1. Dr Mohammed Malik INFLAMMATORY HYPERPLASIA - 1

2. Contents Inflammatory Hyperplasia – 1Inflammatory Hyperplasia – 2 Introduction Introduction Inflammatory and Reactive Hyperplasia Inflammatory and Reactive Hyperplasia Fibroma Fibroma Pyogenic granuloma Pyogenic granuloma Epulis fissuratum Epulis fissuratum Epulis Granulomatosum Epulis Granulomatosum Inflammatory papillary hyperplasia Inflammatory papillary hyperplasia Giant Cell Granuloma Giant Cell Granuloma Hamartoma Hamartoma Hemangioma Hemangioma Lymphangioma Lymphangioma Neurofibroma Neurofibroma Syndromes with neoplastic Component Syndromes with neoplastic Component Von Recklinghausan Disease Von Recklinghausan Disease Gardner’s Syndrome Gardner’s Syndrome Peutz Jgheger’s Syndrome Peutz Jgheger’s Syndrome Gingival Enlargements Gingival Enlargements Inflammatory Inflammatory Fibrotic Fibrotic Phenytoin Induced Phenytoin Induced Acute Inflammations Acute Inflammations

3. Specific Learning Objective To know the clinical appearance of various tumors of the oral cavity To identify the lesion based on its clinical appearance

4. Introduction Hyperplasia – increase in the size of tissue or organ due to increase in the size of cells. Inflammatory Hyperplasia – an increase in the size of the tissue or organ due to an increase in the number of its constituent cells, as a local response of tissue to injury

5. Pyogenic Granuloma / Lobular Papillary Hemangioma Pyogenic granuloma is a pedunculated hemorrhagic nodule having a tendency to develop on the gingiva Etiology – Chronic irritation Local factors – calculus, food impaction, overhanging restorations etc.. Hormonal changes Clinical features – They are friable, hemorrhagic, and frequently ulcerated. They are comprised of proliferating endothelial tissue, much of which is canalized into a rich vascular network with minimal collagenous support.

6. Polymorphs, as well as chronic inflammatory cells, are consistently present throughout the edematous stroma, with micro abscess formation. Pregnancy epulis is due to the hormonal changes – seen more commonly in 3 rd trimester and gets partially or totally subsided in few months after pregnancy. Treatment – surgical excision followed by thorough debridement and cleaning

7. Peripheral Ossifying Fibroma Has similar clinical features of pyogenic granuloma except that it does not bleed profusely History – of a long standing duration than the pyogenic granuloma There is no pain Teeth are vital Swelling attached by a stalk Radiograph – if taken with a reduced radiation exposure may reveal an ossification in the swelling. Treatment – surgical excision.

8. Epulis Fissuratum A lesion that is associated with the periphery of ill fitting dentures Growths are often split by the edge of the denture. One part of the lesion lying under the denture and the other part lying between the lip or cheek and the outer denture surface.

9. This lesion may extend the full length of one side of the denture. Many such hyper plastic growths will become less edematous and inflamed following the removal of the associated chronic irritant, but they rarely resolve entirely

10. Epulis granulomatosum Hyperplastic growths of granulation tissue that some times arise in healing extraction sockets. They resemble pyogenic granulomas and usually represent a granulation tissue reaction to bony sequestra in the socket.

11. Parulis/Gum boil At the opening of the sinus tract due to abscess there is a mass of sub acutely inflamed granulation tissue A gutta purcha can be inserted through the parulis to find out the exact source from which this sinus tract belongs.

13. Inflammatory Papillary Hyperplasia Papillary hyperplasia's are usually seen under an over hanging restoration, underneath RPD and Complete dentures. Its most common in complete dentures especially in the palate and underneath those dentures which has a suction under them. They are seen as growths with different sizes of same color as that of adjacent mucosa or may be seen with candidal growths

14. Giant Cell Granulomas First described by Jaffe as central giant cell reparative granuloma. peripheral exophytic lesion on the gingiva As a centrally located lesion within the jaw,skull, or facial bones. Lesions are highly vascular; hemorrhage is a prominent clinical & histologic feature

15. Peripheral lesions are five times as common as central lesions. Central lesions are common in mandible, anterior to the first molar, and often cross the midline. Important investigation is test for hyperparathyroidism Treatment – surgical excision.

16. Chief Complaint – patient complains of facial disfigurement and discoloration of left half of face since birth. History of Present Illness (HOPI) – She said it was very ugly at the time of birth but has slowly reduced over the years to present status She has intolerence to sunlight, heat and causes itching She has been applying cold water or ice when ever she has itching sensation. None of her family members have the same problem. She has 1 brother who is healthy and fine History of marriage of her parents in the same family Case - 1

17. Hemangioma Clinical Feature – on the mucosa it appears as a reddish discoloration over the involved area. Gingival bleeding can be initiated by passing the probe through the teeth though she has good oral hygiene. Hemangiomas may cause profuse bleeding due to forces of occlusion

18. Hemangioma – other clinical features Tumor like malformations composed of seemingly disorganized masses of endothelium-lined vessels These vessels are filled with blood and connected to the main blood vascular system They have been described in almost all locations. M=F in distribution. Clinical Types – Range from simple red patches (nevus flammeus, Port-wine stain Birthmarks Histologically – cavernous type and capillary type

19. Tram Track Appearance on Radiograph Radiographic Findings – may show calcification of the blood vessels of long standing condition and is called as STURGE WEBER SYNDROME Other investigations – CT, Ultrasound. Treatment - Cryosurgery

20. Case - 2 Chief Complaint – patient complains of teeth placed very inside his jaw HOPI – patient has frequent tongue biting since last 5 to 6 years. He feels his teeth are very inside and hence they bite the tongue He has loss of taste sensation. Tongue is big, it was normal but now he feels the tongue us very big He is unable to pronounce most of the words as the tongue cannot stick in the small jaw Tongue cannot be fully protruded out. He feels some swelling in tongue, but no pain, all movements are normal but restricted due to big tongue Family History – not relevant

21. Lymphangioma Benign hamartomatous tumors of lymphatic vessel. They most likely represent developmental malformations that arise from sequestrations of lymphatic tissue that do not communicate normally to rest of lymphatic system. 3 types of lymphangioma – 1. Lymphangioma simplex 2. Cavernous lymphangioma 3. Cystic lymphangioma

22. Clinical Features Most commonly seen in head and neck region. Seen commonly in ant 2/3 rd of the tongue Seen as a birth defect or arise within 2 to 3years after the birth. On the tongue the tumor is superficial and has a pebbly surface that resembles a tumor of translucent vesicles. Deeper tumors are present as soft, ill defined masses. Treatment – surgical excision, cryosurgery.

23. Case - 3 Inspection – swelling of left side of face. Extent – Superiorly – from the left lower eyelid Inferiorly – 2cm above the lower border of the body of mandible. Anteriorly – from the left ala of the nose. Posteriorly – to posterior border of ramus of mandible. Nodular swelling about 2cm in diameter located at the anterior aspect of large swelling

24. Inspection Skin over the lesion is normal in colour No ulceration, sinus opening or punctum present on surface. Palpation – larger swelling – soft Smaller swelling – firm in consistency. Larger swelling was movable and the smaller was fixed. No localized rise in temp., tenderness, pulsations, non compressible.

25. Examination Of Nose Inspection – increase in size more evident on left side. Swelling near the left ala of nose just lateral to the tip gives a cleft like appearance. Nose slightly deviated to the Right side. Nostrils – normal Palpation – Swelling near the ala of nose was firm in consistency, non tender, non pulsatile, non compressible.

26. General Examination  Examination Of Flexor Surface Of Fore Arm –  Multiple nodular lesions measuring about a cm covered my normal skin.  Palpation – The skin over the nodules could be pinched off.  Lesion is non tender and firm in consistency.

27. Lymph nodes R & L sub mandibular lymph nodes were palpable. Lips – competent No Palor - Icterus; - Cyanosis and Clubbing

28. INTRA ORAL EXAMINATION Dental Caries i.r.t – 15, 16. Moderate stains and calculus

29. Clinical Investigation Central Lesion in seen in the bony cavity. Neurofibroma

30. NEUROFIBROMA Syndrome associated with it is called as VON RECKLINGHAUSEN DISEASE This syndrome has two distinct varieties – Neurofibromatosis – 1 Neurofibromatosis – 2 Neurofibromatosis – 1 – is most classic type Neurofibromatosis – 2 – is genetic in nature, Is less common Has no or rare oral lesions

31. Thank You Any Questions ?