article:
Jain PR, Jain S, Awadhiya S, Sethi P. Excision of traumatic fibroma by diode laser. J Dent Lasers 2018;12:67-9

How to cite this URL:
Jain PR, Jain S, Awadhiya S, Sethi P. Excision of traumatic fibroma by diode laser. J Dent Lasers [serial online] 2018 [cited 2019 May 22];12:67-9. Available from: http://www.jdentlasers.org/text.asp?2018/12/2/67/248004


  Introduction Top


“Inflammatory hyperplasia” or traumatic fibroma is a term which can be described as nodular growths that is presented as granulation tissue fibrous in nature.[1] It has no malignancy and recurrence if surgical excision and removal of irritation source.[2] In general, fibroma presents as a painless, round or ovoid, sessile or pedunculated (in some cases), smooth surface, pinkish in color similar to surrounding mucosa, and rubbery to firm in consistency due to its collagen content.[3],[4] In the black race, it may demonstrate brown-to-gray pigmentation.[4] Fibroma can be seen in any surface of the oral cavity. Usually, it is measured <1.5 cm in diameter; however, in rare case, it has more than 3 cm in diameter. When treatment is required, surgical excision is the choice. It reoccurs very rarely, but it can happen when source of irritation does not eliminate or the excision does not completely do.

The prognosis of these lesions is good overall.[4],[5] The primary area of clinically using laser in dentistry is the removal of soft-tissue lesions.[6],[7] The laser surgery can be used for incisional and excisional biopsies, gingivectomy, frenectomy, canal and pocket disinfection, crown lengthening, and ablation of the soft-tissue lesions in various fields of dentistry.[8] The soft-tissue diode laser can be more effective than conventional surgery, electrosurgery, and cryosurgery in reduction of bleeding and pain.[9] Histopathological features of this lesion consist of connective tissue which is fibrous in nature. The arrangement of the collagen bundles is circular, radiating, or haphazard fashion.[4]


  Case Report Top


A 52-year-old male patient visited to the Department of Periodontology, People's Dental Academy, Bhopal. His chief complaint was swelling in his lower front gums for 2 years which interfered in mastication. Swelling was associated with mild pain, intermittent, nonradiating in nature. There was no associated history of any pus discharge, bleeding, or trauma. Intraoral examination revealed peanut-sized mass which gradually increased in size, measuring 2 cm × 2 cm, pale pinkish in color, smooth surface with no ulcer and also some telangiectatic vessels, broad base, pedunculated, and firm in consistency located in lower anterior teeth region [Figure 1]. Overlying mucosa appears to be predominantly erythematous with interspersed white keratotic areas in between. Differential diagnosis was neurofibroma, irritation fibroma, and soft-tissue mesenchymal tumors.
Figure 1: Preoperative picture

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Excision technique

Because of its size, location, and possible excessive bleeding, we decided the removal of the lesion under local anaesthesia [Figure 2] with diode laser at the 810 nm wavelength with an average of power 4 W and a 0.4-mm diameter fiber tip in 5 min. The irradiation mode was a continuous wave. Precautionary measures included wearing of protective goggles, using gauze in the operative field and high vacuum suction. After a good coagulation, surgical wound was not sutured and left to heal by secondary intention [Figure 3]. Chlorhexidine mouthwash 0.12% was prescribed for the patient twice daily.
Figure 2: Excised tissue

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Figure 3: Postoperative picture

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Histopathological report

The specimen was sent to oral and maxillofacial pathology department in formalin-buffered solution 10%. The sections showed characterization by a much profusion of vascular channels. Some vessels show endothelial cells with prominent plump nuclei while some vessels show separation by less vascular/fibrous tissues. Rest of stroma is fibrous, and superficial areas show dense aggregates of neutrophils. The stroma showed admixture of chronic and acute inflammatory cells with predominance of neutrophils. Overlying epithelium is keratinized stratified squamous epithelium and at areas showed prominent ulceration along with infiltration of neutrophils [Figure 4].
Figure 4: Histopathological photomicrograph

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  Discussion Top


The irritation fibroma can occur anywhere in the mouth, the prevalent site being the mucosa, especially buccal mucosa. The tongue, palate and lips, and gingiva are also common sites. The lesion typically appears as pink nodule which is smooth surfaced and similar in color to the surrounding mucosa.[10] The mass may be sessile or pedunculated. Usually, it is nonsymptomatic, moderately firm in consistency, and immovable mass with a colored surface. Different kinds of treatment for soft-tissue lesions include scalpel excision, electrical surgery, and laser surgery.[6] There are some complications in conventional surgery such as intra- and postoperative bleeding, difficulties in wound healing, anesthetizing the area, swelling, scarring, and postsurgical pain.[6],[8] Diode lasers have many advantages such as less bleeding, scarring, pain, infection, swelling, reduction in surgical time, and a good coagulation without anesthesia.[6],[7],[8] Diode laser is absorbed by pigmented tissue and hemoglobin.[7],[8],[11] Numerous studies revealed that laser makes area sterile because of reduction of bacteremia at the site of operation.[6] Laser can be considered as a good modality even for very large lesions which are difficult to access by conventional surgery.

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.


  Conclusion Top


Diode laser radiation is an excellent, simple, and safe form of treatment of oral lesions. With laser irradiation, there is less damage to adjacent tissues and better visibility. In the above-mentioned case, the patient was satisfied with laser surgery since it was a painless procedure both intra- and postoperatively.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Bagde H, Waghmare A, Savitha B, Vhanmane P. Irritation fibroma – A case report. Int J Dent Clin 2013;5:39-40.  Back to cited text no. 1
    
2.
Hashemi Pour MS, Rad M, Mojtahedi A. A survey of soft tissue tumor – Like lesions of the oral cavity: A clinicipathological study. Iran J Pathol 2008;3:81-7.  Back to cited text no. 2
    
3.
Singh A, Vengal M, Patil N, Sachdeva SK. Traumatic fibroma – A saga of reaction against irritation. Dent Impact 2012;4:49-52.  Back to cited text no. 3
    
4.
Halim DS, Pohchi A, EE Yi P. The prevalence of fibroma in oral mucosa among patient attending USM dental clinic Year. 2006-2010. Indones J Dent Res 2010;1:61-6.  Back to cited text no. 4
    
5.
Harshavardhana B, Rath SK, Mukherjee M. A rare case of irritation fibroma associated with aleukoplakia of oral mucosa. AOSR 2012;2:34-6.  Back to cited text no. 5
    
6.
Asnaashari M, Azari Mehrabi S, Alirezaei S, Asnaashari N. Clinical application of 810 nm diode laser to remove gingival hyperplastic lesion. J Lasers Med Sci 2013;4:96-8.  Back to cited text no. 6
    
7.
Ayoub AH, Negm SA. Removal of fibroma using 980 nm diode laser: A case report. Int J Dent Clin 2014;6:26-7.  Back to cited text no. 7
    
8.
Eliades A, Stavrianos C, Kokkas A, Kafas P, Nazaroglou I. 808 diode laser in oral surgery: A case report of laser removal of fibroma. J Med Sci 2010;4:175-8.  Back to cited text no. 8
    
9.
Singh G, Yulia Y, Chhibber A. laser assisted biopsy of intra – Oral irritation fibroma: A case report. Solaze 2009;3:28-30.  Back to cited text no. 9
    
10.
Neville B, Damm DD, Allen CM, Bouqout J. Oral and Maxillofacial Pathology. 3rd ed. United Kingdom: Saunders Elsevier; 2009.  Back to cited text no. 10
    
11.
Azma E, Safavi N. Diode laser application in soft tissue oral surgery. J Lasers Med Sci 2013;4:206-11.  Back to cited text no. 11
    


    Figures

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



 

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