Abstract
Intraoral squamous papilloma is an uncommon lesion which presents as a verrucous, exophytic or papillary growth of the oral mucosa. Human Papilloma Virus (HPV) is often detected associated with this condition but HPV may be an incidental finding. In this report we present the surgical management of squamous papilloma of hard palate and discuss its association with HPV.
Highlights
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Large papilloma of hard palate is a clinical rarity.
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Association of Intraoral squamous papilloma with Human Papilloma Virus (HPV) was found negative.
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Free buccal fat pad graft for palatal coverage demonstrated.
1
Introduction
Oral squamous papilloma may be described as an exophytic or papillary growth of the oral mucosa due to proliferation of stratified squamous epithelium. Usually non-tender and asymptomatic, it causes concern in patients due to possibility of malignancy. Other conditions that have a similar clinical presentation are exophytic carcinoma, verrucous carcinoma and condyloma acuminatum [ ].
Human Papilloma Virus (HPV) is often associated with this condition and it is thought to promote cell proliferation and transformation, leading to more severe disease. Though, high-risk HPV types have been detected in hyperplastic and dysplastic mucosal lesions of the oral cavity, it has been suggested that HPV is an incidental finding [ ].
Lesions are amenable to excision by scalpel or laser [ ].
2
Case report
A 60-year-old female reported with a chief complaint of growth of soft tissue mass on the hard palate since one month. History revealed that it started as painless slow-growing mass, gradually enlarging to cause discomfort on eating and interference while swallowing. There was also a history of receiving treatment with anti-candidal mouth paint due to burning sensation and scrapable white patches in right buccal mucosa, anterior one-third of tongue and hard palate. Patient was diabetic on medications since two years and personal history was non-contributory and she was not a denture user.
General and extra oral examination of the patient did not reveal any significant findings. Intraoral examination revealed a pale pink exophytic papillary lesion on vault of hard palate measuring approximately 1.5 × 1.5cm. ( Fig. 1 ). The lesion was well circumscribed, soft to firm in consistency, non-tender, not associated with bleeding. Hard palatal mucosa was reddish and inflamed. Radiographic examination of the area revealed intact underlying bone with no evidence of bony erosion. Lymph node examination revealed no lymphadenopathy.
A provisional diagnosis of papilloma was made. Under general anaesthesia surgical excision was performed with a scalpel including a safety margin of surrounding unaffected tissue. Further, the excision margins were cauterized to eliminate any remnants and to help achieve haemostasis. The exposed bone was covered with free fat graft obtained from buccal fat pad. ( Figs. 2 and 3 ).
Histopathologic examination of the specimen revealed proliferating hyperplastic stratified squamous epithelium with papillomatosis, hyperkeratosis with parakeratosis and fibrovascular cores. The subepithelium showed minor salivary glands and mild to moderate degree of chronic inflammatory infiltrate ( Figs. 4 and 5 ). Immunohistochemistry was negative for p16 in the lesional cells.
