case presentation

1. EPULIS FISSURATUM
By: Aleia S. Guzman

2. WHAT IS EPULIS FISSURATUM?
 is a benign hyperplasia of fibrous connective tissue which develops
as a reactive lesion to chronic mechanical irritation produced by the
flange of a poorly fitting denture

3. OTHER TERMS
 inflammatory fibrous hyperplasia
 denture-induced fibrous inflammatory hyperplasia
 denture epulis
 denture injury tumor
 denture induced granuloma
 granuloma fissuratum

4. DEFINITION OF TERMS
 Epulis- is a general term for any gingival or alveolar tumor
 Granuloma- a mass of granulation tissue, typically produced in response
to infection, inflammation, or the presence of a foreign substance.
 Tumor- a swelling of a part of the body, generally without inflammation,
caused by an abnormal growth of tissue, whether benign or malignant.
 er cr ysgg laser – erbium laser.
 Excisional biopsy- procedure where the entire abnormality or area of
interest is removed

5. ETIOLOGY
 Prolonged use of ill fitting denture (removable partial
denture/complete denture.
 Continued use of broken denture.

6. DIFFERENTIAL DIAGNOSIS
pain bleeding color Fast
growing
Pyogenic Granuloma Red/pink
- purple
Metastatic Neoplasms to
the Oral Cavity
Reddish
Squamous Cell
Carcinoma
Reddish
Epulis fissuratum pink /red

7. RELATED LITERATURE
 . This report presents a case of a 68-year old male patient with two
soft tissue hyperplastic growths seen in the buccal vestibule in the
lower anterior region. These lesions were removed using an
Er,Cr:YSGG laser. The healing was uneventful and no suture or
analgesic was required. The histopathological report confirmed the
presurgical diagnosis. No relapse was observed till one year after
surgery.

8. RELATED LITERATURE

9. CASE PRESENTATION

10. PERSONAL DATA
Name: Lorna Gines
Address: Cabubugan, Guimbal, Iloilo City
Sex: Female
Age: 57 years old
Occupation: Massage therapist

12. CHIEF COMPLAINT
“ Nabudlayan ko magkaon kai naguba akon pustiso”

13. HISTORY OF PRESENT ILLNESS
20 years ago she visited a dentist because she can’t eat well
due to she is partially edentulous and was fabricated a set of denture.
3 years prior to consultation her denture was destroyed while she was
eating, according to her she ate something hard that cause the
damaged to her denture. Despite the incident she continuously wears
her denture because she can’t afford to pay a private dentist.

14. MEDICAL HISTORY
The patient was admitted to the hospital in 1993 due to
child birth. She has no serious illness or systemic disease and is
healthy.

15. PAST DENTAL HISTORY
She had her first tooth extraction year 1984 and had her
last tooth extracted 3 years ago due to severe caries.

16. PERSONAL AND SOCIAL HISTORY
The patient does not smoke and drink
alcoholic beverages.

17. X-RAY

18. TREATMENT PLAN
Surgical excision on lesion
Fabrication of complete denture

19. SURGICAL APPROACH
 Excisional biopsy
Using:
• Removal by scalpel
• Electrocautery

20. PRINCIPLES OF SURGERY
 Asepsis - Is a state of being free from disease-causing contaminants, or
preventing contact with microorganism.
Attained by:
 Proper hand washing
 Sterilizing of instruments and equipmentssss
 Reusing of used equipment is contraindicated
 Proper gear is needed (gloves, mask, lab gowns, head cap)
 Proper infection control before and after any procedure

21. PRINCIPLES OF SURGERY
 Atraumatic Injury
 Maintenance of patient airway
 Good Anesthesia
 Control of Infection

22. ADVANTAGES
 Tissue separation is clean with little or no bleeding.
 The technique is less pressure and precise.
 Planning of soft tissue is possible.
 Healing discomfort and scar formation is minimal.
 Access to difficult to reach area is increased.
 Chair time and operator fatigue are reduced
 No need to suture.
 Short healing period.

23. DISADVANTAGES
 Cannot be used on patients with poorly shielded pacemaker
 Cannot be used near flammable gasses.
 Odor of burning tissue is present if high volume suction is not
used.

24. ARMAMENTARIUM

25. ARMAMENTARIUM

27. ARMAMENTARIUM
• Mouth mirror
• Cheek retractor (minesotta)
• Allis forceps
• Hemostat
• 1% betadine
• Tissue forceps
• Cotton gauze
• Disposable syringe
• Syringe
• Needle
• Mask
• Gloves
• Anesthetic cartridge
• Topical anesthesia
• Normal saline solution
• Suction tip
• scalpel
• Kidney basin
• Electrocautery
• Scalpel holder
• Specimen cup
• Head cap and gauze

28. PRE-OP INSTRUCTIONS
 Get enough sleep the night before the procedure.
 Take amoxicillin 500mg 1 capsule every 8hours for 7days.
 Eat before the procedure.

29. PROCEDURE
 Take blood pressure
 Let the patient gargle 1% betadine.
 Put betadine around the patients’ mouth.
 Retract.
 Dry the surgical area and apply topical anesthesia.
 Perform local infiltration.
 Use Allis forcep to grip the lesion and slightly pull.
 Using scalpel, remove the lesion with 2-3mm of normal appearing surrounding tissue and clean
the area with NSS.
 Put the lesion in a specimen cup with NSS for biopsy.
 After removing the lesion use electrocautery to close the wound and to stop bleeding.
 Recall after 7 days.

30. PROCEDURE

31. PROCEDURE

32. PROCEDURE

33. PROCEDURE

34. MEDICATION
 Mefenamic acid 500mg
28 caps
Sig: take 1 capsule every 6 hours for 7 days for pain or as needed.
 Amoxicillin 500mg
21 caps
Sig. take 1 capsule every 8 hours for 7 days.

35. POST-OP INSTRUCTIONS
 Take all medications religiously 30 mins. after meal
 Gargle chlorhexatedine 15 ml for 30 seconds twice a day for 2 weeks.
 Avoid stressful activities.
 Do not wear the denture.
 Avoid touching the affected.
 Avoid sipping beverages.
 Soft diet for 7 days.

36. RECALL

37. AFTER 14 DAYS

38. BIOPSY

39. CONCLUSION
Surgical wound healing using electrocautery is faster
compared to other techniques and the chance of epulis fissuratum
recurrence is very low if new denture is fabricated.