Fibromatous Epulis of the Maxillary Gingiva in a Hypertensive Patient: A case report

Abstract

Background: Fibromatous epulis is a benign, reactive, non-neoplastic gingival lesion characterized by fibrous connective tissue proliferation secondary to chronic local irritation. The lesion typically originates from the gingival connective tissue, periodontal ligament, or periosteum and is commonly associated with local irritants such as dental plaque, calculus, residual root fragments, and poor oral hygiene. Surgical excision is the treatment of choice; however, management in patients with hypertension requires special perioperative considerations due to the increased risk of bleeding and potential cardiovascular complications.

Case Presentation: A 59-year-old female presented with a large, slowly growing mass in the right maxillary gingiva causing difficulty in mastication and speech. The lesion had been present for approximately 1.5 years. Clinical examination revealed a pedunculated, elastic mass measuring 4×4×3 cm extending from the right maxillary first premolar to the maxillary tuberosity. The patient had a history of hypertension and was taking amlodipine. Radiographic examination showed no bony involvement, while panoramic imaging revealed residual roots of teeth 14 and 15. The provisional diagnosis was a benign soft tissue tumor, with fibromatous epulis as the differential diagnosis.

Management and Outcome: Preoperative medical consultation was performed, and antihypertensive therapy with amlodipine was administered to achieve adequate blood pressure control prior to surgery. Following stabilization, complete surgical excision of the lesion along with extraction of the retained roots was carried out under general anesthesia, and local anesthetic infiltration with a vasoconstrictor is also administered to ensure optimal hemostasis, postoperative pain control, reduction of surgical stress response, and improved postoperative patient comfort. The lesion was completely excised, accompanied by extraction of residual root fragments and bone contouring. Histopathological examination confirmed the diagnosis of fibromatous epulis, characterized by hyperplastic stratified squamous epithelium and fibrous collagenous connective tissue without malignant features. Postoperative healing was uneventful, with no bleeding or recurrence observed at the two-week follow-up.

Conclusion: Complete surgical excision combined with elimination of local irritative factors is an effective treatment for fibromatous epulis. Careful systemic, anesthetic, and psychological management is essential when performing oral surgical procedures in hypertensive patients to minimize complications.

Keyword: Fibromatous epulis, gingival enlargement, hypertension, oral surgery