neonatal oral surgery
Congenital Epulis Report of a Case and Literature Review Ryan D. Jelicich, D.D.S.; Brian M. Will, D.D.S.; Scott M. Peters, D.D.S.
ABSTRACT The congenital epulis (CE) is an uncommon, albeit benign, soft-tissue lesion in newborns. These tumors have a strong predilection for females, measure approximately 1 cm to 2 cm in diameter, and most commonly arise from the maxillary alveolar mucosa. Although the CE is a benign lesion, it can potentially impair both respiration and feeding, which can cause polyhydramnios prenatally or respiratory impairment postnatally. Recommended treatment is often surgical resection under local or general anesthesia, although, in some cases, the lesion may spontaneously regress. First described by Neumann in 1871, the congenital epulis (CE), also known as Neumann tumor, is a rare, benign, soft-tissue tumor seen in newborns.[1] Although the histogenesis of the CE is still not confirmed, it has been theorized that these tumors originate from either undifferentiated mesenchymal cells, pericytes, fibroblasts, epithelial cells, smooth muscle cells or nerve-related cells.[2] The CE occurs almost exclusively on the alveolar ridge, but there have been rare reports of tongue involvement.[3] Approximately 80% to 90% of cases are seen in females, presenting as a solitary, smooth-surfaced polypoid nodule firmly attached by a narrow or broad base to the labial aspect of the dental ridge.[4] Although rare, roughly 10% of cases present with multiple masses.[5] Lesions are two- to three-times more likely to involve the maxil-
22 NOVEMBER 2021 The New York State Dental Journal ●
lary ridge as compared to the mandible; they are often seen in a non-midline position, usually in the canine-premolar region. CEs may vary in size, and while they are most commonly 1 cm to 2 cm in diameter, lesions ranging from a few millimeters to 9 cm have been reported.[4,7-9] The CE often does not continue to grow postnatally; however, it can cause issues postpartum, such as difficulty with feeding and respiration.[10] Microscopically, the CE resembles a granular cell tumor; however, there are structural and immunohistochemical differences that classify it as a separate entity. Recommended treatment is conservative surgical resection of the lesion under local or general anesthesia, although some cases may spontaneously regress.[6-9] The aim of this case report is to address the clinical presentation, histologic features and clinical management of congenital epulis. Case Presentation A 3-day-old female presented to the pediatric dental clinic at Columbia University Irving Medical Center; the patient’s mother reported a 2 cm mass on the patient’s anterior maxillary gingiva that was interfering with latching while feeding. The baby was born full term, at 6 pounds 8 ounces, by uncomplicated vaginal delivery and was otherwise healthy, with no known medical problems. Clinical examination revealed a pink, firm, sessile mass of the anterior maxillary gingiva that measured 2 cm at its greatest width (Figure 1). Given the clinical presentation of the lesion, the differential diagnosis included a CE and a melanotic neuro-
