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Idiopathic gingival hyperplasia
Idiopathic gingival hyperplasia Report
of a case
L. E. Albjerg, D.D.S.,* Minneapolis, Minn. VETERANS
ADMINISTRATION
HOSPITAL
AND
UNIVERSITY
OF
MINNESOTA
Idiopathic gingival hyperplasia (idiopathic fibromatosis, elephantiasis gingivae, or fibromatosis gingivae) is a rare type of hyperplasia. of the gingiva.. CASE
REPORT
A 22.year-old man was seen in the Oral Surgery Clinic at the Veterans Administration Hospital in Minneapolis, Minnesota. His chief complaint was a palatal enlargement causing speech impediment, difficulty in eating, and impingement on his tongue spsze. Past
history
Two years previously, while in military service, he was treated for the same problem. An electrosurgical technique was employed to remove the growth in quadrants in four separate procedures. The postoperative period was accompanied by edema, prolonged healing, and severe bleeding which required transfusion. Subsequent blood studies did not reveal any blood dyscradas. Examination
Clinical examination of the oral cavity revealed rather normal gingivae. On the palate, however, an enlarged mucosal overgrowth was noted. The tissue was pink, moderately firm to palpation, nontender, corrugated in surface texture, and loosely attached to the underlying tissues. It extended from the papilla of the incisive canal to the soft palate in an anteroposterior direction, bisecting each half of the palate (Fig. I). Operation
The patient was given a local anesthetic, and the thickne48 of the palate was gauged with a graduated millimeter probe. It ranged from 2.5 cm. to 3.5 cm. in depth and was actually much thicker than it appeared clinically because of the patient’s very deep narrow vault. The excess tissue was removed with an electrosurgieal loop 1 cm. in diameter. This left a uniform thickness of approximately 5 to 7 mm., with the greatest amount overlying the anterior palatine foramen (Fig. 2). A gauze pack impregnated with periodontal dressing was secured to the maxillary teeth (Fig. 3). Healing progressed well until the sixth day, when there was a sudden onset of hemorrhage from the descending palatine artery on the *Oral
Surgery
Resident,
Veterans
Administration
Hospital.
823
Fig.
1. Preoperative
photograph
Pig.
8. Photograph
taken
tlemarcat
immediately
illg
after
areas
of
operation
of palate.
Ilyperplasia
with
tissue
removed
electrosurgi-
dly.
right side. and ligated
The bleeding vessel was readily controlled with 3-O silk. The palate healed without
when further
clamped surgical
with a mosquito hemostat treatment (Fig. 4).
DlSCUSSlOPJ
Although the name idiopathic gingival hyperplmia directs attention to pathosis of the gingiva, in this rare case it included the pa,latal tissue from the incisive papilla to the soft palate in an area centered from the lingual surfaces of the teeth to the midline of the palate. The literature emphasizes the occur-
Volume Xumber
Pig.
Fig.
Idiopathic
23 6
3. Gauze
pack,
4. Photoffsaph
impregnated
of palate
with
6 months
periodontal
after
dressing,
operation.
gingival
secured
hyperplasia
to maxillary
825
teeth.
826
Alb jerg
o.ti., 0.X1.& 0.1’. .Junc,
I Mi
rence of hyperplasia during the eruption period of the teeth a.nd to its rare recurrence. This patient had a complete dentition for sevtrral years and was experiencing the second surgical procedure for removal of the tissue. Immed,iate postoperative control of hemorrhage was excellent following electrosurgical removal of the hyperplastic. tissue. The proper control of hemorrhage is extremely important and must be given prime consideration in surgical procedures involving the area of the anterior palatine artery. The USC of an acrylic splint, created preoperatively, with a lining of periodontal dressing is the preferred postoperative treatment, This is a necessary adjunct to the control of hemorrhage and gives comfort during t,hc healing period. REHRENCES
of Oral Pathology, rd. 2, St. Louis, 196,5, The C. V. Moshy 1. Bhaskar, S. N.: Synopsis Company. 2. Shafer! W. G., Hine, M. K., and Levy, B. M.: A Textbook of Oral Pathology, ed. 2, Philadelphia, 1963, W. B. Saunders Company. 3. Thoma, K. H., and Goldman, H. M.: Oral Pathology, ed. 5, St. Louis, 1960, The C. V. Mosby Company.
of a case
L. E. Albjerg, D.D.S.,* Minneapolis, Minn. VETERANS
ADMINISTRATION
HOSPITAL
AND
UNIVERSITY
OF
MINNESOTA
Idiopathic gingival hyperplasia (idiopathic fibromatosis, elephantiasis gingivae, or fibromatosis gingivae) is a rare type of hyperplasia. of the gingiva.. CASE
REPORT
A 22.year-old man was seen in the Oral Surgery Clinic at the Veterans Administration Hospital in Minneapolis, Minnesota. His chief complaint was a palatal enlargement causing speech impediment, difficulty in eating, and impingement on his tongue spsze. Past
history
Two years previously, while in military service, he was treated for the same problem. An electrosurgical technique was employed to remove the growth in quadrants in four separate procedures. The postoperative period was accompanied by edema, prolonged healing, and severe bleeding which required transfusion. Subsequent blood studies did not reveal any blood dyscradas. Examination
Clinical examination of the oral cavity revealed rather normal gingivae. On the palate, however, an enlarged mucosal overgrowth was noted. The tissue was pink, moderately firm to palpation, nontender, corrugated in surface texture, and loosely attached to the underlying tissues. It extended from the papilla of the incisive canal to the soft palate in an anteroposterior direction, bisecting each half of the palate (Fig. I). Operation
The patient was given a local anesthetic, and the thickne48 of the palate was gauged with a graduated millimeter probe. It ranged from 2.5 cm. to 3.5 cm. in depth and was actually much thicker than it appeared clinically because of the patient’s very deep narrow vault. The excess tissue was removed with an electrosurgieal loop 1 cm. in diameter. This left a uniform thickness of approximately 5 to 7 mm., with the greatest amount overlying the anterior palatine foramen (Fig. 2). A gauze pack impregnated with periodontal dressing was secured to the maxillary teeth (Fig. 3). Healing progressed well until the sixth day, when there was a sudden onset of hemorrhage from the descending palatine artery on the *Oral
Surgery
Resident,
Veterans
Administration
Hospital.
823
Fig.
1. Preoperative
photograph
Pig.
8. Photograph
taken
tlemarcat
immediately
illg
after
areas
of
operation
of palate.
Ilyperplasia
with
tissue
removed
electrosurgi-
dly.
right side. and ligated
The bleeding vessel was readily controlled with 3-O silk. The palate healed without
when further
clamped surgical
with a mosquito hemostat treatment (Fig. 4).
DlSCUSSlOPJ
Although the name idiopathic gingival hyperplmia directs attention to pathosis of the gingiva, in this rare case it included the pa,latal tissue from the incisive papilla to the soft palate in an area centered from the lingual surfaces of the teeth to the midline of the palate. The literature emphasizes the occur-
Volume Xumber
Pig.
Fig.
Idiopathic
23 6
3. Gauze
pack,
4. Photoffsaph
impregnated
of palate
with
6 months
periodontal
after
dressing,
operation.
gingival
secured
hyperplasia
to maxillary
825
teeth.
826
Alb jerg
o.ti., 0.X1.& 0.1’. .Junc,
I Mi
rence of hyperplasia during the eruption period of the teeth a.nd to its rare recurrence. This patient had a complete dentition for sevtrral years and was experiencing the second surgical procedure for removal of the tissue. Immed,iate postoperative control of hemorrhage was excellent following electrosurgical removal of the hyperplastic. tissue. The proper control of hemorrhage is extremely important and must be given prime consideration in surgical procedures involving the area of the anterior palatine artery. The USC of an acrylic splint, created preoperatively, with a lining of periodontal dressing is the preferred postoperative treatment, This is a necessary adjunct to the control of hemorrhage and gives comfort during t,hc healing period. REHRENCES
of Oral Pathology, rd. 2, St. Louis, 196,5, The C. V. Moshy 1. Bhaskar, S. N.: Synopsis Company. 2. Shafer! W. G., Hine, M. K., and Levy, B. M.: A Textbook of Oral Pathology, ed. 2, Philadelphia, 1963, W. B. Saunders Company. 3. Thoma, K. H., and Goldman, H. M.: Oral Pathology, ed. 5, St. Louis, 1960, The C. V. Mosby Company.