epulis fissuratum

case presentation

1. Epulis Fissuratum By: Aleia S. Guzman

2. What is epulis fissuratum ? is a benign hyperplasia of fibrous connective tissue which develops as a reactive lesion to chronic mechanical irritation produced by the flange of a poorly fitting denture

3. Other terms inflammatory fibrous hyperplasia denture-induced fibrous inflammatory hyperplasia denture epulis denture injury tumor denture induced granuloma granuloma fissuratum

4. Definition of terms Epulis - is a general term for any gingival or alveolar tumor Granuloma- a mass of granulation tissue, typically produced in response to infection, inflammation, or the presence of a foreign substance. Tumor- a swelling of a part of the body, generally without inflammation, caused by an abnormal growth of tissue, whether benign or malignant. er cr ysgg laser – erbium laser. Excisional biopsy- procedure where the entire abnormality or area of interest is removed

5. etiology Prolonged use of ill fitting denture (removable partial denture/complete denture. Continued use of broken denture.

6. Differential diagnosis pain bleeding color Fast growing Pyogenic Granuloma Red/pink- purple Metastatic Neoplasms to the Oral Cavity Reddish Squamous Cell Carcinoma Reddish Epulis fissuratum pink /red

7. Related literature . This report presents a case of a 68-year old male patient with two soft tissue hyperplastic growths seen in the buccal vestibule in the lower anterior region. These lesions were removed using an Er,Cr:YSGG laser. The healing was uneventful and no suture or analgesic was required. The histopathological report confirmed the presurgical diagnosis. No relapse was observed till one year after surgery.

8. Related literature

9. Case presentation

10. Personal data Name: Lorna Gines Address: Cabubugan , Guimbal , Iloilo City Sex: Female Age: 57 years old Occupation: M assage therapist

11. Chief Complaint “ Nabudlayan ko magkaon kai naguba akon pustiso ”

12. History of present illness 20 years ago she visited a dentist because she can’t eat well due to she is partially edentulous and was fabricated a set of denture. 3 years prior to consultation her denture was destroyed while she was eating, according to her she ate something hard that cause the damaged to her denture. Despite the incident she continuously wears her denture because she can’t afford to pay a private dentist.

13. Medical history The patient was admitted to the hospital in 1993 due to child birth. She has no serious illness or systemic disease and is healthy.

14. Past dental history She had her first tooth extraction year 1984 and had her last tooth extracted 3 years ago due to severe caries.

15. Personal and social history The patient does not smoke and drink alcoholic beverages.

16. X-ray

17. Treatment plan Surgical excision on lesion Fabrication of complete denture

18. Surgical approach Excisional biopsy Using: Removal by scalpel Electrocautery

19. Principles of surgery Asepsis - Is a state of being free from disease-causing contaminants, or preventing contact with microorganism . Attained by: Proper hand washing Sterilizing of instruments and equipmentssss Reusing of used equipment is contraindicated Proper gear is needed (gloves, mask, lab gowns, head cap) Proper infection control before and after any procedure  

20. Principles of surgery Atraumatic Injury Maintenance of patient airway Good Anesthesia Control of Infection

21. advantages Tissue separation is clean with little or no bleeding. The technique is less pressure and precise. Planning of soft tissue is possible. Healing discomfort and scar formation is minimal. Access to difficult to reach area is increased. Chair time and operator fatigue are reduced No need to suture . Short healing period.

22. disadvantages Cannot be used on patients with poorly shielded pacemaker Cannot be used near flammable gasses. Odor of burning tissue is present if high volume suction is not used.

23. Armamentarium

24. Armamentarium

25. Armamentarium Mouth mirror Cheek retractor ( minesotta ) Allis forceps Hemostat 1% betadine Tissue forceps Cotton gauze Disposable syringe Syringe Needle Mask Gloves Anesthetic cartridge Topical anesthesia Normal saline solution Suction tip scalpel Kidney basin   Electrocautery Scalpel holder Specimen cup Head cap and gauze

26. Pre-op instructions Get enough sleep the night before the procedure. Take amoxicillin 500mg 1 capsule every 8hours for 7days. Eat before the procedure.

27. procedure Take blood pressure Let the patient gargle 1% betadine . Put betadine around the patients’ mouth . Retract. Dry the surgical area and apply topical anesthesia. Perform local infiltration. Use Allis forcep to grip the lesion and slightly pull. Using scalpel, remove the lesion with 2-3mm of normal appearing surrounding tissue and clean the area with NSS. Put the lesion in a specimen cup with NSS for biopsy. After removing the lesion use electrocautery to close the wound and to stop bleeding. Recall after 7 days.

28. procedure

29. procedure

30. procedure

31. procedure

32. medication Mefenamic acid 500mg 28 caps Sig : take 1 capsule every 6 hours for 7 days for pain or as needed. Amoxicillin 500mg 21 caps Sig . take 1 capsule every 8 hours for 7 days .

33. Post-op instructions Take all medications religiously 30 mins . after meal Gargle chlorhexatedine 15 ml for 30 seconds twice a day for 2 weeks. Avoid stressful activities. Do not wear the denture. Avoid touching the affected. Avoid sipping beverages. Soft diet for 7 days.

34. recall

35. After 14 days

36. biopsy

37. conclusion Surgical wound healing using electrocautery is faster compared to other techniques and the chance of epulis fissuratum recurrence is very low if new denture is fabricated.