Oral fibroma is a benign neoplasm consisting of fibers of mature connective tissue. It is a clearly delimited rounded nodule on a leg or a wide base, covered with unchanged mucosa. It is characterized by slow exophytic growth. Pathology can be located on the inner surface of the cheeks, the mucous membrane of the lips, the soft palate, gums, tongue. Diagnosis of disease is made by examination, palpation, ultrasound and histological examination. Orthopantomogram, radiography and periodontogram are used to identify inflammatory processes that provoked the formation of fibroma. Treatment is reduced to its excision, for which a laser or a radio wave knife can be used.
ICD 10
D10 Benign neoplasm of the mouth and pharynx
Meaning
Oral fibroma is a tumor of mesodermal nature. Along with papilloma, lipoma, fibroids, nevus and myxoma, it is a benign tumor of the oral cavity. There are tumors of mixed structure – for example, angiofibromas. A type of oral fibroma is epulis. Fibroma is most common in children from 6 to 15 years old. It is localized in the gums, cheeks, lips, soft palate, tongue.
Causes
Clinical dentistry considers traumatic and inflammatory factors to be the causes of the formation of oral fibroma, and hereditary predisposition is also traced. Quite often, in the anamnesis of patients with oral fibroma, regular biting of the same area of soft tissues of the oral cavity preceding its appearance is revealed. Factors provoking the appearance of fibroma also include injury to the mucous membrane with a sharp tooth edge, poorly fixed prosthesis or crown; chronic inflammatory processes of the oral cavity (gingivitis, stomatitis, periodontitis, glossitis, etc.).
Classification
Dense oral fibroma has a dense consistency due to the fact that it consists of coarse connective tissue fibers containing a small number of nuclei and tightly adjacent to each other. It is usually located on the hard palate and in the gum area.
Soft fibroma has a soft consistency due to the fact that it is formed by thin loosely arranged connective tissue fibers with a large number of nuclei. Frequent localization of soft oral fibroma is the mucous membrane of the tongue and cheeks. On the tongue and the mucous membrane of the bottom of the oral cavity, sometimes there are neoplasms of a mixed type — fibrohemangioma, fibrolipoma, etc.
Fibroma from irritation is not a true tumor, but is the result of hyperplasia of a reactive nature, developing in response to chronic irritating effects of mechanical or chemical factors. This is the most common type of oral fibroma. Fibroma from irritation appears on the mucous membrane in the form of a pinkish papule. As it grows, it transforms into a dense nodule having a regular rounded shape. Repeated injury can lead to the appearance of tuberosity on the surface of the formation and its ulceration.
Symmetrical fibroids are formed in the area of the third painters on the palatine surface of the gum. They have a dense consistency and bean-shaped shape. These formations are not a true oral fibroma, but represent an overgrowth of the gum, accompanied by cicatricial changes.
Lobular oral fibroma is characterized by a bumpy surface and occurs as a result of reactive hyperplasia of the gum tissue during its chronic injury with a removable prosthesis.
Fibrous epulis. This name is the oral fibroma, localized on the gum. Usually fibrous epulis is characterized by a dense consistency and very slow growth.
Symptoms
The oral fibroma has the appearance of a formation towering above the general surface of the mucous membrane with a wide base or leg. It is painless, has a hemispherical shape and is covered with a mucous membrane of the usual pink color. The surface of the oral fibroma is smooth and, unlike papilloma, has no outgrowths. There are usually no changes in the mucosa in the fibroma area.
In rare cases, ulceration is noted above the tumor. In this case, it is possible to attach an infection with the development of inflammatory manifestations: redness, swelling, soreness in the fibroma area. For oral fibroma, a slow increase in size is typical. If the fibroma is not traumatized, then its size can remain stable for a long time. With constant traumatization, malignant degeneration of the tumor is possible.
Diagnostics
The characteristic clinical picture of oral fibroma in most cases allows the dentist to make a diagnosis based on examination and palpation of the formation. An important point is the diagnosis of the causal factor of the formation of oral fibroma. For this purpose, a thorough dental examination is carried out, aimed at identifying inflammatory diseases of the oral cavity. Patients with dentures need to consult an orthopedic dentist to exclude the traumatic effect of the existing prosthesis on the tissues of the oral cavity.
Ultrasound is possible to determine the depth of germination of the fibroma base into the underlying tissues. In order to correctly assess the neoplasm, radiovisiography and orthopantomogram are performed. In rare cases, usually in the presence of ulceration or inflammatory changes in the fibroma area, a biopsy of the formation is indicated. More often, histological examination of oral fibroma is carried out after its removal.
Differential diagnosis
Differential diagnosis of fibroma should be carried out with lipoma, papilloma, wart, epulis of various structures, neurinoma, etc. When the oral fibroma is localized on the tongue, it is differentiated from other benign tumors of the tongue and from tongue cancer.
Treatment
The most effective method of treating oral fibroma is its surgical excision, which can be performed using a laser or radio wave method. Fibroids of the oral cavity on the leg are removed together with the leg by two edging incisions. The fibroma on the base is excised together with the base by a fringing or arcuate incision.
Removal of the fibroma on the red border of the lip is performed by an incision perpendicular to the passage of the fibers of the circular muscle of the mouth. In case of oral fibroma of a large size, a flap closure of the defect remaining after removal of the tumor is performed to prevent deformation of the mucosa. The flap is cut out by a V-shaped incision from adjacent fabrics.
Literature
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- Amirchaghmaghi M. Survey of reactive hyperplastic lesions of the oral cavity in Mashhad, Northeast Iran / M.Amirchaghmaghi, N.Mohtasham, PM.Mozafari, Z.Dalirsani // J Dent Res Dent Clin Dent Prospect. – 2011. – Vol. 5. – №4. – P. 128-131.
- Barot VJ. Peripheral ossifying fibroma: a case report / V.Barot, S.Chandran, S.Vishnoi // J Indian Soc Periodontol. – 2013. – Vol. 17. – №6. – P. 819-822. link
- Bentz B .G . Masses of salivary gland region in children / BG.Bentz, CA.Hughes, JP.Ludemann, J.Maddalozzo // Arch Otolaryngol Head Neck Surg. 2000. – Vol. 126. – P. 1435-1439.
- Bharti V. Capillary hemangioma of palatal mucosa / V.Bharti, J.Singh // J Indian Soc Periodontol. – 2012. – Vol. 16. – №3. -P. 475-478.
- Gallarreta F .W. Oral changes stemming from hemangioma of the tongue / F.W.Gallarreta, K.A.Pieroni, C.P.Mantovani, F.W.Silva, P.Nelson-Filho, A.M.de Queiroz // Pediatr Dent. – 2013. – Vol.35. №2. – P. 75-78.
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