Irritational Fibroma in Children: A Case Report

INTRODUCTION

Fibroma, a benign neoplasm of fibroblastic origin, represents a reactive hyperplasia of fibrous connective tissue in response to local irritation or trauma.¹ Various kinds of reactive lesions may occur on gingival mucosa. The etiology for these lesions may be irritants like plaque, calculus, overhanging margins and restorations. Irritational fibroma represents a reactive focal fibrous hyperplasia due to trauma or local irritation.² The size of the growth is generally smaller than 1.5 cm, although there are few reports of 4–6 cm. Irritation fibroma is most commonly prevalent in anterior region and usually associated with interdental papilla.³ The most common clinical aspect is the growth of a well-limited smooth-surfaced tissue, usually of a normal coloured mucosa, having a sessile or pedunculated base, hard consistency, and smaller than 1.5 cm at its highest diameter.³ It is usually characterized by a slow, painless growth accumulated over a period of months or years.⁴

This paper represents the case of a Irritational fibroma present on the labial mucosa of upper anterior in a 5-year-old child.

CASE REPORT

A 5-year-old female patient reported to the satellite centre running by KD dental college Shri Shyam Laxmi Dant Chiktsalaya (Shri Mataji Gaushala), Barsana Mathura (UP) with a chief complaint of an uncomfortable growth in the upper front tooth region of her mouth. She described it as a slow-growing mass on the upper labial region that appeared roughly 1 month ago. It was painless but created an irritation during speech and aesthetically.

On intraoral examination, a small, smooth-surfaced, and pedunculated growth was observed in the interdental papillary region of the labial mucosa, in front of the Right central & Lateral incisor. It was about 1 × 1cm in size, soft, nontender, and attached to the labial mucosa.

After obtaining an informed consent, routine blood investigations were carried out before undertaking the patient for surgery. Based on all the findings, the provisional diagnosis was made to be irritation fibroma on the labial mucosa due to unknown etiology. Possible differential diagnoses included giant cell granuloma, pyogenic granuloma, neurofibroma, or a benign salivary gland tumor, which would further be investigated by the biopsy. The treatment was thus planned to surgically excise the lesion. Phase I therapy involved supragingival scaling and rinses with chlorhexidine mouthwash twice daily for 1 week. The surgical procedure was then carried out wherein the lesion was completely excised using a BP blade after administering local anesthesia.

The histopathological report of the excisional biopsy showed Ortho keratinized stratified squamous epithelium with short rete pegs. The connective tissue stroma consisted of abundant collagen fibre bundles with proliferating fibroblasts, chronic inflammatory cells, and blood vessels, all of which were suggestive of a fibroma. The patient was followed up for 9 months since the treatment throughout which he displayed no signs of recurrence.

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).⁵ 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.⁶

In this case report, the recurrence of the pathology was attributed to two possible reasons: non removal of the irritant and/or incomplete surgical excision of the lesion. A thorough oral examination was essential to point out the previously unnoticed irritant/etiological factor, which was found to be trauma from occlusion on the palate from the lower incisors, owing to the presence of a deep bite. Thus, for complete treatment, a multidisciplinary approach was adopted.⁷

CONCLUSION

Irritational fibroma clinically resembles with various lesions such as and peripheral giant cell granuloma, pyogenic granuloma so proper histopathologic investigation and radiographic evaluation are necessary for exact and final diagnosis.

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