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of some clinical features as well as the histologic the local irritant are eliminated and the pregRancy terpicture, the final diagnosis was pyogenic granuloma, minated Otherwise, treatment of PG involves conservative surgical exicison. DISCUSSION Differential diagnosis in this case included benign Pyogenic granuloma (PG) of the oral cavity, lesions such a fibrous epulis, peripheral giant cell although a relatively common lesion, may sometimes granuloma, calcigying fibrooblastic granuloma and present in an unusual manner. It is described to be ameloblastic fibroma. Anneroth and Sigurdson 2 proa well cricumscribed, soft tissue tumor with a size vided an excellent review and classification of the varying from 0.5 cm to 2 cm or more. Trauma and above-mentioned hyperplastic lesions of the gingiva. microtrauma due to toothbrushing and gingival in- In this case, a malignant process was also highly flammation were cited as pathogenic elements His- considered because of the unusually large size of the tologically, PG arises from the com_ective tissue of mass with its ulcerative surface and friability on tissue the skin and more commonly of the oral mucosa where biopsy. Among the malignant lesions, a fibrosarcoma it can be partly or completely covered by squamous as well as a squamous cell carcinoma were considepithelium. In 65% of cases, there is a varying degree ered. All these lesions will however, have distinct of ulceration covered by a mucinousexudate. Usually, histologic features quite different from PG. lobulated lesions are Composed of solid ennthelial proliferation or proliferation of capillary sized blood The case presented is very unusual in that lesion vessels Clinically, it appears as an elevated, sessile has attained a large size, unprecedented in world or pedunculated soft tissue mass. It may have a smooth literature. Of particular interest is its highly vacular lobulated appearance sometimes with ulcerative sur- nature observed intraoperatively. Surprisingly, there face which tends to bleed spontaneously. 5 Occasion- was no radiographic evidence of bone resorption in ally, white sloughy material resembling pus maybe this case despite its size and duration. The clinical observed, thus the term "pyogenic" granuloma given appearance was however suggestive of a malignancy by earlier clinicians. In a review of 762 cases, PG such that repeated biopsies were done. involves in decreasing order of frequency the gingiva, lips, tongue, buccal mucosa, palate, mucobuccal fold and alveolar mucosa ofedentulous areas. From further SUMMARY analysis of gingival involvement, the upper gingiva are more common site than the lower gingiva. Sta- A case illustrating a huge mass in the oral cavity blein and Silverglade in their comparative anlaysis of has been presented. A rather aggressive and maliga total of 834 consecutive biopsy specimens from the nant process was considered because of the unusually gingiva and 448 from the alveolar mucosa reported large size and the ulcerative surface of the lesion. an 85% incidence of inflammatory or reactive hyperplasia with PG being most common in the gingiva Histophatologic examination often does not with 23.6% incidence. There was a 10:l ratio of conform with the clinical impression thus resulting : benign to malignant neoplasia in the gingiva which in repeated biopsies to establish the definitive diagwas greater than in the alveolar (almost 1;1). Moriconi nosis. and Popowich 6 reported a case of alveolar granuloma measuring 4 x 6 cm in size. Previous to this report, Finally, management was simple and straightforthis case represents the largest PG to be reported in ward as conservative surgical excision need be done world literature. The lesion occurs in all ages with when histologic identification of a benign process is peak incidence in the third decade as in this patient, confirmed. Radiographically, there maybe evidence of alveolar bone resorption in large and long-standing gingival masses. There is a reported female preponderance ACKNOWLEDGEMENT especially in pregnant women presumably due to hormonal factors. It is therefore known as a preg- The authors wish to tank Dr. Joselito Jamir and nancy or hormonal tumor. This is one instance when R. Armando T. Chiong of the Department of Otopyogenic granulomas need not be excised surgically laryngology, Jniversity of the Philippines for their since regression and resolution of the mass occurs as invaluable advice. 27
._ REFERENCES 5. Kfir, Y., Buchner, A. and Hansen, L.: Reactive lesions of the gingiva: A clinical 1. Angelopoulos, A.: Pyogenic granulomas of the pathological study of 741 cases. J oral cavity: statistical analysis of its Periodontol, 51:655-661,1980. clinical features. J Oral Surg., 29:840- 847, 1971. 6. Moriconi, E. and Popowich, L.: Alveolar pyogenic granuloma: Review and report of case. 2. Anneroth, G. and Sigurdson A.: Hyperplasia lesions Laryngoscope, 94:807-909, 1984. of the gingiva and laveolar mucosa: A study of 175 cases. Acta Odontol 7. Stablein, M. and Silverglade, L.: Comparative Scan(I, 41 (2):75-86, 1983. analysis of biopsy specimens from gingiva alveolar mucosa. J. 07 3 3. Bhaskar, S.; Pyogenic granuloma - clinical featurers, Pciodontol, 56:671-678, 1985. incidence, histology and result of trcatment: Report of 242 cascs. JOral 8. Vilmarm, A., Vilmann, P. and Vilmann, H.: Surg, 24:391-398, 1966. Pyogenic granuloma: evaluation of oral conditions. Br J Oral Maxillofac 4. Eversole, L. and Rovin, S,: Reactive lesions of Surg, 24:376-382, 1986. the gingiva. Oral Surg, 1:30, 1972. 28
Page 2 and 3: Iq4LIPl:qut=S TABLE OF CONTENTS NEC
Page 4 and 5: HEAD AND NECK SURGERY - TO ADD OR N
Page 6 and 7: PRESIDENT'S PAGE The years 1989-90
Page 8 and 9: RIZAL MEDICAL CENTER DEPARTMENT OF
Page 10: muscles. Again it is likely possibl
Page 15 and 16: area measuring 4.8 x 3.7 cm extendi
Page 17 and 18: tend to recur locally, even after p
Page 20 and 21: UNIVERSITY OF THE PHILIPPINES PHILI
Page 22 and 23: The majority of patients with hyper
Page 24 and 25: mass wa uttrasonograImy. Neck explo
Page 26 and 27: Figure 2 : Parathyroid Adcnoma vs.
Page 28 and 29: E.wa_ileMassonLe_Maxilla "salt& pep
Page 34 and 35: MCU HOSPITAL DEPARTMENT OF OTOLARYN
Page 37 and 38: JOSE REYES MEMORIAL MEDICAL CENTER
Page 39 and 40: nonetheless stated: "We have the im
Page 41 and 42: to the diagnostic know-how of the c
Page 43 and 44: PATIENTS & METHODS: These signs and
Page 45 and 46: Most patients in group 1 complained
Page 47 and 48: DISCUSSION: and septal deviation mi
Page 49 and 50: OSPITAL NG MAYNILA DEPARTMENT OF OT
Page 51 and 52: ..temporary relief. According to Ha
Page 53 and 54: CASE REPORT phonuclear cells. The r
Page 55 and 56: TITLE:Cleft Lip Surgeryfor Rural Fi
Page 57 and 58: After intubation and the endoctrach
Page 59 and 60: BIBLIOGRAPHY Converse, J.M., Recons
Page 61 and 62: UNIVERSITY PHILIPPINE DEPARTMENT OF
Page 63 and 64: Table 3. Distribution of Organism b
Page 65 and 66: J BIBLIOGRAPHY Y MACKOWIAK, P.A., J
Page 67 and 68: Figure 3. SENSITIVITY PATTERN OF Pr
Page 69 and 70: Figure 3. Percent SENSITIVITY PATTE
Page 71 and 72: loradatine 10 mg/tabletgiven once a
Page 73 and 74: 1. Severity of Symptoms 3. Comparis
Page 75 and 76: -J;r,ceiving 40 mg of loratadine da
Page 79 and 80: : ' : _ : ::::::: : : i : ::
Page 81 and 82:
These patients are new patients see
Page 83 and 84:
- Table Vl Baseline Signs and Sympt
Page 85 and 86:
The following Table VII will show t
Page 87 and 88:
• 14.Drowsiness: None 30 2 4 10 2
Page 89 and 90:
Actifed's side effect of drowsiness
Page 91 and 92:
" to be packed with one type of pac
Page 93 and 94:
With regard to microbiology of nasa
Page 95 and 96:
TABLE 6: MANNER OF CONTROL OF REBLE
Page 97 and 98:
APPENDIX C MICROBIALGROWTH POTENTIA
Page 99 and 100:
EAST AVENUE MEDICAL CENTER DEPARTME
Page 101 and 102:
type (20%-30% of cases) varies from
Page 103 and 104:
TABLE Ii HistologicalClassification
Page 105 and 106:
THE LATERAL NASAL WALL IN FILIPINOS
Page 107 and 108:
MIDDLE MEATUS: Diameter of ostium:
Page 109 and 110:
.;4".,..:'.-" ............. '---.",
Page 111 and 112:
Figure 4. Variation in the location
Page 113 and 114:
This study presents variations with
Page 115:
ACKNOWLEDGMENT The authors would li
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