Management of a Recurrent Pyogenic Granuloma of the Hard Palate with Diode Laser: A Case Report

Abstract

IntroductionPyogenic granuloma (PG) is a prevalent, benign mucocutaneous lesion exhibited by an exuberant tissue, caused by a local irritation or trauma.1-3 It was first described in English literature by Hullihen 4 in 1844; but the term 'pyogenic granuloma' or 'granuloma pyogenicum' was presented by Hartzell 5 in 1904. However, the term 'pyogenic granuloma' can be a misnomer because the lesion neither causes pus formation nor it represents a true granuloma, histologically. Some researchers use the term "lobular capillary hemangioma" which is histologically a more accurate term for this lesion. 2,6,7 Clinically, PG appears as a sessile or pedunculated exophytic mass with smooth or lobulated surface that may easily bleed or ulcerate, and covered by yellow fibrinous membrane. The color of the lesion depends on the vascularity of the growth, so it can be red, purple or pink. 1,3,[8][9][10] In the 75% of all cases, gingiva is the most affected site by PG. Aside from the gingiva it is also encountered on the lips, tongue, buccal mucosa and the hard palate. The maxillary gingiva is more commonly affected than the mandibular one and the anterior region more than the posterior. Also the lesions are more frequently on the buccal side of the gingiva than the lingual side. 6,10,11 The lesion usually develops slowly, without pain and asymptomatically. But in some cases it may develops fast, reaches its full size and remains stable. The size ranges from a few millimeters to several centimeters but it rarely Gazi University, School of Dentistry, Department of Oral Surgery, Ankara, Turkey Abstract Introduction: Pyogenic granuloma (PG) is a prevalent inflammatory hyperplasia of skin and oral mucosa which is often caused by constant low-grade local irritation, traumatic injury or hormonal factors. In many cases, gingival irritation and inflammation due to poor oral hygiene are precipitating factors. Oral PG occurs predominantly on the gingiva, but it is also encountered on the lips, tongue, buccal mucosa and rarely on the hard palate. Although surgical excision is the first choice of treatment, many other treatment modalities could be counted such as cryosurgery, sodium tetradecyl sulfate sclerotherapy, intralesional steroids, flash lamp pulsed dye laser, neodymium-doped yttrium aluminium garnet (Nd:YAG) laser, carbon dioxide (CO2) laser, erbium-doped yttrium aluminum garnet (Er:YAG) lasers and diode laser have been suggested. After surgical excision recurrence occurs up to 16% of these lesions. It is believed that recurrence ensues as a result of incomplete excision, failure to eliminate etiologic factors or repeated trauma. Case Report: A 50-year-old female was referred to the Department of Oral Surgery, Gazi University, School of Dentistry, complaining of a swelling and growth on the right side of the hard palate for four months. Patient reported a similar growth in the same area about two years earlier, which had turned out to be a PG by histopathology. The treatment plan included surgical excision of the lesion using diode ...

Therapeutic approaches to pyogenic granuloma: an updated review

“…Hasanoglu et al . report similar results in the treatment of another adult patient with gingival PG, with parameters of 808 nm wavelength in continuous wave mode, with a power output of 2 W and a 0.4‐mm‐diameter fiber optic …”

Pyogenic granuloma of the incisive papilla: A rare case report

“…7 The oral pyogenic granuloma occurs more in the maxilla than the mandible with most of the cases seen in the anterior region, involving buccal side more than the lingual. 5 Oral pyogenic granuloma usually has a painless and slow growth but on occasions may grow fast till its full size and thereby remains stable. Initially the lesions are more vascular, bleed easily and are often elevated and ulcerated and later become collagenized and turn pinkish.…”

“…10 Few drugs (e.g., Isotretinoin, oral contraceptives), bacteria, viruses, primary dentition injury, aberrant tooth development and even eruption of teeth could lead to oral pyogenic granuloma. 5 Oral pyogenic granuloma has two histopathological variations, Lobular Capillary Hemangioma (LCH) and non-LCH. The LCH type shows lobular collections of proliferating blood vessels, although superficially there is no specific change in the lesion including capillary dilation, edema or inflammatory granulation reaction in the tissues.…”

“…4 The treatment of choice for oral pyogenic granuloma is surgical excision. The recurrence rate of 16% is attributed to incomplete excision, persistent etiological factors or continued trauma 5 , therefore, to avoid recurrences any potential irritants should be completely removed at the time of surgical intervention.…”

Pyogenic granuloma: Clinicopathological and treatment scenario

“…[ 12 14 ] However, the recurrence of the lesion was reported and rated between 5.8% and 16% after surgery. [ 15 16 ]…”