Madhuri Nath et al

126

JDSOR

Excision of Irrational Fibroma with Diode Laser1Madhuri Nath, 2Pallavi Vashisth, 3Sathyajith Naik, 4Shiva Manjunath, 5Swati Tripathi, 6Shivangi Sharma

ABSTRACT

Irritational fibroma represents a reactive focal fibrous hyperpla-sia due to trauma or local irritation. The lesion is hyperplastic proliferation of the oral mucosa and classified as reactive tumor of fibrous connective tissue. Various treatment modalities are available like scalpel excision, electrocautery, cryosurgery, and lasers. The use of lasers in different dental procedures has become very common because of its ease of use, pain-less procedure, and better quality of hemostasis. This article presents a case of a 9-year-old patient with painless growth on the ventral surface of tongue, which was diagnosed as irritation fibroma and treated with diode laser.

Keywords: Fibroma, Irritation, Lasers, Oral cavity.

How to cite this article: Nath M, Vashisth P, Naik S, Manjunath S, Tripathi S, Sharma S. Excision of Irrational Fibroma with Diode Laser. J Dent Sci Oral Rehab 2017;8(3):126-129.

Source of support: Nil

Conflict of interest: None

INTRODUCTION

Fibromas are the most common benign oral soft-tissue neoplasms of mesenchymal origin that are composed of fibrous connective tissue.1 These lesions clinically appear as firm, pink, painless, sessile or pedunculated, polypoid swelling with varying sizes, which range in a few millimeters.2 They can occur in any body organ and are known as irritation fibroma, traumatic fibroma, focal fibrous hyperplasia, fibrous nodule, or fibroepi-thelial polyp.3 Traumatic fibroma also known as irrita-tion fibroma is a common benign exophytic oral lesion that develops secondary to tissue injury. The traumatic fibroma is among the most common benign reactive lesions.4,5 The definite treatment of irritation fibroma is surgical excision with no recurrence after removal of the stimulus. Conventional scalpels, electrocautery, radiosurgery, and lasers have been used for excision.6

CASE REPORT

1Postgraduate Student, 2,5Reader, 3,4Professor and Head 6Senior Lecturer1-6Department of Pedodontics and Preventive Dentistry, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India

Corresponding Author: Madhuri Nath, Postgraduate Student Department of Pedodontics and Preventive Dentistry, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India, Phone: +918954621116, e-mail: madhurinath2015@gmail.com

10.5005/jp-journals-10039-1173

This case report presents a case of traumatic or irritation fibroma on ventral surface of tongue, which was excised with diode lasers.

CASE REPORT

A 9-year-old male patient reported to the Department of Pedodontics and Preventive Dentistry with a chief complaint of a growth on the tongue. The growth started as a small painless growth 6 months back and gradually increased to its present size. Patient did not present any relevant medical history. Extraoral examination revealed no abnormality, whereas the intraoral examination revealed growth on the ventral surface of the tongue on left side. The growth was pinkish red in color, smooth, pedunculated, ovoid in shape, and firm in consistency (Fig. 1). The growth was around 0.9 × 0.6 cm in dimension, painless, and firm in consistency. After administration of local anesthesia (Fig. 2), a diode laser of wavelength of 810 nm fibers with a diameter of 400 nm at 0.8 to 1.2 W in a continuous mode was applied in contact mode. The fiberoptic tip was placed at the periphery and gradually moved around the lesion, continuously fixing the laser to dissect out the fibroma completely (Fig. 3). The excised tissue was immersed in 10% formalin solution and sent for histopathological examination. After excision of the lesion, sutures were placed and patient reported back with uneventful healing of the tissue (Fig. 4).

HISTOPATHOLOGICAL ANALYSIS

Hematoxylin and eosin-stained section showed the following:

Fig. 1: Preoperative intraoral view

Excision of Irrational Fibroma with Diode Laser

Journal of Dental Sciences and Oral Rehabilitation, July-September 2017;8(3):126-129 127

JDSOR

Fig. 2: Administration of local anesthesia before excision Fig. 3: Excision of the lesion with diode laser

Fig. 4: Postoperative suture placement

Under scanner view: Two pieces of tissue with irregular, discontinuous epithelium overlying extremely cellular and vascular connective tissue stroma.

Under low power and higher magnification: The overly-ing epithelium is of the stratified squamous parakera-tinized type. Connective tissue stroma comprises loose dense bundles of collagen fibers with predominantly plump-shaped fibroblasts. Numerous epithelial lined blood vessels with red blood cells (RBCs) and extravas-sated RBCs were evident. Numerous budding capillar-ies along with endothelial cell proliferation were also appreciated. Chronic inflammatory infiltrate predomi-nantly comprising lymphocytes was evident in many areas (Fig. 5).

DISCUSSION

Irritational fibromas are localized lesions and typically appear as dome-shaped or pedunculated nodules of the same color as the surrounding mucosa. The lesion surface may appear white as a result of hyperkeratosis due to

continued irritation. Lesion size varies from several milli-meters to several centimeters in diameter. However, the majority of fibromas are 2.0 cm or less in diameter. These lesions are associated with no particular symptoms except for a feeling of irritation, unless secondary traumatic ulceration of the surface has occurred.7,8

Lesions are often encapsulated, usually well delimi-ted, and do not produce metastasis. Microscopically, fibromas appear as a nodular mass of fibrous connec-tive tissue with collagen fibers mixed to fibroblasts and covered by a keratinized squamous epithelium. Recur-rence is rare and may be caused by repetitive trauma at the same site.9,10

Various treatment modalities are available for treat-ing fibromas like excision with scalpel, electrocautery, radiosurgery, and lasers. Complete treatment of irri-tational fibroma consists of elimination of etiological factors, scaling of adjacent teeth, and total aggressive sur-gical excision along with involved periodontal ligament and periosteum to minimize the possibility of recurrence. In case of soft tissue, excision of involved surrounding tissue is done. Long-term postoperative follow-up is extremely important because of the high growth potential of incompletely removed lesion.

Excision is one of the most regularly conducted treatment procedures; the perfect removal of the lesion should be instant, bloodless, painless, and linked with quick recovery from treatment. Scalpel is often used because of its perfection, minimal harm to cells, and convenience of use. However, conversely, better quality of hemostasis will not be offered by scalpel, which is crucial in oral cavity as it is an incredibly perfused region. This led to use of laser in dentistry where it is the most frequently used cutting tool in most parts of the world.2

Madhuri Nath et al

128

Fig. 5: Histopathological analysis of the specimen

Excision of Irrational Fibroma with Diode Laser

Journal of Dental Sciences and Oral Rehabilitation, July-September 2017;8(3):126-129 129

JDSOR

Electrocautery is another means of treatment. Advan-tages of this technique include: It cuts on its side as well as tip, cuts are made with ease when the device is set cor-rectly, hemostasis is immediate and consistent, the wound is nearly painless, and the tips are self-disinfecting. Various disadvantages are also related to it like there is need for administration of local anesthesia for cutting, unavoidable burning flesh odor, low tactile sense, and bone damage also occurring. The limitations with these conventional modalities lead to the use of lasers for soft tissue surgeries.11

The laser is a relatively new and modern technology developed by Maiman in 1960. However, it was first suc-cessfully used in the oral cavity in 1977 with subsequent improvements and innovations over time. These included the development of the carbon dioxide laser, neodymium-doped yttrium aluminum garnet, and the diode laser. The diode laser, which was introduced in dentistry since 1999, is a solid state semiconductor laser that typically uses a combination of gallium, arsenide, and other elements, such as aluminum and indium. The diode laser system has found wide recognition in the areas of lasers as a result of its practical characteristics and is considered as an important tool for a large number of applications. It has a wavelength ranging from 810 to 980 nm. This energy level is absorbed by pigments in the soft tissues and makes the diode laser an excellent hemostatic agent. Thereby, it is a tool for soft tissue surgeries as well.12

The significant benefits described in the literature for treating a lesion with diode laser are negligible postop-erative inflammation and damage, enhanced healing, and reduced postoperative pain. Other advantages of the laser when compared with scalpel are highly decon-taminated surgical bed, reduced mechanical trauma, no need for periodontal dressing, and the appearance of fewer myofibroblasts resulting in comparatively lesser wound contraction.2

It also increases collagen production, fibroblastic proliferation, and increases in local microvascularization. This biological effect occurs due to increase of adenosine triphosphate synthesis, increase of nuclear acid produc-tion, and gene expression.

As this procedure is simple and painless, it would be more acceptable for pediatric patients. The procedure can be done using behavior management techniques, which are well tolerated by children. Thus, lasers are the preferred choice of treatment in the present case.

CONCLUSION

It can be concluded that excision of traumatic fibroma with diode laser is a relatively simple and safe method. Easy handling of the fiberoptic tip combined with the properties of diode laser helped in obtaining a clean, thin, and fast cut; without bleeding or scarring. Because of the sterilizing and tissue growth stimulating properties of the laser, we were able to obtain excellent healing in a few days, even without surgical suturing.

REFERENCES

1. Patel H, Fernandes S, Ranadher E. Excision of irritation fibroma in a child with diode laser: a case report. Int J Adv Res 2015 Sep;3(9):813-819.

2. Koppolu P, Mishra A, Kalakonda B, Swapna LA, Bagalkotkar A, Macha D. Fibroepithelial poly excision with laser and scalpel: a comparative evaluation. Int J Curr Microbiol App Sci 2014 Aug;3(8):1057-1062.

3. Toida M, Murakami T, Kato K, Kusunoki Y, Yasuda S, Fujitsuka H, Ichihara H, Watanabe F, Shimokawa K, Tatematsu N. Irrita-tion fibroma of the oral mucosa: a clinicopathological study of 129 lesions in 124 cases. Oral Med Pathol 2001 Jan;6:91-94.

4. Bouquot JE, Gundlach KK. Oral exophytic lesions in 23, 616 white Americans over 35 years of age. Oral Surg Oral Med Oral Pathol 1986 Sep;62(3):284-291.

5. Kalyanyama BM, Matee MI, Vuhahula E. Oral tumors in Tan-zanian children based on biopsy materials examined over 15 years period from1982 to 1997. Int Dent J 2002 Feb;52(1):10-14.

6. Arora S, Lamba AK, Faraz F, Tandon S, Chawla K, Yadav N. Treatment of oral fibroma of the tongue using Erbium, Chromium:Yttrium-Scandium-Gallium-Garnet lasers: report of two cases. Clin Adv Periodont 2014 Feb;4(1):25-30.

7. Marx, RE.; Stern, D. Oral and maxillofacial pathology: a rationale for diagnosis and treatment. 2nd ed. Vol. 4. Chicago: Quintessence Publishing Company, Incorporation; 2012. pp. 399-466.

8. Im Y-G, Kim B-G. Survey of pain to palpation of the occipi-tofrontalis muscle in patients with temporomandibular disorders. J Oral Med Pain 2010 Sep;35:213-219.

9. Bahadure RN, Fulzele P, Thosar N, Badole G, Baliga S. Conven-tional surgical treatment of oral mucocele: a series of 23 cases. Eur J Paediatr Dent 2012 Jun;13(2):143-146.

10. Neville, B.; Damm, DD.; Allen, CM.; Bouquot, J. Oral and maxillofacial pathology. 3rd ed. Vol. 3. Oxford: Saunders Elsevier; 2009. pp. 507-509.

11. Funde S, Baburaj MD, Pimpale SK. Comparison between laser, electrocautery and scalpel in the treatment of drug-induced gingival overgrowth: a case report. Int J Sci Soc 2015 Mar;1(10):27-30.

12. Ize-Iyamu IN, Saheeb BD, Edetanlen BE. Comparing the 810 nm diode laser with conventional surgery in orthodontic soft tissue procedures. Ghana Med J 2013 Sep;47(3):107-111.