traumatic fibroma case report

1. CASE
PRESENTATION

2. NAME–CHAMMO
AGE/SEX –50/F
OCCUPATION–HOUSEWIFE
ADDRESS-MEERUT

3. CHIEF COMPLAINT
Growth on the left cheek region since 4-5
yrs.

4. HISTORY OF PRESENT ILLNESS
Patient was apparently asymptomatic few
years back when she noticed a small growth
on the left buccal mucosa which was initially
very small in size and gradually increased to
the present size
• The growth was aymptomatic

5. PAST HISTORY

6. PERSONAL HISTORY
ORAL HYGIENE - Brushing once a day.
ADVERSE HABITS – no adverse habits

7. CLINICAL EXAMINATION
# GENERAL EXAMINATION –
* GAIT – NORMAL
* BUILT – MESOMORPHIC
* PULSE RATE –81/MIN
* RESPIRATORY RATE –15/MIN
* CYANOSIS –ABSENT
* BLOOD PRESSURE –120/80mmHg
* TEMPERATURE – 36 degree celcius
* WEIGHT –65 kgs

8. # LOCAL EXAMINATION
• EXTRA ORAL EXAMINATION –
* FACIAL SYMMETRY –Bilaterally symmetrical.
* TMJ –
1.MOUTH OPENING
2. TENDERNESS
3. CLICKING
4. DEVIATION
5. MUSCLES OF MASTICATION
* LYMPH NODES - No lymphadenopathy
NAD

10. •INTRA ORAL EXAMINATION
LIPS – Competent
* SOFT TISSUE EXAMINATION –
1. BUCCAL MUCOSA– growth on left buccal mucosa
2. PALATE(soft&hard) – Normal
3. GINGIVA – Soft & edematous
4. ALVEOLAR MUCOSA – Normal
5. FLOOR OF THE MOUTH – Normal
6. TONGUE- Normal

11. *HARD TISSUE EXAMINATION -
OCCLUSION –
1. MOLAR RELATIONSHIP - Angle’s class 1 occlusion
2. CROWDING/ SPACING OF TEETH - Absent
3. TRAUMA FROM OCCLUSION - Absent
4. OVERJET – Normal
5. OVERBITE - Normal

12. TOOTH WEAR PATTERN -
• ATTRITION - Generalised
• ABRASION – Absent
• EROSION – Absent
• Stains-++
• Calculus-+

13. LESION PROPER
• INSPECTION –
* SITE – Nodular growth was present on left
buccal mucosa
* SIZE/ EXTENSION – 3.5x2.5x2.0 in diameter.
* COLOR – color of the normal mucosa
* NUMBER – Single in number.
* BORDERS – regular & circumscribed
* SURFACE - Smooth.

15. •PALPATION-
1. TENDERNESS – Absent on palpation.
2. CONSISTENCY – Soft to firm in consistency.
3. COMPRESSIBILITY – Absent
4. FLUCTUATION – Absent
5. FIXED / MOVABLE- Movable

16. PROVISIONAL DIAGNOSIS
TRAUMATIC FIBROMA

17. DIFFERENTIAL DIAGNOSIS
 MUCOCELE
 SALIVARY GLAND TUMOR
 MESENCHYMAL NEOPLASM

18. Lesions Clinical features Age and sex Location Sign and
symptoms
Mucocele Dome shaped nodule
usually covered by
epithelium;
Caused by pooling of
saliva at the site of
injured minor salivary
gland.
Commonly seen
in adolescents
and children.
With equal male
and female
predilection
Frequently seen in
lower lip and
buccal mucosa
and rare in upper
lip.
Generally
painless but
may be slightly
painful.
Salivary gland
tumour
Solitary , firm ,
asymptomatic mass
usually covered by
epithelium
Young adults and
adults are
commonly
involved
Commonly seen
on palate
by tongue ,upper
lip and buccal
mucosa
Causes pain
and
parasthesia
Mesenchymal
neoplasm
Firm asymptomatic
tumescence covered
intact epithelium;may
arise from connective
tissue cell
Can occur in any
age
Commonly seen
buccal mucosa
Pain/ painless

19. MACROSCOPIC DESCRIPTION
Received single bit of tissue specimen measuring 3.5 x 2.5 x2.0
cm in dimension, it was creamish white in color and soft in
consistency.

20. Atrophic epithelium
Mild inflammatory cells
Bundles of fibers

21.  The H and E stain of the received specimen shows
atrophic stratified squamous epithelium with
underlying connective tissue stroma.
 Mild subepithelial inflammatory cell infiltrate with
few macrophages are also seen
Thick bundles of collagen fibres are also evident.

22. FINAL DIAGNOSIS
Traumatic fibroma

23.  Soft tissue tumor-like lesion is said to be any
pathologic growth that projects above the normal
contour of the oral surface.
Different mechanisms may lead to the development of
a soft tissue tumor-like lesion in the oral cavity.

24. NATURE
The most common mechanisms included
reactive hyperplasia and neoplasia
The great majority of localized overgrowths of the oral
mucosa are considered to be reactive rather than
neoplastic in nature.

25. Many of these lesions can be identified as specific
entities on the basis of their histopathological features
and are divided into fibrous, vascular and giant cell
types.

26. REACTIVE LESIONS (SOLITARY)
Irritation fibroma
Peripheral ossifying fibroma
Pyogenic granuloma
Peripheral giant cell granuloma

27. ETIOPATHOGENESIS
Oral mucosa
subjected to low grade injuries like – chewing,
calculus,fractured teeh,iatrogenic factors like
overextended flanges of dentures,overhanging dental
restorations.
induce inflammation

28. Produce granulation tissue formation with endothelial and chronic
inflammatory cells
later fibroblasts proliferate
Manifest as an overgrowth
called reactive hyperplasias

29. Different histological entities of reactive hyperplasias
may be due to connective tissue response to varied
intensities of mucosal irritation

30. TRAUMATIC FIBROMA
• A fibroma is a benign tumour of connective tissue
commonly occuring in the oral cavity.
• Fibroma may occur in any part of the oral cavity but
most commonly seen on buccal mucosa along the
plain of occlusion.

31. OTHER NAMES
Irritational fibroma
Fibrous hyperplasia( histopathologic term)
It is a solitary reactive lesion

32. CLINICAL FEATURES
Commonly involved site is buccal mucosa and other
sites are gingiva, palate , tongue , lips .
It appears as an elevated nodule of normal color with
a smooth surface and a sessile or ocassionally
pedunculated base.
The tumor may be small or may range upto several
centimeters in diameter .
Projecting above the surface the tumor sometimes
become irritated and inflamed and even show
ulcerations.

33. HISTOPATHOLOGY
The fibroma consists of bundle of interlacing collagenous
fibres interspersed with varying number of fibroblasts or
fibrocytes .
The surface of lesion is covered by stratified squamous
epithelium which frequently appears stretched and shows
shortening of rete pegs .
If trauma to the tissue has occurred vasodilatation , edema
and inflammatory cells infiltrate
This has to be differentiated from neoplastic variant of fibroma

34. DIFFERENCES BETWEEN FIBROMA AND
INFLAMMATORY FIBROUS HYPERPLASIA
Characters Fibroma Inflammatory fibrous hyperplasia
Nature Neoplasia of connective tissue origin Inflammatory process
Etiology Constant irritation Trauma
Reversibility Does not regress even after removal
of cause
Resolves when irritant is removed
Epithelium Stretched and atrophic Proliferative with pseudoepithelium
atous hyperplasia
Inflammation It is seen only is lesion is traumatized Inflammation is integral part of the
lesion
Diagnosing fibroma from inflammatory fibrous hyperplasia becomes difficult.
When inflammatory fibrous hyperplasia heal completely it resemble fibroma by
formation of fibrous tissue

35. TREATMENT
The treatment is conservative surgical excision.

36. PROGNOSIS
The prognosis is good .