ABSTRACT : Telangiectatic granuloma is benign hyperplastic lesion that is supposed to result from trauma or local irritation. It is composed of granulation tissues and numerous blood vessels and develops as solitary, pedunculated granuloma-like, easily bleeding tumor. It is one of the various names given to the entity granuloma depending on the etiopathogenesis. It predominately occurs in vestibular gingiva of anterior region, affecting second young women in second decade of life. Gingiva being the most common site of occurrence elucidating about 75% of all cases due to presence of chronic low grade irritation cause by calculi. This present case report deals with an unusual occurrence of telangiectatic granuloma on the palatal gingiva and its removal by laser.

1 2 3 4 Sukanya Mohanty, Sania, Vipin Kumar Arora, Ellora Madan1Post Graduate Trainee, Dept of Periodontics, Kothiwal Dental College

2& Research Centre, Moradabad Post Graduate Trainee, Dept of Periodontics, 3Kothiwal Dental College & Research Centre, Moradabad .Proffesor, Department

of Periodontics, Kothiwal Dental College & Research Centre, Moradabad,Reader, Department of Periodontics, Kothiwal Dental College & Research Centre, Moradabad

INTRODUCTION : The oral cavity is often exposed to

traumatic and irritating tissue lesions that produce tissue

response, especially soft tissues. The gingiva, oral mucosa,

lips and tongue are the areas most affected by the lesions.1

The oral telangiectatic granuloma (OTB), formerly called as

pyogenic granuloma, is a benign inflammatory hyperplastic

lesion that affects the skin and the oral mucosa, and appears as

a response to local trauma or chronic irritation creating a

repair tissue (granulation) produced by the body as a defense

mechanism.2 This condition is very common in South

American countries; Gordon, Vasconcelos et al, in 2010,

published a study of 293 cases of OTB in Brazilian

population3, Duarte, Vallejos et al, in 2006, reported 12 cases

in Argentina,4 Espinoza, Rojas et al, in 2003, in Chile,

reported 62 cases in patients over 65 years of age.5

The etiology of this disease comprehends with aspects such as

presence of bone spicules, use of orthodontic appliances, root

fragments, gingival irritation and plaque or calculus. Several

authors claim that its etiology is largely related to traumatic

factors or to local irritants that seem to be associated to

hormonal female sex changes, as it appears especially in

pregnancy and puberty, altering tissue response thus enabling

the appearance of granulation tissue.6, 7 Clinically the lesion

is characterized by redness, whose size varies from few

millimeters to larger size, surface might be smooth or rough.

Its base might be sessile or pedunculated. The initial treatment

procedures include removal of etiologic factors followed by

excision depending on the regression of size after initial

treatment. Amongst the getatable treatment modalities are the

use of CO2, laser, cryosurgery and application of acidic

substances. The most effective modality is surgical removal

reaching the periosteum and removing the entire base of the

lesion followed with root planing. The coeval case report

encompasses the management of a telangiectatic granuloma

by laser.

CASE REPORT : A 50 year old female presented with a

growth in the upper left back teeth region that bled while

chewing and brushing since 6 months. She suffered from low

blood pressure, apart from that no other medical problem was

reported. The growth was small in size initially that grew to

the present size of 1x1 cm (figure-1). The patient also reported

“PRODIGIOUS KNURL” A CASE REPORT ON TELANGIECTATIC GRANULOMA.

Journal of Dental Sciences

University

Keywords : Human botryomycosis, pyogenic granuloma, Telangiectatic granuloma.

Source of support : NilConflict of interest : None

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University J Dent Scie 2015; No. 1, Vol. 3

Case Report

of occasional pain while mastication and brushing. The

growth extends 1cm from the marginal gingiva of upper left

molar region to the palatal mucosa. There was no pocket of

7mm present with respect to mesial surface of 26, while distal

accounted for 6mm of pocket depth. Intraoral periapical

radiograph revealed horizontal bone loss with respect to 26

(figure-2). Owing to the proximity of the lesion to greater

palatine vessels, the chances of profuse bleeding was

possible, hence to avoid it excision of the lesion with laser was

planned. Greater palatine block was given and excisional

biopsy of the lesion was done with the aid of diode laser 980

nm (FONA® SYRONA dental system Gmbh, Fabrikstrasse-

31, 64625, Bensheim, Germany). The laser was kept in

continuous mode and after the excision the rough edges were

merged. The surgical site was covered with periodontal

dressing and the tissue was sent for histopathological

examination. Histopathology revealed the presence of

stratified squamous epithelial lining overlying dense fibro

cellular connective tissue stroma. The stratified squamous

epithelium was hyperplastic and exhibits thin and elongated

rete pegs. The connective tissue stroma consisted of dense

collagen fibers. Numerous endothelial lined blood vessels

were also seen. Focal areas of chronic inflammatory cell

infiltrate chiefly lymphocytes and plasma cells were also

seen.

Patient was recalled after one week and periodontal dressing

was changed and the area was irrigated. The periodontal

dressing was removed after 15 day. Owing to the loss of

tissue, sensitivity and the recession that occurred due to the

extent of growth into alveolar bone, hence the patient was

advised for root canal treatment of 26. In addition to that a

second stage surgery was planned for that particular area and

patient was informed about the same.

FIGURE-1 Depicting the site and extend of the lesion.

FIGURE-2 Radiograph revealed horizontal pattern of bone

loss.

FIGURE-3 Showing the use of diode laser for excision.

FIGURE-4 Shows the site after excision

FIGURE-5 Excised tissue

FIGURE-6 Site after 15days post operative

University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 105

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FIGURE-7 Histopathological view

DISCUSSION : Telangiectatic granuloma is described as a

localized reactive lesion caused by a given stimulus that

produces excessive connective tissue; it is frequently found in

the oral cavity, usually affecting areas such as gingiva, lips

and alveolar mucosa.6 Telangiectatic granuloma was

formerly described under the heading “human

botryomycosis” by Poncet and Dor, who first described these

little granulomata in man and claimed to have found the

typical cocci (1879). Already in 1899, however, Sabrazes and

Laubie denied a relation with botryomycosis and created the

name telangiectatic granuloma. The staphylococci are chiefly

found on the surface and not in the typical arrangement in

globules. Nevertheless, recently authors again tend to accept

the pathogenetic role of staphylococci, expressed in the name

granuloma pyogenicum (Hartzell).8The telangiectatic

granuloma develops as a generally solitary, pedunculated,

granuloma-like, easily bleeding tumor. It feels rather solid, at

least, is not as soft as an ordinary granuloma. It may grow to

the size of a pigeon's or chicken's egg in weeks, months or

years and, though benign, shows a marked tendency to

recurrence if not carefully excised. It especially develops in

the uncovered parts of the skin; 1/3 is found at the fingers, 1/4

at the lips and mucous membranes of the mouth. The

diagnosis is easily missed, and malignant growth suspected.

Treatment modalities include nonconventional surgical

modalities, cryosurgery in the form of either liquid nitrogen

spray or a cryoprobe, Nd: YAG, CO2, and flash lamp pulsed

dye lasers as well as surgical excision of the lesion.6

CONCLUSION :

Telangiectatic granuloma is clinically, a rather sharply lined,

not uncommon variety of granuloma. The treatment modality

of this case was varied due to the close proximity of the lesion

to the greater palatine vessels. It is a form of pyogenic

granuloma, non-neoplastic growth.

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CORRESPONDING AUTHORS

dR. Sukanya Mohanty

Kothiwal Dental College

Moradabad.

nancy_mohanty@yahoo.co.in

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