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.
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.
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].
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.
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.
- 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
- 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
Han Wei Zheng, MD
MetroHealth Medical Center, Department of Emergency Medicine
Cleveland, Ohio
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