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SAEM Clinical Image Series: Oral Trauma and Mass

Posted by Han Wei Zheng, MD on

A 38-year-old African American male without a significant past medical history presented with an oral mass. He was struck on the mouth by a wrench handle about two prior. Since then he has had a growing mass originating from the gum of his left front upper teeth. He is no longer able to eat solid foods and has to use a straw for all oral intake. The patient denies fevers, chest pain, shortness of breath, and weight loss.

Additional Images

Physical Exam

Vitals:

Temp 36.9 °C; BP 152/92; HR 106 bpm; RR 16 bpm; O2 sat 100 % on room air

General: Awake, alert, in mild discomfort but with no acute distress

HEENT:

  • large, firm, oozing, four-by-three-centimeter growth on the premaxilla with necrotic material on the anterior aspect and ulceration
  • poor dentition, no fluctuance or halitosis
  • supple neck without adenopathy

The rest of the exam was unremarkable.

Case Question: What is the generic name for such a lesion?

Epulis

An epulis is a benign growth on the gingiva or alveolar mucosa.

This patient had an ossifying fibroid epulis diagnosed by a computed tomography scan of facial bones and confirmed on pathology. An ossifying fibrous epulis contains bone or calcification and is usually caused by trauma [1].

Case Question: What is the preferred treatment?

Surgical excision

There are various types of epulis depending on the components or etiology, however, the definitive treatment is surgical excision [2].

This patient had his epulis surgically removed by an ear, nose, and throat (ENT) physician with a good cosmetic outcome.

Case Discussion

Take-Home Points

  • An epulis is a generic term for a growth of the gingiva or alveolar mucosa.
  • The treatment of choice for an epulis is surgical removal.

References

  1. Mohiuddin K, Priya NS, Ravindra S, Murthy S. Peripheral ossifying fibroma. J Indian Soc Periodontol. 2013;17(4):507-509. doi:10.4103/0972-124X.118325 PMID: 24174733
  2. Holmstrup P, Plemons J, Meyle J. Non-plaque-induced gingival diseases. J Clin Periodontol. 2018;45 Suppl 20:S28-S43. doi:10.1111/jcpe.12938 PMID: 29926497

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2020 SAEM Annual Meeting | Copyrighted by SAEM 2020 – all rights reserved. View other cases from this Clinical Image Series on ALiEM.

Author information

Han Wei Zheng, MD

Resident
MetroHealth Medical Center, Department of Emergency Medicine
Cleveland, Ohio

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The post SAEM Clinical Image Series: Oral Trauma and Mass appeared first on ALiEM.

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