GOOD MORNING

7/20/16

A Preoperative case of benign enlargement of

gingiva in right side of maxiila and mandible

Presented by
Dr. Dwarika Prasad Bajgai
Department of Oral and maxillofacial Surgery
MS Residency Phase B
BSMMU
7/20/16

PARTICULARS OF PATIENT
Name- Sapna
Age- 13 yrs
Sex- Female
Address- Anurosanmajhi, Faridpur
Date of admission: 18-06-201
Date of History recording: 19-042016

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CHIEF COMPLAINTS
Swelling of gums in right side of both
jaws since last 2 and half years.

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HISTORY OF PRESENTING ILLNESS

According to the history of patient, she was apparently well two and half years
back .Then she noticed swelling of gums in lower jaw right side which was
initially smaller in size . Similar swelling was present in gums of upper jaw
also . There was no pain associated with it . No h/o of bleeding . No h/o of
high grade fever . Since last 6 months she noticed nodular swelling in along
the right side of her neck which is non tender .She gave no h/o of anaetheia
or no loose paresthesia and no loose tooth associated with it.

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Past Medical and Dental history

Past Medical History-NRH

Past Dental History- NRH
Drug History- Antibiotic, Analgesic
Personal Oral hygiene History-brushes
once daily with toothpaste and toothbrush
Immunization history-Partially Immunized
Socioeconomic status- lower class family
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General Examination
Appearance- Anxious,Well oriented to time,
place and person
Built- Average built
Nutrition- Normal
Decubitus- on choice
IcterusEdema PallorDehydrationAll -ve
Cyanosis- Lymphodenopthy-

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Vital Signs

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BP 130/80 mm of Hg
Pulse- 76 beats/ min
Respiratory rate- 14 breaths/min
Temperature - afebrile

Syestemic Review

Cardiovascular
Respiratory
Neuromuscular
Gastrointestinal
Genitourinary

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Non contributory

Extraoral examination

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Extra oral examination

Inspection and palpation
Face- symmetrical
Range of movement of mandible-normal
Cervical Lymph nodes-Enlarged and
present bilaterally. palpable, not enlarged,
non tender
No any other significant abnormalities
detected.
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Intraoral examination

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Intraoral Examination

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Intraoral examination

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Intraoral examination
Inspection Mouth opening adequate
Oral hygiene poor
Occlusion- normal( Angles class I on right side, left
sided upper molar extracted)
Generalized gingivitis , stains on tooth

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Intraoral Exaination(contd..)
Well circumscribed swelling, approx. 3cmx3cm
in size, present on left side of palate not
crossing midline, with normal colour of
overlying mucosa , extending anterolaterally
from near 1st PM tooth to distal surface of 2 nd
molar, anteromedially from near to rugae area
to posteriorly near to end of hard palate,
surrounding skin normal in appearance with no
distinction between swelling mucosa and
normal palatal mucosa.
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Intraoral Exaination(contd..)
PALPATION
Painless swelling of firm consistency,
temperature over lining mucosa of swellingnormal, non compressible, non-indurated, nondischarging non-mobile, fixed with the palatal
mucosa and underlying bone, pain on adjacent
2nd PM tooth on exerting digital pressure on
swelling.

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Salient
Features
Mrs Farida, 35 yrs female, normotensive ,non-diabetic, school teacher by

profession was admitted in OMFS department of BSMMU with pain on tooth

in upper left back region of jaw and swelling in upper left palatal region with
the duration of 5 years . Previously for the same problem she was treated
with antibiotics and analgesics, extraction of offending tooth, 5 intralesional
alcohol injections in the swelling over a period of 3 month (5 years ago).
Pain was reduced for some years after treatment , swelling persisted and in
last 2 months duration, she noticed increasing pain, increasing swelling and
occasional discharge of pus .
On extraoral examination , face is symmetrical, no extraoral swelling or any
abnormalities seen ,range of movement of jaw is normal, no any palpable or
tender cervical lymphadenopthy.
On intraoral examination, mouth opening is adequate, oral hygiene poor,
with generalized gingivitis and stains. There is a well circumscribed palatal
swelling on left side of hard palate, approx. 3cmx3cm in size, extending
anterolaterally from 1st PM tooth to near distal surface of 2nd molar
posteriorly and anteromedially from near to rugae area to the near the end
of hard palate posteriorly.
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 Overlying mucosa is normal in color, surrounding mucosa is also

normal in color, with no any signs of inflammation or ulceration. On
palpation swelling is non-tender, temperature of surface is not
raised, non- indurated, attached to palatal mucosa and underlying
bone , non- compressible, no any discharge on pressing the
swelling, on exertering more digital pressure on swelling patient
experiences pain on adjacent 2nd Pm tooth.
With all these complaints and clinical findings patient was admitted
to OMFS department of BSMMU for further management.

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Provisional Diagnosis
Benign palatal soft tissue lesion
D/Dx
-Pleomorphic adenoma
-canalicular adenoma
-neurofibroma

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D/Dx of a Palatal swelling

Lesions in order of occurrences
Pleomorphic adenoma
Adenoid cystic carcinoma
Mucoepidermoid carcinoma
Low grade adenocarcinoma
Canalicular adenoma
Non -Hodgkin Lymphoma
Neurofibroma
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Investigations
Specific to lesion
OPG
FNAC/Deep Incisional
biposy and H/P
CT with Contrast and 3D
reformatting

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General and for G/A fitness

Blood for CBC,Hb, RBS,
S. Creatinine, BT, CT,
Blood grouping
CXR P/A view
ECG
HBSAg, Anti-HCV

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OPG

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FNAC and C/P

Pleomorphic adenoma

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Treatment Plan
Wide surgical excision of lesion with 1 cm
normal healthy tissue around the lesion.
Periosteum included in the depth of dissection.
Placement of acrylic surgical stent and left to
heal by secondary intension.
Adjacent palatal flap can be used to cover the
defect.
Free tissue transfer such as anterolateral thigh
flap or radial forearm free tissue
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THANK YOU

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