VEGETATIVE GRANULOMA : A DIAGNOSIS SELDOM SUSPECTED CLINICALLY

ABSTRACT

Vegetative granuloma is granulomatous foreign body response to impaction of vegetative or plant material in periapical and sulcus areas of oral cavity, generally secondary to trauma and/or poor oral hygiene. Other names being used in literature for vegetative granuloma are pulse granuloma, chronic mandibular periostitis, hyaline ring granuloma and giant cell hyaline angiopathy. Most cases are seldom suspected clinically and confirmed by microscopic examination only. We present here a case of 42 years old female with peanut sized nodular swelling over left maxilla associated with gradually increasing pain since 3 months. Her oral examination revealed poor oral hygiene. Radiological investigation depicted soft tissue swelling without any bony involvement. Histomorphology showed tissue lined by hypertrophied stratified squamous epithelium having vegetative matter impacted in fibro-collagenous stroma surrounded by prominent giant cell reaction with well-formed granulomas, suggestive of diagnosis of vegetative granuloma. It is important to correctly diagnose this entity as it is an uncommon one and rarely encountered in routine practice. It may clinically mimic as malignancy or tuberculosis at times, hence an accurate diagnosis saves from undue over treatment. Vegetative granuloma is treated by complete excision of lesion and maintenance of oral hygiene to prevent recurrence.