Photoclinic: Traumatic Fibroma

A 14-year-old Hispanic boy presented with bilateral nodular lesions on the dorsal aspect of his tongue. He guessed that the lesions had been present for more than a year. They were not painful and had not changed in size or color.

Chris Taylor, APRN, FNP, of Metro Nashville Public Health Department, Tenn, noted that the patient's tongue was large and thickened but did not protrude from the mouth or interfere with oral function--as in functional macroglossia.

This teenager has traumatic fibromas, the most common soft tissue lesions. These usually dome-shaped masses are frequently found on the buccal mucosa of the lips and tongue along the line of occlusion.¹ Traumatic fibromas result from repeated irritation of the oral mucosa (eg, from biting or other trauma, such as grinding of the teeth).² In this patient's case, bruxism was thought to be the cause of the macroglossia and fibromas. The color of the lesion is typically similar to that of the surrounding mucosa. In African American patients, lesions on the buccal mucosa may demonstrate a grayish brown pigmentation. Most fibromas are less than 1.5 cm in diameter. Histologic examination of the lesions reveals densely packed, nonencapsulated fibrous connective tissue.³

Causes of tongue enlargement are usually acute, such as trauma, glossitis, oral infections, and angioedema. Chronic causes of tongue enlargement may include acromegaly, Down syndrome, mucopolysaccharidosis, and tongue cancer. This patient had none of these conditions.

Treatment of traumatic fibromas consists of excision. However, if the contributory cause is not corrected, the lesions frequently recur.⁴ This patient chose not to have the lesions excised.

References:

REFERENCES:

1.

Dunlap C, Barker B.

A Guide to Common Oral Lesions.

Dept. of Oral and Maxillofacial Pathology, UMKC School of Dentistry, 2004. Available at:

http://dentistry.umkc.edu/practition/assets/ OralLesions.pdf

Accessed October 24, 2006.

2.

Lynch M, Brightman V, Greenberg M.

Burket's Oral Medicine: Diagnosis and Treatment.

8th ed. Philadelphia: JB Lippincott Co; 1984:462-466.

3.

Neville B, Damm D, Allen C, Bouquot J, eds.

Oral and Maxillofacial Pathology.

2nd ed. Philadelphia: WB Saunders Co; 2002:438-439.

4.

Bhaskar S.

Synopsis of Oral Pathology.

7th ed. St Louis: Mosby; 1986:535-537.