Inflammatory Fibrous Hyperplasia
Inflammatory fibrous hyperplasia, also called epulis fissuratum or denture fibrosis, is a generalized hyperplastic enlargement of mucosa and fibrous tissue in the alveolar ridge and vestibular area, which most often results from
ill-fitting dentures.’ In the early stages of fibrous hyperplasia, when fibrosis is minimal, nonsurgical treatment with a denture in combination with a soft liner is frequentIy sufficient for reduction or elimination ‘of this tissue. When the condition has been present for some time, significant fibrosis exists within the hyperplastic tissue. This will not respond to nonsurgical treatment’ (Fig, 13-22); excision of the hyperplastic tissue is the treatment of choice. 273
simple excision. B, Closure of wound margins. C, Large area of inflammatory fibrous hyperplasia.
Removal ana primary closure would result in elimination of labial vestibule. 0, After supraperiosteal
removal of excess tissue, mucosal edge is sutured to periosteum at depth of vestibule.
E, Postoperative vie”:,,of Figure 13-21. The smaller well-localized area on patient’s left has been
• removed and closed primarily. The larger area of excessive tissue on right has been removed and
wound margin sutured to periosteum at depth of vestibule, which leaves exposed periosteum.
Three- techniques can be used for successful treatment o f inflammatory fibrdus hyperplasia. Local anesthetic infiltration in the area of the redundant tissue is sufficient for anesthesia. When the area to be excised is minimallyenlarged. electrosurgical or laser techniques provide good results for tissue excision. If the tissue mass is xtensive, large areas of excis.ion using electrosurgical techniques may result in excessice estibular carring. Simple excision and reappr0::imat;on of the remaining tissue is preferred. The redundant areas of tissue are grasped with ti.ssue pickups, a sharp mcislon is made at the base of the excessive fibrous tissue down to the periosteum, and the hyperplastic tissue is removed (Fig. 13-23). The adjacent tissue is gently undermined and reapproximated using interrupted or continuous sutures. When areas of gross tissue redundancy are found, excision frequently results in total elimination of the vestibule. In such cases excisicn of the epulae, with peripheral mucosal repositioning and secondary epithelialization, is preferable (see Fig. 13-23). In this procedure the !lyperplastic soft tissue is excised superficial to the periosteulll from the alveolar ridge area. A clean supra periosteal bed is created over the lveolar ridge area. and the unaffected margin of the tissue excision is sutured to the most superior aspect ot’the vestibular periosteum with all interrupted suture technique. A surgical splir or denture lined with soft tissue conditioner is inserted and worn continuously for the first 5 to
7 days, with removal only for oral saline rinses. Secondary epithelialization usually takes place, and denture impressions can be made within 4 weeks. Laser excision of large epulis allows complete removal without excessive
scarring or bleeding. A soft relined denture can provide for additional postoperative comfort from a procedure that initially creates minimal pain, but the pain peaks several days later. . The hyperplastic tissue usually represents only the result of an inflammatory process; however, other pathologic conditions may exist. It is therefore imperative that
representa tive tissue samples always’ be submitted for pathologic examination after removal.
