Fibrous hyperplasia involving the orifice of Stensen’s duct

Abstract

This study aimed to describe the clinical features and surgical management of fibrous hyperplasia involving the orifice of Stensen’s duct. The clinical data of three patients (one male and two females) were collected and analyzed to characterize this lesion. The lesions surrounding the orifice of Stensen’s duct were painless and without obvious causes. The patients’ clinical features included sensation of a foreign body and an awkward bite during mastication. All patients received surgical management to resect the polyp and reconstruct the orifice of Stensen’s duct. The ducts were preserved intact and parotid glands functioned normally after 12–18 months follow-up. In conclusion, the key point for surgical management of fibrous hyperplasia involving Stensen’s duct is to keep the duct intact and unobstructed in consideration of its particular location.

Reactive fibrous hyperplasia is a common lesion on the buccal mucosa; most such lesions arise from trauma or chronic inflammation. Surgical resection is recommended for the treatment of these lesions. Physiologically, the opening of Stensen’s duct is located on the buccal mucosa opposite the second molar of the maxilla. The anatomically thickened mucosa surrounding the opening forms the orifice of Stensen’s duct, which can be an unusual anatomical siting of this common oral lesion. The surgical treatment of fibrous hyperplasia involving the orifice of Stensen’s duct is a challenge for the maxillofacial surgeon because the duct is easily damaged and obstruction of the duct may occur.

Recently, three patients with fibrous hyperplasia involving the orifice of Stensen’s duct were treated in our department. The key points with regard to the diagnosis and management of this lesion are discussed herein.

Materials and methods

From May to November 2011, three patients were diagnosed with fibrous hyperplasia involving the orifice of Stensen’s duct. Data from the medical records and information on the surgical process, histopathological findings, and follow-up were collected and analyzed to define the characteristics of this lesion.

Results

The patients included one male aged 29 years and two females aged 49 and 57 years. One lesion was located in the left buccal mucosa and the other two were found in the right buccal mucosa.

Medical history

The case histories ranged from 3 months to 2 years. None of the patients had a history of obvious trauma or of medication for general diseases. Treatment was required because a painless lesion on the buccal mucosa was increasing slowly in size. Two of the three patients complained of the sensation of a foreign body on the buccal mucosa no matter whether they were chewing or not, and of an awkward bite during mastication. However, there was no history of a demonstrated obstruction of Stensen’s duct for any of the three patients. None of these patients complained of symptoms of xerostomia.

Clinical symptoms

Clinically, all patients showed a polyp-like lesion with a pedicle that surrounded the orifice of Stensen’s duct. The diameter of the lesion ranged from 1.0 cm to 1.5 cm and its superficial mucosa was smooth ( Fig. 1 ). Palpation indicated that the lesion was soft, painless, and able to be mobilized. Upon milking the parotid gland, clear saliva was discharged from the orifice of the duct. Parotid sialography was performed in each case, which revealed the imaging of the parotid gland with filling of contrast in the acini and the duct system and a longer Stensen’s duct.

Fig. 1
Polyp-like exogenous lesion surrounding the orifice of Stensen’s duct. The site of the ductal orifice is indicated by a probe or nylon tube inserted into the duct. (A) Case 1; (B) Case 2; and (C) Case 3.

Surgical management

All three patients underwent resection of their lesions and reconstruction of the orifice of Stensen’s duct under general anaesthesia. The surgical procedure used was as follows: (1) design of the incision: a circular incision was marked on the mucosa according to the location of the ductal orifice. Approximately 0.3 cm of mucosa surrounding the ductal orifice was reserved as a cuff to ensure its reconstruction ( Fig. 2 A) ; (2) lesion resection: before resecting the lesion, a silver probe or a nylon tube was inserted into the duct to indicate the direction of the duct. The lesion was then resected carefully and the duct was protected such that it remained intact ( Fig. 2 B); and (3) reconstruction of the ductal orifice: after resection of the lesion, the remaining mucosa surrounding the ductal orifice was put back in place and sutured with the buccal mucosa to form a new orifice ( Fig. 2 C and D). A nylon tube was maintained inside the duct for 7–10 days to ensure the duct remained unobstructed.

Fig. 2
The surgical procedure. (A) A circular incision was marked on the mucosa; a 0.3-cm cuff of mucosa surrounding the ductal orifice was preserved; (B) the lesion was resected and the duct was protected such that it remained intact; (C) the remaining mucosa surrounding the ductal orifice was put back in place; and (D) the mucosa surrounding the ductal orifice was sutured with the buccal mucosa to form a new orifice.

Histopathology

The surgical specimens from all three patients were determined to be benign fibrous hyperplasia. Mild oedema of epithelial cells and hyaline degeneration were observed accompanied by mild inflammatory cell infiltration ( Fig. 3 ). No tumour cells were found.

Jan 19, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Fibrous hyperplasia involving the orifice of Stensen’s duct
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