|Year : 2016 | Volume
| Issue : 2 | Page : 67-69
Epulis fissuratum in the soft palate: Report of a case in a very rare location
Hamed Mortazavi, Hamid Reza Khalighi, Soudeh Jafari, Maryam Baharvand
Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
|Date of Web Publication||9-Jun-2016|
Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Daneshjoo Blvd, Tabnak Street, Chamran Highway, 1983963113, Tehran
Source of Support: None, Conflict of Interest: None
Introduction: Epulis fissuratum is a tumor-like hyperplasia developing in association with an ill-fitting denture. Case Report: We report a 73-year-old female with epulis fissuratum in the soft palate as a very rare clinical location. She presented with the chief complaint of an abnormal growth along the posterior border of her ill-fitting upper complete denture as well as pain and discomfort during mastication. Intraoral examination revealed a polypoid fibrous mass, soft in consistency and smooth in texture. On history and clinical examination, a provisional diagnosis of denture-induced hyperplasia was made. The patient was prescribed topical anti-fungal medications for 10 days. Then, the lesion was excised surgically. Discussion: Histopathological examination revealed hyperplastic epithelium as well as a fibrous connective tissue with moderate inflammation which confirmed the clinical diagnosis. Although rare, epulis fissuratum can happen along the posterior portion of the upper denture and should be considered in intraoral examination.
Keywords: Denture-induced hyperplasia, epulis fissuratum, soft palate
|How to cite this article:|
Mortazavi H, Khalighi HR, Jafari S, Baharvand M. Epulis fissuratum in the soft palate: Report of a case in a very rare location. Dent Hypotheses 2016;7:67-9
| Introduction|| |
Denture-induced hyperplasia (DIH) or epulis fissuratum is a tumor-like hyperplasia of fibrous connective tissue, which develops in association with an ill-fitting complete or partial denture.  This entity most often occurs in middle-aged and older adults. It is reported in 5-10% of the jaws with dental prosthesis.  The anterior portion of the jaws is affected much more commonly than posterior areas.  According to the literature, two-thirds to three-fourths of all cases submitted for biopsy occurred in women.  Clinically, DIH appears as a single or multiple fold or folds of hyperplastic tissue along the denture borders. The size of this lesion can be <1 cm to massive lesions. , DIH is usually asymptomatic, but in some cases, severe inflammation and ulceration were reported. The chronic nature of this phenomenon means that discomfort is not a prominent feature. Therefore, the patient may continue to wear the offending denture until the hyperplastic lesion of considerable size develops before the patient becomes aware of the lesion and seeks for treatment.  Rosenquist pointed out that chronic trauma to the oral mucosa by the sharp edges of teeth or ragged borders of ill-fitting dentures have a potential to cause oral carcinoma. Hence, ill-fitting dentures and their sequelae should not be overlooked. 
| Case Report|| |
A 73-year-old female attended at the Oral Medicine Department with the chief complaint of an abnormal growth along the posterior border of her ill-fitting maxillary complete denture, which gradually grew in size over the past 5 months [Figure 1]. The denture was fabricated about 20 years ago. The patient has been suffering from pain and discomfort during mastication for the past 2 months. Meanwhile, she used to wear the denture during night time. Intraoral examination revealed a fibrous mass which was about 1 cm × 2.5 cm in size. The lesion was polypoid, soft in consistency, and smooth in texture [Figure 2]. In addition, clinical presentation of denture stomatitis and angular cheilitis was observed. Medical history was not contributory, and she did not use any medications except for vitamins and minerals.
|Figure 1: Epulis fissuratum along the posterior border of the upper denture|
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Differential diagnoses included irritation fibroma, leaf-like denture fibroma, benign mesenchymal tumors, and minor salivary gland tumors. , According to the patient's history and clinical examination, a provisional diagnosis of DIH was made.
The treatment protocol consisted of both medical and surgical approaches. The entire treatment plan was described to patient and written consent form was obtained from patient. The patient was instructed not to wear the denture. Nystatin oral suspension (Savorite Pharmaceuticals, Gujarat, India) and ointment of triamcinolon N.N. (RAHA Pharmaceutical Co., Isfahan, Iran) were prescribed for her denture stomatitis and angular cheilitis, respectively. The patient was educated and motivated to maintain her oral hygiene at optimum level.
After 10 days, the patient was recalled and the lesion was excised surgically. The specimen was sent for histopathological examination, which showed hyperplastic epithelium as well as a fibrous connective tissue with moderate inflammation [Figure 3].
|Figure 3: High-power photomicrograph showing hyperplastic fibrovascular connective tissue covered by stratified squamous epithelium (H and E)|
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After 7 days, the patient was reexamined and the healing process was satisfactory. Finally, the patient was referred to prosthodontics department to fabricate a new denture.
A 3-month follow-up showed complete resolution without any recurrence.
| Discussion|| |
The term "epulis" was first coined by Virchoft, and its dictionary meaning is "over the gum." Over the years, it was noticed that the usage of this term is not appropriate as it only referes to the site of lesion. Moreover, the affected mucosa is usually the oral mucosa of the vestibular sulcus or the palatal region and not the gingival mucosa. Therefore, "denture-induced fibrous hyperplasia" was considered to be a much preferred term.  DIH may be the result of ill-fitting denture, wearing denture all day and night long, poor oral hygiene, smoking, age-related changes, and systemic conditions.  In our case, ill-fitting denture and poor oral hygiene seemed to induce oral mucosal overgrowth. In agreement to the present case, Macedo Firoozmand et al. showed that 78% of denture wearer females presented with DIH mostly in the maxilla.  On the other hand, in almost all previous reports, DIH was demonstrated in the anterior portion of the mandible or maxilla. ,, To the best of our knowledge, this is the first report of DIH occurring in the soft palate along the posterior border of the upper denture.
DIH can be treated surgically or conservatively. In the early stage, denture coverage with a soft liner material is frequently sufficient for elimination or reduction of the lesion. However, in later stages, when the hyperplastic tissue is composed of significant fibrosis, surgical excision is the treatment of choice. Excision can be performed by either conventional surgical approach or laser ablation, which provides minimal postoperative edema and pain. ,, In a recent case report, the use of liquid nitrogen cryosurgery has been suggested to manage epulis fissuratum in geriatric patients.
| Conclusion|| |
Epulis fissuratum is a common oral lesion, which might develop in unusual locations as well.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]