Pediatric Palatal Fibroma

IJCPD Rahul Mishra et al 10.5005/jp-journals-10005-1414 CASE REPORT Pediatric Palatal Fibroma 1 Rahul Mishra, 2Tayyeb S Khan, 3Tarannum Ajaz, 4Mamta Agarwal ABSTRACT The diagnosis of these lesions is based mainly on his- topathological features. Most of these lesions are relatively Fibroma is one of the most common soft tissue benign tumors characteristic in presentation, leaving very little doubt about of the oral cavity. These masses represent hyperplasias instead of true neoplasm, which develop due to irritation to the mucosal the diagnosis. In certain instances, however, unusual find- tissue resulting in proliferation of the cells. Although so common ings may result in diagnostic uncertainty. Here, we report a in the oral cavity, its occurrence on the palate is rare, mainly due rare case of palatal fibroma occurring in an 8-year-old boy to fewer chances of trauma. Here, we report a case of palatal where the causative irritational factor was due to a seem- fibroma in a child diagnosed on the basis of clinical, radiological, ingly innocuous parafunctional habit of thumb sucking. and histological features. The case represents an extremely rare occurrence as unusual trauma due to thumb sucking seemed to be the only apparent traumatic factor in the palatal region. CASE REPORT Keywords: Oral habits, Palatal fibroma, Surgical pedodontics. An 8-year-old boy reported to the Department of Pedo- dontics and Preventive Dentistry at our center with a How to cite this article: Mishra R, Khan TS, Ajaz T, Agarwal M. Pediatric Palatal Fibroma. Int J Clin Pediatr Dent 2017; chief complaint of palatal growth in the midline region. 10(1):96-98. History revealed that the problem started with ulceration in the palate about 3 years back. After a few days, he Source of support: Nil observed a small growth in the same region, which gradu- Conflict of interest: None ally enlarged during the following months. Patient also reported of thumb sucking habit till the age of 5 years. He INTRODUCTION was advised antibiotic and antifungal medication by the local physician to which there was no response. Fibroma or focal fibrous hyperplasia of the oral mucosa On intraoral examination, a large, smooth-surfaced, is the most common benign neoplasm of the oral cavity. and pedunculated growth was observed (2.5 × 2 × 1.5 cm According to Torres-Domingo et al,1 out of 300 benign approx) in the palatal area (Fig. 1). On palpation, the tumors of the oral mucosa, 53% were histologically outgrowth was soft, nontender, and attached with a stalk diagnosed as fibroma, and it is the most frequently found to the palatal mucosa. Ipsilateral submandibular lymph benign tumor of the oral cavity. nodes were enlarged, palpable, and nontender. Fibromas are hyperplasias of fibrous connective tissue in response to local irritation or trauma. Tissue Investigation enlargements attributable to injury represent a hyper- • Radiographically, no abnormality was seen. plastic reaction and are collectively grouped as “reactive • Routine blood investigations were within normal range. proliferations.” It is also known as irritational fibroma, traumatic fibroma, fibrous nodule, or fibroepithelial polyp.2 It was first reported in 1846 as fibrous polyp and polypus and is found in 1.2% of adults.3,4 1 Assistant Professor, 2,3Reader, 4Professor 1 Department of Dentistry, University of Medical Sciences, Saifai Etawah, Uttar Pradesh, India 2,4 Department of Oral and Maxillofacial Surgery, Purvanchal Institute of Dental Sciences, Gorakhpur, Uttar Pradesh, India 3 Department of Prosthodontics, Purvanchal Institute of Dental Sciences, Gorakhpur, Uttar Pradesh, India Corresponding Author: Rahul Mishra, Assistant Professor Department of Dentistry, University of Medical Sciences, Saifai Etawah, Uttar Pradesh, India, Phone: +919721949191, e-mail: dr.rahulmishra07@gmail.com Fig. 1: Preoperative view with palatal fibroma 96  IJCPD Pediatric Palatal Fibroma Incisional biopsy was done, and the tissue was sent for histopathalogic examination. The report showed orthokeratinized stratified squamous epithelium with short rete pegs encircling the connective tissue stroma with abundant collagen fiber bundles along with pro- liferating spindle-shaped fibroblasts, few myxomatous areas, chronic inflammatory cells infiltration, and blood vessels (Fig. 2). Overall, the histopathological features were suggestive of fibroma. Differential Diagnosis Clinically, the soft tissue overgrowth appeared of normal mucosal color and texture, and due to the specific loca- tion, the possible differential diagnosis included salivary Fig. 2: Histopathological view gland tumors, giant cell fibroma, myxoma, pyogenic granuloma, and neurofibroma. As the site of soft tissue DISCUSSION growth was at the midline of posterior hard palate, the Irritational fibroma is usually sessile, round or ovoid, possibility of irritation fibroma was not considered prior nontender and may be lighter in color than the surround- to the histopathological report. ing tissue due to reduced vascularity. Due to the gradual Final diagnosis of irritational fibroma was made and and slow growth of the lesion, the patients are generally surgical excision of lesion was done (Figs 3A and B). aware of the mass. Follow-up showed perfect healing and no recurrence The irritational fibroma has a 66% female predilection until 1 year postsurgery (Figs 4A and B). and can occur at any age, but is usually seen in the 4th A B Figs 3A and B: Intraoperative view and excised lesion A B Figs 4A and B: Postoperative views after 1 month and 1 year International Journal of Clinical Pediatric Dentistry, January-March 2017;10(1):96-98 97 Rahul Mishra et al to sixth decades of life.5 Contrary to the aforementioned Fibromas, though very common lesions of the oral evidence, this case presents an 8-year-old male child with cavity and characteristic in presentation, may sometimes the lesion. The presumed etiology of fibroma is trauma to pose a diagnostic challenge. Clinicians should consider the affected mucosa. In the case presented, although there the possibility of diagnosing irritation fibroma in younger was no direct history of trauma, a traumatic stimulus age groups and in unusual locations as palate. Detailed could have been inflicted due to parafunctional habit of history regarding the lesion, precise clinical workup thumb sucking or maybe due to trauma from any sharp combined with microscopic presentation is required foreign object.6 The patient did report of initial ulceration for diagnostic confirmation and proper management of prior to the growth formation. Although the irritational such cases. fibroma can occur anywhere in the oral cavity, the most common site is the buccal mucosa along the occlusal CONCLUSION line; other common sites are labial mucosa, tongue, and Fibrous growths of the oral soft tissues are fairly common gingiva. Midline palatal fibroma at such a young age and include a diverse group of reactive and hyperplastic has not been reported till date in literature, except in old conditions. As a pedodontic, the key for management denture wearers, where it presents as a flat, pancake- should be early education and interception of abnormal shaped mass. oral habits in children followed by identification of any As far as size is concerned, the lesions generally are reactive hyperplastic lesion by devising a differential less than 1 cm in diameter.7,8 In contrast to the common diagnosis to enable precise patient evaluation and, clinical presentation, the present lesion was of a much thereon, its treatment. larger dimension than normal, covering about two-thirds of the hard palate. REFERENCES The pathological mechanism of fibroma involves hyperplasia due to trauma to the mucosal tissue resulting 1. Torres-Domingo S, Bagan JV, Jiménez Y, Poveda R, Murillo J, Díaz JM, Sanchis JM, Gavaldá C, Carbonell E. Benign tumors in proliferation of cells followed by collagen fibrillogen- of the oral mucosa: a study of 300 patients. Med Oral Patol esis. 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