Excision of Irritational Fibroma of Tongue with Electrocautery: A Case Report

Moitra PN, Bansod s, Ghom S, Agrawal PK and Banerjee A

Published on: 2024-04-10

Abstract

Traumatic or irritational fibroma is a common benign exophytic and reactive oral lesion that develops secondary to injury. Fibroma is a result of a chronic repair process that includes granulation tissue and scar formation, resulting in a fibrous submucosal mass. The most common sites of traumatic fibroma are the tongue, buccal mucosa, and lower labial mucosa. This article presents the case of a 41-year-old male patient with a 2-month-long proliferation on the lateral surface of the tongue. Here, electrocautery was used for the complete excision of the lesion. The main advantages of using it are effective hemostasis that can be achieved in a short span, being less invasive, and a better postoperative phase.

Keywords

Case Report, Traumatic Fibroma, Electrocautery

Introduction

Oral mucosa and soft tissues are constantly exposed to multiple low-intensity internal and external injuries, which may produce different reactive anomalies, including chronic infectious or inflammatory processes, physical or chemical irritations, and neoplastic tumor-like conditions. Common examples of this type of stimulus are cheek and tongue biting, trapped food, impacted biofilm or debris, sharp edges of broken or carious teeth, and overhanging dental restorations or orthodontic appliances [1,2]. Possible consequences of such irritating factors include the occurrence of localized proliferative hyperplastic progressive lesions [3]. Focal fibrous hyperplasia (traumatic fibroma, irritation fibroma, and fibrous epulis) is considered the most common soft-tissue benign neoplastic lesion in the oral cavity [4,5]. It constitutes around 20% of the oral reactive hyperplastic lesions, and females are affected almost twice as frequently as males [1,5]. Its clinical manifestations are a pedunculated or sessile firm mass with a few centimeters in diameter, smooth-surfaced (the surface can be hyperkeratotic or ulcerated), yellowish-white or mucosal coloured (pink to red), and more frequently present in the gingiva and mucosa (along the line of occlusion) [6]. Other less common intraoral sites are the tongue, lower lip, hard palate, and floor of the mouth [3,6]. Histologically, this entity is characterized by an unencapsulated solid, nodular mass of dense and sometimes hyalinized fibrous connective tissue; it is composed of interlacing collagen fiber bundles, within which there are fibroblasts and some small blood vessels [2]. It rarely causes erosions in the underlying bone tissue or the separation of adjacent teeth [5]. The removal of the etiological factor is mandatory. In several cases, it disappears after this measure. When the lesion persists, the first treatment option is surgical excision, and recurrences are very uncommon [7]. Various surgical options, including the conventional scalpel and laser, have been suggested; electrosurgery and cryotherapy are other available treatment options. The aim of this report is to describe the clinical presentation, provided treatment, and follow-up of a fibroma on the right lateral surface of the tongue in a 41-year-old male patient.

Case Report

A 41-year-old male patient reported to the department of oral medicine and radiology complaining of a small, painless swelling seen in relation to the right lateral surface of the tongue for 2 months. On clinical examination, the lesion revealed a single, pink, pedunculated, and smooth-surfaced nodule of size 1x0.8 cm, approximately on the right lateral aspect of the tongue. Based on history and clinical findings, a provisional diagnosis of irritational fibroma was given. The list of differential diagnoses includes chronic fibrous epulis, peripheral giant cell granuloma, osteosarcoma, chondrosarcoma, pyogenic granuloma, and peripheral odontogenic fibroma. The patient was systemically healthy. A complete hemogram revealed all blood cell counts within normal limits. As the patient reported discomfort during eating and while speaking, it was decided to go for an excisional biopsy performed under LA using an electrocautery following oral prophylaxis. An infiltration anesthesia of lignocaine containing 1:200,000 adrenaline was given in the area of interest. The electrocautery unit was set to cutting mode, and the growth was excised en masse using the loop electrode with normal saline for irrigation. Hemostasis was achieved. The specimen was then transferred to a vial containing 10% formalin and sent for histopathological assessment. Prior to discharge, post-operative instructions were given to the patient, with the advice to take analgesics should the need arise. The one-week recall revealed uneventful healing. No recurrence of the growth was observed during the two-month and six-month follow-up periods.

Fig 1: Intraoral Photograph Showing Irritation Fibroma.

Fig 2: Postoperative View.

Fig 3: Biopsy Specimen.

Fig 4: Follow Up After 1 Week.

Histological Examination

The hematoxylin and eosin-stained sections show parakeratinized stratified squamous epithelium. The connective tissue shows increased cellularity with numerous small and large endothelial cell-lined blood vessels, diffuse chronic inflammatory infiltrates chiefly composed of lymphocytes and plasma cells, and dense collagen fiber bundles arranged haphazardly. Based on this, a diagnosis of “irritational fibroma” was made.

Fig 5: Histopathological View.

Discussion

Localized fibrous tissue growths are common in the oral mucosa. The etiology of an irritational fibroma is usually due to continuous irritation. irritational fibromas shows 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) [8]. Other 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. The treatment of irritation fibroma is removing the etiological factors, scaling of adjacent teeth, and total surgical excision along with periosteum to minimize the possibility of recurrence. any irritant which can be seen, such as an ill-fitting denture, root stumps, and rough restoration should be removed. Long-term postoperative follow-up is most important because of the high growth potential of incomplete removed lesion [9]. It does not have a risk for malignancy [10]. Excisional biopsy is curative and its findings are diagnostic, sometimes recurrence is possible if the exposure to irritant persists [9]. Females are affected more than males [11]. The high female predilection and a peak occurrence in the second decade of life suggested hormonal influences. It Commonly occurs on buccal mucosa and other sites like gingiva, palate, tongue, lips. It appears as an elevated growth of normal colour with a smooth surface and a sessile or occasionally pedunculated base.

Conclusion

So, it is of importance to distinguish between hyperplasia and neoplasia as neoplasia are not self-limiting conditions and long-standing hyperplastic lesions in presence of chronic irritation can get converted to neoplasia. In addition to the physical characteristics of the lesion, the patient’s demographics, presence of associated symptoms, related systemic disorders, and location and growth patterns of the lesion all give clues to adequately diagnose and treat their typical histopathologic architecture.

Source of Funding

None

Conflict of Interest