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Epulis fissuratum in the soft palate: Report of a case in a very rare location

Article  in  Dental Hypotheses · January 2016

DOI: 10.4103/2155-8213.183798

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Maryam Baharvand Soudeh Jafari

Shahid Beheshti University of Medical Sciences Shahid Beheshti University of Medical Sciences
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Case Report

Epulis fissuratum in the soft palate:

Report of a case in a very rare location
Hamed Mortazavi, Hamid Reza Khalighi, Soudeh Jafari, Maryam Baharvand
Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran

A B S T R A C T

Introduction: Epulis fissuratum is a tumor-like hyperplasia developing in association with an ill-fitting denture. Case Report: We
report a 73-year-old female with epulis fissuratum in the soft palate as a very rare clinical location. She presented with the chief
complaint of an abnormal growth along the posterior border of her ill-fitting upper complete denture as well as pain and discomfort
during mastication. Intraoral examination revealed a polypoid fibrous mass, soft in consistency and smooth in texture. On history and
clinical examination, a provisional diagnosis of denture-induced hyperplasia was made. The patient was prescribed topical anti-fungal
medications for 10 days. Then, the lesion was excised surgically. Discussion: Histopathological examination revealed hyperplastic
epithelium as well as a fibrous connective tissue with moderate inflammation which confirmed the clinical diagnosis. Although rare,
epulis fissuratum can happen along the posterior portion of the upper denture and should be considered in intraoral examination.

Key words: Denture-induced hyperplasia, epulis fissuratum, soft palate

Introduction that discomfort is not a prominent feature. Therefore, the

Denture-induced hyperplasia (DIH) or epulis fissuratum
is a tumor-like hyperplasia of fibrous connective
tissue, which develops in association with an ill-fitting
complete or partial denture.[1] This entity most often
occurs in middle-aged and older adults. It is reported in
5-10% of the jaws with dental prosthesis.[2] The anterior
portion of the jaws is affected much more commonly
than posterior areas.[3] According to the literature, two-
thirds to three-fourths of all cases submitted for biopsy
occurred in women.[4] Clinically, DIH appears as a single
or multiple fold or folds of hyperplastic tissue along the
denture borders. The size of this lesion can be <1 cm
to massive lesions.[1,5] DIH is usually asymptomatic, but
in some cases, severe inflammation and ulceration were
reported. The chronic nature of this phenomenon means
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patient may continue to wear the offending denture until
the hyperplastic lesion of considerable size develops
before the patient becomes aware of the lesion and seeks
for treatment.[1] Rosenquist pointed out that chronic
trauma to the oral mucosa by the sharp edges of teeth
or ragged borders of ill-fitting dentures have a potential
to cause oral carcinoma. Hence, ill-fitting dentures and
their sequelae should not be overlooked.[6]
Case Report
A 73-year-old female attended at the Oral Medicine
Department with the chief complaint of an abnormal
growth along the posterior border of her ill-fitting
maxillary complete denture, which gradually grew in
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DOI: Cite this article as: Mortazavi H, Khalighi HR, Jafari S, Baharvand M. Epulis
10.4103/2155-8213.183798 fissuratum in the soft palate: Report of a case in a very rare location. Dent
Hypotheses 2016;7:67-9.

Corresponding Author: Dr. Maryam Baharvand, Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences,
Daneshjoo Blvd, Tabnak Street, Chamran Highway, 1983963113, Tehran, Iran. E-mail: m-baharvand@sbmu.ac.ir

© 2016 Dental Hypotheses | Published by Wolters Kluwer - Medknow 67

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Mortazavi, et al.: Epulis fissuratum in the soft palate

size over the past 5 months [Figure 1]. The denture was
fabricated about 20 years ago. The patient has been
suffering from pain and discomfort during mastication
for the past 2 months. Meanwhile, she used to wear the
denture during night time. Intraoral examination revealed
a fibrous mass which was about 1 cm × 2.5 cm in size.
The lesion was polypoid, soft in consistency, and smooth
in texture [Figure 2]. In addition, clinical presentation of
denture stomatitis and angular cheilitis was observed.
Medical history was not contributory, and she did not
use any medications except for vitamins and minerals.

Differential diagnoses included irritation fibroma, leaf-

like denture fibroma, benign mesenchymal tumors,
and minor salivary gland tumors.[4,7] According to the
patient’s history and clinical examination, a provisional
Figure 1: Epulis fissuratum along the posterior border of the upper denture
diagnosis of DIH was made.

The treatment protocol consisted of both medical and

surgical approaches. The entire treatment plan was
described to patient and written consent form was
obtained from patient. The patient was instructed not
to wear the denture. Nystatin oral suspension (Savorite
Pharmaceuticals, Gujarat, India) and ointment of
triamcinolon N.N. (RAHA Pharmaceutical Co., Isfahan,
Iran) were prescribed for her denture stomatitis and angular
cheilitis, respectively. The patient was educated and
motivated to maintain her oral hygiene at optimum level.

After 10 days, the patient was recalled and the lesion

was excised surgically. The specimen was sent for
histopathological examination, which showed
hyperplastic epithelium as well as a fibrous connective
tissue with moderate inflammation [Figure 3].
Figure 2: Polypoid epulis fissuratum on the soft palate
After 7 days, the patient was reexamined and the
healing process was satisfactory. Finally, the patient
was referred to prosthodontics department to fabricate
a new denture.

A 3-month follow-up showed complete resolution

without any recurrence.

Discussion
The term “epulis” was first coined by Virchoft, and its
dictionary meaning is “over the gum.” Over the years, it
was noticed that the usage of this term is not appropriate
as it only referes to the site of lesion. Moreover, the
affected mucosa is usually the oral mucosa of the
Figure 3: High-power photomicrograph showing hyperplastic
vestibular sulcus or the palatal region and not the fibrovascular connective tissue covered by stratified squamous
gingival mucosa. Therefore, “denture-induced fibrous epithelium (H and E)

68 Dental Hypotheses Apr-Jun 2016 / Vol 7 | Issue 2

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Mortazavi, et al.: Epulis fissuratum in the soft palate
hyperplasia” was considered to be a much preferred
term.[8] DIH may be the result of ill-fitting denture,
wearing denture all day and night long, poor oral
hygiene, smoking, age-related changes, and systemic
conditions.[1] In our case, ill-fitting denture and poor oral
hygiene seemed to induce oral mucosal overgrowth. In
agreement to the present case, Macedo Firoozmand et al.
showed that 78% of denture wearer females presented
with DIH mostly in the maxilla.[9] On the other hand, in
almost all previous reports, DIH was demonstrated in
the anterior portion of the mandible or maxilla.[5,10,11] To
the best of our knowledge, this is the first report of DIH
occurring in the soft palate along the posterior border
of the upper denture.
DIH can be treated surgically or conservatively. In the
early stage, denture coverage with a soft liner material is
frequently sufficient for elimination or reduction of the
lesion. However, in later stages, when the hyperplastic
tissue is composed of significant fibrosis, surgical
excision is the treatment of choice. Excision can be
performed by either conventional surgical approach or
laser ablation, which provides minimal postoperative
edema and pain.[1,5,8] In a recent case report, the use
of liquid nitrogen cryosurgery has been suggested to
manage epulis fissuratum in geriatric patients.
Conclusion
Epulis fissuratum is a common oral lesion, which might
develop in unusual locations as well.
Apr-Jun 2016 / Vol 7 | Issue 2
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Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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