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This paper reports four cases of osteosarcoma of the jaw, a rare malignant bone tumor in the oral and maxillofacial region. Two patients were males and two were females. The age at the first visit ranged 55–69 years (average age, 63.8 years). Three and one patients had a tumor in the mandible and the maxilla, respectively. One mandibular patient had a history of radiotherapy for laryngeal cancer. Radiologically, two cases were of the osteolytic type, and two were of the osteosclerotic type. Two cases of the osteolytic type were diagnosed as malignant tumors, while the other two cases of the osteosclerotic type were as benign lesions (e.g., epulis osteoplastica and osteomyelitis). Pathologically, three and one cases were classified as conventional (osteoblastic type) and secondary (radiation-induced) osteosarcomas, respectively. All patients underwent surgical tumor resection without any adjunctive treatments. Consequently, one patient had no recurrence for 14 years after surgical treatment and the other three had local recurrence and/or distant metastasis, resulting in unfavorable outcomes despite further treatments. Osteosarcoma should be included as a differential diagnosis for bone-forming lesions of the jaw. Furthermore, complete surgical resection combined with adjuvant therapies would be necessary to improve the treatment outcome of jaw osteosarcomas.

Background: Congenital bifid tongue without other craniofacial abnormalities is a very rare malformation. Here, we discuss a case of the bifid tongue with cleft palate, reported in a 7-month-old girl with no other syndromes or craniofacial abnormalities. Case Reports: This case report described a 7-month-old girl with an anterior bifid tongue, separated medially by a soft, solitary sublingual mass measuring 3 cm x 2 cm in size. There was also an associated incomplete cleft palate. A soft solitary mass measuring 2 cm x 2 cm in size was also seen within the cleft palate. Results: Computed facial tomography (CT) revealed a midline hard palate defect with an intact alveolar process of the maxilla. Pedunculated cystic lesion suspected with epulis was noted to arise on premaxillary alveolar mucosa. Excision of the tongue and hard palate mass and repair of the bifid tongue were done. Summary: Congenital bifid tongue with a cleft is a very rare malformation with different variations. Early surgical intervention is critical to prevent speech impairment and swallowing disorders. A multidisciplinary approach, including well-planned staged operations and rehabilitation, is important to achieve favorable outcomes.

Rhabdomyosarcoma is a malignant neoplasm of mesenchymal cells, which shows varying degrees of striated muscle cell differentiation. It predominantly occurs in children while rarely found in adults. Involvement of the oral cavity accounts for only 10-12% of all head and neck cases. Herewith, we report a rare case of oral spindle cell / sclerosing rhabdomyosarcoma in a 47-year-old male presented with a small mass involving the gingiva of right upper incisor. The mass was excised with a preoperative diagnosis of gingival epulis and subjected to histopathological and immunohistochemical examination which confirmed it to be spindle cell / sclerosing rhabdomyosarcoma. Data regarding its clinical course, genetic abnormalities and prognosis as a combined subtype is scant. Keywords: Adult spindle cell/sclerosingrhabdomyosarcoma (S­ScRMS) Oral Cavity, Rhabdomyosarcoma, Maxillary Gingiva, Immunohistochemistry

“Epulis” is a widely used term to describe a localized gingival enlargement. However, a wide range of neoformations might present as localized, slow-growing, asymptomatic gingival masses. A systematic review was conducted to outline the pathological entities that were provisionally dignosed as “epulis” and whose final diagnosis was made after microscopic examination. An electronic search of PubMed, Google Scholar and Scopus databases from January 2000 to February 2021 was performed. An initial search of the databases identified a total of 864 documents, and after a careful process of screening and selection, 14 studies were included in this systematic review and processed for data extraction. The results show that histological examination, sometimes combined with immunohistochemistry, might reveal a wide spectrum of lesions, including hamartomatous lesions, non-neoplastic lesions, benign and malign neoplasms and metastases from distant cancers.

Summary Congenital granular cell epulis is a rare benign lesion usually arising as single mass from the alveolar ridge of maxillary bone of female newborns, composed of polygonal granular cells that typically stain negative for S-100, in contrast to the adult counterpart. Larger lesions can disturb breathing and breast-feeding, requiring surgery. Prenatal diagnosis is achieved in few cases, even if this would be important for best management of delivery and therapy. Here we present a case of multiple CGCE in a female newborn discovered at birth, together with a brief review of pathogenesis, differential diagnoses and treatment implications of early diagnosis.

Peripheral Giant Cell Granuloma or the so called “Giant Cell Epulis” is the most common oral giant cell lesion. It is described as non-neoplastic, hyperplastic lesion occurring exclusively on gingival/alveolar crest that appears as a overgrowth of tissues, following trauma or irritation arising from periosteum or periodontal membrane. It can be sessile or pedunculated with size usually less than 2cm. Although being uncommon, this lesion carries a lot of uncertainity in terms of its etiology, growth potential, biological behavior (recurrence), histogenesis of its cells and its treatment. We hereby report a case of a 49-year old male patient, with peripheral giant cell granuloma in mandibular posterior region, who was successfully treated and is on regular follow up since 6 months. Keywords: Peripheral giant cell granuloma, Epulis, Reactive, Benign, Hyperplastic, Osteoclasts, Multinucleated giant cell, Reparative giant cell granuloma, Osteoclastoma

Epulis is a benign neoplasm that is quite common in the practice of a dentist. It is a soft tissue formation on the peduncle that connects it to the gum. Sources of growth of epulis are most often the periodontium of the tooth, therefore, the neoplasm is very rarely found on the edentulous jaw or in the area of implants. Treatment of epulis is to eliminate the etiological factor, and excision of the formation together with the periosteum. In our practice, we first encountered an epulis that appeared in the area of previously installed implants. The excised mass was sent for pathological and histological examination, according to the results of which the conclusion was given: angiomatous epulis with a giant cell area with an expression.

Congenital granular cell tumour (CGCT) is a benign lesion that predominantly arises from the alveolar ridges of neonates, especially the maxilla. However, it’s only 10 percent of multiple lesions in all reported cases, in which simultaneously mandibular and maxillary involvements are more extremely rare. For treatments of multiple CGCTs, few standard procedures were reported. In addition to surgical excision, which refers to a preferred method, conservative treatment is an available choice. Here, a case of multiple CGCTs using different therapeutic strategies was reported because of its rarity and innovation. A five-day-old female newborn presented two congenital masses attached to the right mandibular and maxillary alveolar ridge. The size of the mandibular lesion causing difficulty in feeding was 3 cm in diameter and 0.5 cm in the maxilla. Based on different manifestations, surgical excision and conservative treatment were adopted respectively. The mandibular mass was excised while that in the maxilla underwent spontaneous regression. Satisfactory results were achieved for this patient. There was no evidence of recurrence after a 6-month follow-up. Microscopic examination and immunohistochemistry analysis confirmed the diagnosis and differential diagnosis of CGCT and even proposed the possibility of histogenesis from neural crest. Moreover, we reviewed the literature and summarized the characteristics to provide new ideas for the treatment of multiple CGCTs.

Intraoral fibroma is a common lesion that develops in the oral cavity following trauma or tissue injury. It has a strong female predilection and is more frequently seen in the third and fourth decades of life. The most common site of traumatic fibroma is buccal mucosa along the plane of occlusion. The conventional method for excision of fibromas is using surgical blades. However, this method has certain disadvantages such as excessive bleeding and pain to the patient during the excision. Postoperatively, there can be delayed wound healing with occasional scarring. With the introduction of diode lasers for soft-tissue excisions in dentistry, we can now overcome these limitations. Here, we present the case series of two cases of intraoral fibroma. In this case series, intraoral fibroma was excised using a diode laser. It was observed that in both cases, the healing was much faster. There was minimal intraoperative bleeding. Furthermore, the surgical time reduced substantially and the patient was more comfortable during the procedure as well as in the postoperative phase. Thus, the diode laser has been found to be safe, less painful, and with better post-operative outcomes.

The paper presents the findings of the study on the features of surgical treatment and morphological structure of epulis and papillomas in children. The clinical aspect of the paper concerns 123 children with epulis and 185 with papillomas, who were treated at the clinic of the Department of Pediatric Oral Surgery for the period of 10 years. Verification of the histological structure of neoplasms to determine the final diagnosis was performed by the faculty staff of the Department of Pathological Anatomy with Autopsy Course. Statistical processing of the digital data and analysis of the findings of the study showed that epulis and papillomas are more common in girls than in boys (in 2.5 and 2.3 times higher, respectively). A clear pattern of their diagnosis by age was established. Thus, the peak incidence of epulis was recorded in young adolescents of lower and higher secondary school ages (60.3% and 36.6%, respectively). Papilloma was also found quite often in the same age groups (47.0% and 31.4%, respectively). After comprehensive examination, the clinical diagnosis of the giant cell epulis was established in 21.1% of cases, and the share of its fibrous and angiomatous forms accounted for 35.0% and 43.9%, respectively. Neither patients with epulis of all its types nor their relatives could clearly determine the time periods of the appearance of the first clinical signs of the disease. All patients with papillomas and their relatives complained of the presence of newly formed masses on the oral mucosa or skin, which caused some discomfort, growing slowly, rarely reaching large sizes. The exact time periods of their occurrence could not be specified. Treatment of epulis, provided outpatiently for all patients under local anesthesia, was aimed at elimination of the etiological factor (if detected) and surgery. No recurrences were noted after removal of fibrous epulis and in cases of treatment of angiomatous epulis recurrence occurred in 1 girl. Among patients with giant cell epulis, recurrence after surgical removal was observed in 4 patients, 3 of whom underwent repeated surgery with preservation of teeth. In 1 child recurrence occurred for the third time and tooth extraction and partial resection of the alveolar ridge was made as part of the inpatient treatment. Treatment of papillomas involved surgical removal of neoplasms at the border of healthy tissue up to the submucosal layer using an electrocoagulator or radio knife. Depending on the clinical situation and localization of the tumor, manipulations were performed under local (161 cases - 87.0%) anesthesia at the polyclinic, and in 24 children (13.0%) with labile mental health and localization of papilloma on the soft palate, uvula, palatal arches, anesthesia was performed at inpatient. No complications during surgery and in the postoperative period were observed. The surgical material was always sent for histological examination, the results of which allowed determining one of the mentioned nosological forms. Morphological study has established, that the clinical diagnosis did not coincide with the morphological one in 5 cases (4.1%) in fibrous epulis, in 8 - 6.5% in angiomatous and in 10 - 8.1% in giant cell forms, which together made their discrepancy in 23 observations (18.7%). Thus, epulis and papillomas located in the oral cavity have a certain similarity in clinical symptoms and require careful differential diagnosis, and given their unique morphological structure, the final diagnosis must be established taking into account the findings of histopathological examination, as inconsistency of clinical and histopathological examinations, for example, in epulis, reaches 18.7%. When planning the treatment, in an every single case the type, extent and site of surgery, as well as type of anesthesia should be carefully considered. The presented material can serve as the basis for further in-depth scientific and practical research on comparison of clinical manifestations and immunohistochemical features of epulis and papillomas depending the age of patients.

A B S T R A C TBackgroud An excisional biopsy is one of the surgical treatments given to cases ofsmall benign tumors in the soft tissues of the oral cavity. Antibiotics are prescribedby dentists as a follow-up therapy after excisional biopsy to prevent bacterialinfection. The purpose of this study was to determine the profile of antibiotic drugprescription after excision biopsy of oral soft tissue disease by dentists in Palembang.Methods This type of research is descriptive observational with a survey method.The research was carried out by distributing questionnaires to 40 dentists anddental specialists in Palembang who had performed excision biopsy treatment fororal soft tissue disease. Result The results showed that the antibiotic prescriptionof amoxicillin was 55%, the combination of amoxicillin and clavulanic acid was17.5%, and clindamycin was 12.5%. The cases found in this study were epulis57.5%, mucocele 30%, and traumatic fibroma 10%. Conclusion It can be concludedthat the antibiotic most often prescribed by dentists in Palembang after excisionbiopsy treatment was amoxicillin and the most common case was epulis.

エプーリスは慢性的な刺激や炎症によって歯肉に発生する反応性の増殖物である。右側上顎歯肉部に発生した巨大なエプーリスの1例を経験したので報告する。患者は42歳男性で，右側上顎歯肉の腫脹を主訴に当科を受診した。当科受診の約4か月前より右側上顎歯肉部の腫瘤を自覚した。その後数回にわたり腫瘤からの出血を認めたため近医にて止血処置を受けていた。口腔内所見では右側上顎に境界明瞭な弾性やや硬の，有茎性の腫瘤を認めた。CT所見では内部に骨様のX線不透過像を有し，右側上顎歯肉から増生する腫瘤を認めた。全身麻酔下に腫瘍切除術を施行した。摘出標本は70×50×28mm大であった。病理組織学的診断は骨形成性エプーリスであった。術後3年3か月を経過した現在，再発の兆候はなく経過は良好である。

Epulis is a benign tumor, rarely involves aggressive alveolar bone resorption. This study reported a rare case of rapid growth of pregnancy epulis with extensive alveolar bone destruction and the management of this case. A 24-year old pregnant woman at 35 weeks and 1 day of gestation presented a large asymptomatic nodular mass with severe teeth loosening at the anterior mandibular region for 4 weeks. Radiographic examination showed extensive alveolar bone resorption around the affected teeth to the apical area. After delivery, the patient received an extended resection under general anesthesia. The final histopathological analysis revealed the diagnosis of epulis. In conclusion, the rapid growth of epulis during pregnancy mimicking malignant neoplasm with aggressive alveolar bone destruction was rare and puzzling. In such cases, the histopathological and immunohistochemical examinations are the only effective method to reach the correct diagnosis and clinician should proceed with high precaution.

Relevance. Nowadays an important problem in dentistry is the early diagnosis and the treatment of tumors and tumor-like lesions. One of the most frequent lesions of the orofacial region, and particularly of the periodontium, is a non-tumor lesion called epulis. Some tumors and tumor-like lesions may be both clinically and histologically similar, hence the diagnosis and the differential diagnosis of the epulis is still complicated and need to pay attention. Moreover, every type of epulis has particular histological features that make a clinician use a specific treatment in each clinical case. The treatment success and the necessity of the further observations are determined by the correct diagnosis. However, there is still controversial data about epulis diagnosis. Moreover, the reliable criteria for correct diagnosis of each type of epulis have not been discussed yet.Purpose. The aim of this study is to determine the most relevant methods for differential diagnosis of every type of epulis and other tumor and tumor-like lesions of the alveolar ridge with the same clinical and histological descriptions was performed.Materials and methods. In this article the review of the literature is presented. A comprehensive literature search of the studies from 1970 through 2019 in PubMed database regarding the epulis and other tumor and tumor-like lesions with the same clinical and histological descriptions was performed. 71 relevant articles were selected.Results. “Epulis” is a term that refers to tumor and tumor-like lesions of the alveolar ridge. Due to their morphological features it is frequently necessary to carry out not only the histological studies but also use immunohistochemical and genetic analyses. It is not complicated to verify vascular epulis and fibrous epulis. If there is a plasma-cell infiltration of fibrous epulis stroma, clinician is to differ it from IgG4-assosiated diseases. In some cases to discern pyogenic granuloma and hemangioma it is necessary to carry out immunohistochemical study of the blood vessel wall components. It is also important to know diagnostics of giant-cell epulis. Here to divide peripheral and central giant-cell granulomas genetic analysis should be carried out.Conclusion. Usually microscopic study of fibrous and vascular epulis helps to differentiate it with other lesions. The IgG4associated diseases are to exclude by immunohistochemical study. Diagnostics of giant-cell epulis may include both immunochemical and genetic studies. Methods presented in this article are important both for treatment and for prognosis of the disease.

The clinical management of the epulis involves the elimination of causal factors, excision of fibrous tissue excess accompanied by an appropriate prosthetic rehabilitation. The confection of interim prosthesis or the rectification of old prosthesis for the setting up of a tissue conditioner if necessary, to improve the healing and prevent the decrease of the vestibule depth after the surgical exeresis. Throughout this paper, we are going to present a new technique for the correction of old prostheses poorly adapted for the management of a case of the epulis fissuratum. El manejo clínico de un épulis comprende la eliminación de los agentes causales y la eliminación del tejido fibroso, acompañado de una adecuada rehabilitación protésica. Es necesaria la confección de una prótesis provisional o la rectificación de la prótesis vieja, para la colocación del acondicionador de tejidos si fuera necesario para mejorar el sanado y prevenir la disminución de la profundidad del vestíbulo después de la exéresis quirúrgica. En este artículo, presentaremos una nueva técnica para la corrección de la prótesis desajustada en el manejo de un caso de épulis fisurado. &nbsp

Angiofibromas are highly vascular, locally aggressive but histologically benign tumors. A 40-year-old woman complaint of pedunculated mass in the right gingiva of the posterior region since 7 months earlier. Surgical excisional biopsy under general anesthesia was performed. Histopathological examination showed an angiofibroma. Angiofibromas are localized in the superficial soft tissue and the gingiva could have a similar clinical appearance as an epulis. Definitive diagnosis was determined through histopathological analysis.

BACKGROUND & OBJECTIVES: Gingival enlargement is a common characteristic of gums infection. Enlargement of the gums can possibly occur due to numerous factors, comprising of inflammatory disorders as well as certain meditational side effects. Pyogenic granuloma expresses as red, small erythematous papules on pedunculated or rather sessile base. The current study aims to evaluate the cases of epulis and to grade histological types of epulis. METHODOLOGY: This descriptive cross-sectional study was carried out at oral surgery OPD ISRA Dental College for a six-month duration. The diagnosis of epulis was made on the basis of clinical and histological examination. The research data was recorded on pre-designed proforma, and data were analyzed using SPSS version 22.0 (IBM, Corporation). RESULTS: Out of 150 study subjects, 90 (60%) patients were female, while 60 (40%) were male. Majority of the cases in our study were found with a maxillary site (n=93, 62.0%). Most had a size of 2cm-3cm (n=132, 76%). Coral Pink color was the most common in (n=90, 60%) patients, followed by red color (n=45, 30%) and pale color was found in (n=15,10%) of the cases. The histological findings proved pyogenic granuloma was most common in (n=75, 50%) of the cases followed by fibrous epulis (n=63, 42%), peripheral giant cell granuloma (n=6, 4%) and Peripheral ossifying fibroma (n=6, 4%). CONCLUSION: Pyogenic granulomas are the most prevalent reactive lesion. The lesions were more common in females in maxilla portion, and they were mostly found in the second to third decade of life.

Background A congenital granular cell epulis (CGCE) is a rare benign lesion of uncertain histologic origin that is found on the mucosa of the alveolar ridges of newborn babies. There have been less than 250 reported cases of CGCE. They are most commonly found in the anterior maxilla region in female infants. Case Report An 8-week-old female was referred from the Neonatal team with a 10mmX5mm lesion found at birth on the mucosa of the anterior maxilla. She was seen in the Oral and Maxillofacial Department where her parents reported that the lesion was causing discomfort when feeding and they were keen for its removal. On initial medical examination the patient was diagnosed with a Grade 1 ejection systolic murmur and was awaiting further cardiac investigations. With this in mind and the young age of the patient, it was decided an excisional biopsy of the lesion under local anaesthesia (LA) would be the safest option. The lesion was excised uneventfully when the patient was 9 weeks old. It was shown to be a congenital granular cell epulis following histopathological analysis. The patient was reviewed 8 weeks post-operatively. There were no signs of recurrence, the infant’s feeding had improved drastically, and she was thriving. Discussion CGCE is a rare and interesting lesion in neonates. Early diagnosis and treatment of CGCE is essential in facilitating infant feeding. This report highlights that a well-planned surgical excision under LA is a well-tolerated and safer option which is welcomed by parents.

Epulis synonymous with congenital granular cell tumor (CGCT) of the new born is an unusual hamartomatous benign lesionarising from either the maxillary or mandibular alveolar ridge, the later being very rare. CGCT is a lesion of unknown histogenesiswith a strong predilection for the maxillary alveolar ridge of new born girls. Microscopically the tumor is composed of nests oftightly packed, homogeneous, medium to large sized cells with eosinophilic granular cytoplasm. This case report describes themanagement of the tumor in a one day old female child presenting with a mass on the mandibular alveolar ridge associated withdifficulty in breast feeding and inability to swallow the feed which was affecting her normal physical growth. Two modalitiesof treatment include conservative and surgical therapy. The lesion was managed by electrosurgical removal and the infant wasinitially followed up once a month for 3 months and there after every 6 months, for any post operative complications of whichnon were reported.

The peripheral giant cell granuloma (PGCG) is a relatively common benign reactive lesion of the oral cavity, originating from the periosteum or the periodontal ligament. It occurs as a result of local trauma or chronic irritation. This article presents a case of peripheral giant cell granuloma with review of literature. A 9 year old girl reported with a nodular lesion in the maxillary right central incisor region of two months duration. The lesion was excised and sent for histopathologic examination. The lesion was diagnosed as PGCG. The usual line of treatment for PGCG is local excision down to the bony base along with elimination of the local etiologic factors. The clinical one year follow up revealed there was no uneventful soft tissue healing or recurrence. Keywords: Peripheral giant cell granuloma, Epulis, Giant cells, First decade, Female.

Background: Peripheral ossifying fibroma is a rejuvenation of the reactive gingiva, usually occurring in the anterior maxillary gingiva. The condition is often clinically ambiguous when diagnosed on the basis of gingival hyperplastic lesions such as focal fibrous hyperplasia, peripheral giant cell granuloma, peripheral fibroma and pyogenic granuloma because peripheral ossifying fibroma has a tendency to recur with a ratio of around 20%. The literature on the subject predominantly classifies peripheral osifying fibroma as an epulis type, but it has also been identified as a peripheral mesenchymal tumor presenting similar clinical symptoms to ossified fibrous epulis. Purpose: The purpose of this article is to explain the rare case of peripheral ossifying fibroma in the anterior maxillary gingiva which can be clinically misdiagnosed as reactive gingival hyperplastic lesions. Case: A case report of peripheral ossifying fibroma in the left lateral incisor and canine of the maxillary gingiva in a 26 year-old male. The patient chiefly complained of a painless, slow growing gingival enlargement on the upper left jaw during the previous five years. Clinical examination confirmed it to be a single, hard swelling in the 21-24 region, pale in color and with a rough surface. Case management: The procedure constituted a complete surgical excision of the lesion together with the underlying periosteum curettage intended to prevent recurrence. The histopathologic examination results indicated tissue with squamous epithelial lining, stroma consisting of fibroblasts, and immature trabecula with osteoblastic rimming between collagen tissue without signs of malignancy. Osteoblastic rimming has specific features in histopathologic examination of ossifying fibroma. Conclusion: Peripheral ossifying fibroma is a rare solitary enlargement in the oral cavity frequently misdiagnosed as ossified fibrous epulis. A definitive diagnosis is made by means of histopathologic examination. The condition has a low reccurance rate.

BACKGROUND: Congenital granular cell tumour of the new born is a rare benign lesion of soft tissues which normally affects the maxillary alveolar ridge in neonates. Though benign, it can cause respiratory embarrassment and prevent feeding causing physical distress to the infant and psychological distress to the parents or guardian. Very few cases are reported in the literature. AIM: To highlight the clinical presentation, management and a brief review of the literature of the lesion. METHODS: A case of a 3 day-old baby who presented to Oral and Maxillofacial Clinic UBTH was used to illustrate the clinical presentation and management of congenital epulis. FINDINGS: A case of a 3-day-old female full term infant who presented to our clinic with a protruding gingival mass on the anterior alveolar process of the maxilla that was present at birth. CONCLUSION: Congenital epulis of the new-born is a rare occurrence, though it can grow to a frightening size, it still remains benign and no recurrent after excision. The role of counselling to the parents cannot be over-emphasized.

Introduction. Epulis is benign tumor of the oral cavity which develops from alveolar tissue. Fibromatous epulis is common for both male and female. The children are diagnosticated with angiomatous form of epulis.The tumor is revealed during the period of mixed occlusion in the pediatric dentistry. The result of it is a retention of permanent teeth, a divergence of teeth roots. It has been recorded some cases with epulis of newborns. Aim of study. Optimization of surgical technique of treatment of epulis in children.Materials and methods. Evaluation of the pathological process was carried out on the basis of anamnesis and clinical data of the patient K., 12 years. Additional methods of examination - targeted intra-oral radiography of the pathological process, histological examination. Treatment is operative, dispensary observation within 6 months.Results. The treatment tactics was to cut the epulis under local anesthesia. The excised material was sent for histological examination, the results of which confirmed the diagnosis of angiomatous epulis. Recommendations are given after surgery. Dispensary monitoring was carried out for 6 months.Conclusion. Nowadays the most effective treatment of epulis is surgical. It is necessary to do roentgenologic and histological examination for specification of diagnosis

A group of 210 patients with total maxillary and mandibular prostheses were examined to identify the main pathological alterations suffered by edentulous patients. The observed results determined that the average age at which the largest edentulous population is found is between 56 and 65 years with a higher prevalence of females. Of these more than 50% have used oral prostheses for more than 12 years with an adequate hygiene quality in 116 patients where the most frequent oral pathology associated with edentulism was fibrous hyperplasia (epulis), found in 19 patients, followed by stomatitis sub-prosthesis.

A 16-days-old female patient exhibiting an exophytic nodular lesion located at anterior maxilla on the alveolar ridge since birth. The clinical hypothesis of congenital granular cell epulis (CGCE) was established, and the patient underwent excisional biopsy. Microscopically, a sheet-like proliferation of eosinophilic cells with granular cytoplasm was observed in a stroma of vascularized fibrous connective tissue. The immunohistochemical analysis for S100 evidenced the absence of immunostaining. The CGCE hypothesis was confirmed and, after six months, the patient showed no signs of recurrence of the lesion.

Plasmablastic lymphoma (PBL) is a rare and aggressive subtype of non-Hodgkin’s lymphoma that predominantly occurs in the oral cavity of individuals infected with human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV). However, it has been reported that it often occurs in HIV negative patients. In addition, although it is rare, there are cases where spontaneous withdrawal occurs without treatment. We describe a case of the PBL of oral mucosa type that occured in the mandibular gingival. The patient was a 69-year-old man who visited our hospital because of the growth of a gingival swelling in the right mandibular first molar buccal region. The swelling was identified as a spherical tumor with a smooth surface of about 10 mm in diameter. This was diagnosed clinically as a granulomatous epulis, and we performed resection biopsy to establish definite diagnosis. From the histopathological and immunohistological search of the biopsy specimen, the extract was diagnosed as PBL. The patient was HIV-negative; confirmed as a result of the blood test. Afterwards, the biopsy section followed a good healing process, and we are continuing regular follow-up observation, but we do not recognize recurrence.

In a 2-year survey of tumors occurring in ruminants reared in El-Dakahlyia Governorate, Egypt during the period from October 2016 to October 2018. 66 tumor masses were collected: 60 from cattle, 2 from buffaloes and 4 from sheep. According to histopathology of cattle tumors, 15 neoplasms were diagnosed as cutaneous papilloma, 5 neoplasms were diagnosed as cutaneous fibropapillomas, 25 neoplasms were diagnosed as squamous-cell carcinoma (SCC) of the eye; 8 neoplasms were diagnosed as SCC of perineum, 1 neoplasm was diagnosed as SCC in skin of muzzle, 2 neoplasms were diagnosed as epulis in dental pad, 2 neoplasms were diagnosed as vaginal leiomyoma, 1 neoplasm was diagnosed as fibroma and 1 neoplasm was diagnosed as liposarcoma. Histopathology of buffalo tumors revealed SCC in head skin (1 case) and buccal cavity (1 case). Histopathology of sheep tumors revealed SCC in skin under the tail (2 cases), skin of groin (1 case) and skin of abdomen (1 case). In conclusion, cattle (60/66) were more susceptible to tumors than buffaloes (2/66) and sheep (4/66). Females accounted for a higher percentage of the neoplasms (47/66) than males (19/66). Adult animals aged above 2 years were more frequently affected than young. The occurrence of epithelial tumors (60/66) was greater than the mesenchymal tumors (6/66). The most common epithelial tumors were ocular SCC and cutaneous papilloma. Number of malignant tumors (41/66) was higher than number of benign tumors (25/66). Variable degrees of bovine SCC differentiation were detected. Meanwhile ovine SCC appeared only well differentiated.

Giant cell granulomas (GCGs) of the jaws are non-neoplastic lesions that arise either peripherally in periodontal ligament, mucoperiosteum, or centrally in the bone. Histologically, both peripheral and central giant cell granuloma are characterized by the presence of numerous multinucleated giant cells in a prominent fibrous stroma. Peripheral giant cell granuloma is an infrequent reactive, exophytic lesion of the oral cavity, also known as giant-cell epulis, osteoclastoma, giant cell reparative granuloma, or giant cell hyperplasia. It is the most common giant cell lesion of the jaws and originates from the connective tissue of the periosteum or from the periodontal membrane, in response to local irritation or chronic trauma. The lesion develops mostly in adults, commonly in the lower jaw, with slight female predilection although is uncommon in children. Clinically, it shows resemblance to pyogenic granuloma, peripheral ossifying fibroma, and many other peripheral lesions seen in the oral cavity, but in our case it resembled a squamous cell carcinoma, thereby histopathology is mandatory for the diagnosis of this lesion. The lesion although being relatively common, still has a lot of ambiguity. The ambiguity is in terms of its etiology, growth potential, biological behavior (recurrence), histogenesis of its cells, and its treatment. The entity further holds significance because of its notorious behavior and high tendency to recur. This is a case report of a 30-year-old female patient with history of swelling in the lower anterior region of jaw since 1 year. After complete excision of lesion, lesion reoccurred after few months.

Congenital granular cell epulis is a rare benign tumor of soft tissue in newborns. In most cases it arises from the anterior part of the maxillary alveolar ridge and is ten times more prevalent in females than males. We present a case report of a 2-month-old female infant, who presented with a mass on the gingival mucosa. The lesion was completely removed by simple excision. A final diagnosis of a congenital granular cell tumor was made by histologic and immunohistochemical examination.

Background The newborn congenital epulis or granular cell tumor is a benign tumor that appears in the oral cavity of newborns with more frequency in the gingiva of the alveolar crest of the maxilla at the level of the incisive and canine area, predominantly in the female sex. It is of diagnostic importance since it can interfere with feeding, swallowing and via area, putting the health of the newborn at risk. It usually involutes spontaneously and in case of surgical treatment there are no reports of recurrence. The aim of this work was to describe the evolution according to the approach of this patient with congenital newborn epulis. Case report The case of a patient of the newborn congenital epulis and its follow-up for 6 years is reviewed. Conclusions The surgical treatment of the newborn congenital epulis seems to be a good option of approach without the difficulties in the feeding, suction and breathing of the newborn.

espanolLos epulis son lesiones bien conocidas que asientan en encia, de crecimiento generalmente lento; suelen aparecer como un tumor solitario localizado con base sesil o pediculada y color que varia de rojo, violaceo o rosa, segun la vascularizacion de la lesion. Este crecimiento se considera de naturaleza no neoplasica (psuedotumor benigno hiperplasico), que se presenta en la cavidad oral en diversas formas clinicas e histologicas. El objetivo de este articulo es presentar un caso clinico de un epulis fibroso o hiperplasia gingival fibrosa circunscripta, su manejo clinico y la revision de la literatura. EnglishEpulis are well-known gingival lesions, generally slow growing; they usually appear as a solitary localized tumor with a sessile or pedunculated base and a color that varies from red, purplish or pink, depending on the vascularity of the lesion. This growth is considered non-neoplastic in nature (benign hyperplastic psuedotumor), which occurs in the oral cavity in various clinical and histological forms. The objective of this article is to present a clinical case of a fibrous epulis or circumscribed fibrous gingival hyperplasia, its clinical management and a review of the literature.

Ameloblastomas are quite frequent odontogenic tumors, they can be intraosseous or peripheral to the gum, it's rare to find an intraosseous ameloblastoma with gingival extension. Here, we report the case of a 40 years old woman who presented with an exophytic gingival lesion at the gum level of the 46 tooth that was extracted at a quack 01 years before her consultation due to pain in this area. Clinical and radiological examination revealed the presence of two tumors in the same area. The patient benefited from an excision of her gingival tumor and an enucleation of her intraosseous tumor. Histopathological and immunohistochemical examinations revealed that the respective tumors were a spindle cell epulis and an intraluminal unicystic ameloblastoma of different origins, leaving the question and search for the relationship between these two tumors. The postoperative course was uneventful during the 12-month follow-up period after surgical treatment., Highlights • Ameloblastoma is a fairly rare tumor that can be intraosseous or peripheral. • It is rare to find a peripheral ameloblastoma that reaches the bone or an intraosseous ameloblastoma that extends to the gum. • The occurrence of two tumors in the same anatomical region, makes one wonder about the relationship between the two.

Juvenile nasopharyngeal angiofibroma is a rare vascular neoplasm, mostly occurring in adolescent males, and representing 0.05% of all head and neck tumors. Nevertheless, it is usually recognized as the most common benign mesenchymal neoplasm of the nasopharynx. Usually, it originates from the posterolateral wall of the nasopharynx and, although histologically benign, classically shows a locally aggressive behavior with bone destruction as well as spreading through natural foramina and/or fissures to the nasopharynx, nasal and paranasal cavities, spheno-palatine foramen, infratemporal fossa and, very rarely, to the cranial cavity. Extranasopharyngeal angiofibroma is considered a distinct entity due to older age at presentation, different localizations (outside the nasopharyngeal pterygopalatine fossa) and attenuated clinical course. Extranasopharyngeal angiofibroma has been sporadically described in the oral cavity. We report a case of extranasopharyngeal angiofibroma with primary and exclusive involvement of the adherent gingiva of the anterior maxilla, managed by preoperative diode laser trans-mucosal photocoagulation and subsequent surgical removal. The current literature on primary extranasopharyngeal angiofibroma is also reviewed.

Background: Plasma cell granuloma (PCG) is a rare benign pseudotumorous proliferation of unclear etiology that is mainly situated in the lungs. Gingival PCG is an even more peculiar lesion that usually occurs in middle-aged or elderly individuals and clinically manifests as a solitary entity. Case report: A 15-year-old male with no underlying medical conditions presented with multiple gingival masses in the right maxilla, which were initially thought to be epulis. The lesions were resected completely and the excisional biopsies sent for histological examination. Immunohistochemical (IHC) stain revealed dense polyclonal plasma cell infiltration with positive expression of both kappa and lambda light chains, confirming a diagnosis of gingival PCG. Subsequently, the affected gingiva healed uneventfully, with no sign of recurrence over 2 years of follow-up. Conclusions: The present report depicts an extremely unusual case of gingival PCG occurring in a juvenile with multiple lesions, which is worth attention in clinical pediatric dentistry. Excisional-biopsy and histological investigations are imperative for a confirmative diagnosis and to exclude potential aggressive conditions. Complete resection of lesions seems to be a valid treatment, while long-term clinical follow-up is still needed.

The subject of OMF surgery is a specialized branch of dental surgery that deals with identification of diseases of OMF region. This is an important subject not only for a student following dental surgery but also for students in other medical specialties as well.

Congenital granular cell epulis (CGCE) is a rare soft tissue lesion seen exclusively in the neonates whichis benign in nature. The common site of occurrence is the maxillary or mandibular alveolar ridge. Theclinical significance of this tumor is its location which hampers with breast feeding, posing a potentialairway complication and parental apprehension. In this literature we report a case of a one day old baby whoreported with feeding difficulty, diagnosis of the lesion and the surgical management of the same.

L´épulis est une pseudotumeur bénigne hyperplasique des gencives fréquente, elle répondra à deux critères qui font l´unanimité, topographique: la localisation de l´épulis au niveau du collet d´une ou de deux dents contiguës; bénignité: l´épulis est en effet une tumeur qui ne récidive pas après exérèse complète, ne donne pas de métastases, ni d´envahissement ganglionnaire. Le cas d´un patient de 70 ans nous est rapporté. Celui-ci est adressé par son dentiste traitant pour réaliser une édentation mandibulaire totale avant confection d´une prothèse complète et avis concernant une lésion suspecte évoluant depuis 3 ans, indurée, saignant spontanément au contact et associée à une lésion ostéolytique homogène en regard de la dent 47. Le patient présente comme seul antécédent notable une néoplasie prostatique traitée par chirurgie seule en 2012, sans intoxication alcoolo-tabagique. La symptomatologie est fruste avec seulement de faibles douleurs intermittentes calmées par la prise d´antalgiques. Le signe de Vincent est négatif. L´aspect radiologique initial avec une ostéolyse d´aspect homogène centrée sur l´apex dentaire de la deuxième molaire droite avec un liseré radio-opaque et respectant le canal du nerf alvéolaire nous confortait dans l´hypothèse de lésion bénigne. L´examen anatomopathologique posait le diagnostic de certitude à savoir, un épulis inflammatoire. Un contrôle post-opératoire clinique et radiologique est réalisé à quinze jours et montre une bonne cicatrisation accompagnée d´une absence de symptomatologie algique et infectieuse. Devant la présentation clinico-radiologique, les diagnostics différentiels retenus étaient le carcinome épidermoïde, une métastase de l´adénocarcinome prostatique, un épulis inflammatoire ou encore un lymphome.

International audience; Objective To characterise the role of VEGF, EG-VEGF and its receptors in the development and progression of HNC. Design Human serum and tissues samples were collected from healthy, epulis and HNC patients and used for ELISA assays and immunohistochemistry studies, respectively. Setting Ibn Rochd Hospital of Casablanca (Morocco), INSERM and University of Grenoble Alpes (France). Participants We used serum from 64 patients with head and neck cancers and from 71 controls without general pathology. Tissues samples were collected from seven patients with OSCC and from seven patients with Epulis. Main outcome measures We compared circulating VEGF and EG-VEGF in normal and HNC patients and determined the expression, localisation and quantification of VEGF, EG-VEGF and its receptors; PROKR1 and PROKR2 as well as Ki67, CD31 and CD34 in OSCC and Epulis patients. Results Both EG-VEGF and VEGF circulating levels were significantly decreased in the HNC (P < .01). OSCC patients expressed less EG-VEGF and VEGF proteins, higher PROKR1 and PROKR2 with no change in CD31 and CD34 levels. A significant increase in Ki67 was observed in OSCC. Conclusions We demonstrated that circulating VEGF and EG-VEGF are downregulated in HNC patients and in OSCC tissue. EG-VEGF receptors were increased in OSCC, along with a stabilisation of two key markers of angiogenesis. These findings strongly suggest that downregulation of angiogenesis in HNC might explain its moderate metastatic feature.

A 13-year-old female patient presented with a 20×15-mm pedunculated, elastic hard cauliflower-shaped lesion with a healthy color and partial erosion attached to the maxillary gingiva in the right maxillary first molar region. The lesion gradually grew over a year. Excisional biopsy was performed and histopathological analysis indicated epulis osteoplastica.

Congenital epulis is a benign tumor of upper gingiva. Larger lesions interfere with mouth closing and normal feeding and may obstruct airways. We present a neonate with a large epulis. Case Report:...

Lobular capillary hemangioma (LCH) is synonymously known as pyogenic granuloma, epulis gravidarum, eruptive hemangioma...

Lesions of the gingivae are amongst the commonest lesions seen in patients and the vast majority are reactive hyperplasias, related to a number of chronic irritant stimuli. However, there are a number of entities that have a predilection for the gingivae, which are much less common in other parts of the oral cavity. The purpose of this paper is to discuss the clinical and histological differential diagnoses when presented with a lump on the gingivae, including the approach to diagnosis and diagnostic pitfalls.

Introduction: Epulis is a pseudotumor very common in women. If neglected, it can reach a considerable volume. The marginal gingiva is very involved in the tumor either in isolation or with periodontal and alveolar bone. The epulis sits classically on the vestibular gum, rarely on the palatal side. We report a case of palatal giant epulis which posed a diagnostic problem. Case report: This was a 50-year-old patient with a large tumor occupying the entire oral cavity and pushing all nearby organs. This lesion had been evolving for ten years, with a tendency to gradually increase of its volume. The orthopantomogram revealed the destruction of the underlying alveolar bone without signs of tumor invasion. Surgical excision was performed, removing all the tumor in the vicinity of the nasopalatine vascular pedicle. The pathological examination concludes with an inflammatory epulis. Conclusion: The epulis is a benign tumor of the gum, circumscribed, localized preferentially at the neck of one or two contiguous teeth. It occurs more in women, with a predilection for the vestibular side, rarely the palatal side. In the absence of appropriate treatment it can lead to a large tumor, posing a diagnostic problem and causing functional or aesthetic discomfort. Complete surgical excision with histological examination remains the solution. Healing without sequelae is the rule.

Introduction: The fissured epulis is a reactive tissue growth that develops underneath a dental prosthesis. Its etiology is related to removable of partial or total dentures and other irritative or traumatic factors. Oral cancer (CAB) is a malignant neoplasm of aggressive behavior, and it has become one of the most serious health problems worldwide. Currently, squamous cell carcinoma is considered a disease with a high mortality rate. This article aims to describe the clinical management of a squamous cell carcinoma, as a result of a fissured epulis in upper total edentulous patient. Case Report: A female patient, 58 years of age, with no systemic or family history, went for a lower removable prosthesis. The clinical examination in the maxilla presented an enlargement of soft tissue in the bottom of the vestibule on the left side, asymptomatic, compatible with a fissured epulis. Two surgical procedures were performed to remove the pathology and a sample was taken to perform a biopsy, which resulted in a squamous cell carcinoma. The patient was referred to a center specialized in cancer treatments (Society for the Fight Against Cancer) where she currently is receiving the attention of the case. Conclusions: The lack of knowledge of this injury on the part of the patient, and the lack of symptomatology, absence of periodic controls, maladjustment, and incorrect prosthetic design were the risk factors that triggered the injury.

Introduction: The epulis is a hyperplastic tumor-like of the gingival or cheek mucosa that would be due to inflammatory reactions. Its pathogenesis remains incompletely understood. It appears to be common in Africa, but no study has been conducted in Togo. Our purpose was to describe epidemiological, clinical and therapeutic aspects of the epulis at the Campus University Teaching Hospital in Lome. Patients and methods: This was a retrospective descriptive study on 33 cases at the Odontostomatology Department, from January 1st, 2014 to December 31st, 2016. Results: The prevalence of epulis was 0.88%. The average age of the patients was 36.92 years old. The most affected age group was 20 - 29 years old (30.30%). The sex ratio was 0.57. Low education and poor socio-economic conditions were found to be predisposing factors. Mucous swelling was the main reason for consultation. A local irritative factor was found in more than half of the cases. The preferred seat was gum (63.63%). Inflammatory epulis was found in 36.36% of cases. Biopsy-excision was performed in 96.96% of patients, with a cure without sequelae in 100%. Conclusion: The epulis is a rare benign affection of the gum. Its favoring factors are mechanical or infectious local irritation, or hormonal factors. His diagnosis is essentially clinical, but requires histological confirmation to distinguish it from other serious tumors. Biopsy-excision is the main treatment. No sequelae are observed in all patients of our series.

While plaque-induced gingivitis is one of the most common human inflammatory diseases, several non-plaque-induced gingival diseases are less common but often of major significance for patients. The non-plaque-induced gingival lesions are often manifestations of systemic conditions, but they may also represent pathologic changes limited to gingival tissues. A classification is proposed, based on the etiology of the lesions and includes: Genetic/Developmental disorders; Specific infections; Inflammatory and immune conditions and lesions; Reactive processes; Neoplasms; Endocrine, Nutritional and metabolic diseases; Traumatic lesions; and Gingival pigmentation.