The role of viruses in oral mucosal lesions.

The mucosa of the oral cavity is exposed to a large number of different microorganisms such as archaea, bacteria, fungi, parasites, and viruses. Among those, viruses cause specific infections, which can easily be transmitted from one person to another. The infectious route may not only include patients and their relatives but also the dental professional team. Thus, a wide knowledge regarding specific viral infections is crucial for the daily routine. Signs and symptoms of oral viral infections can be completely absent or develop into a pronounced clinical picture, so that early detection and information determine the further course of the infection and its influence on other inflammatory diseases, such as periodontitis, as well as the safety of family members and the social environment. As the clinical manifestation of viral infections may be highly variable leading to heterogenous mucosal lesions it is, in most cases, mandatory to differentiate them by specific microbiological tests in addition to clinical examination procedures. This article will give an overview of the role of viruses infecting the oral mucosa, and in addition, describe their clinical manifestation and management.

Photodynamic therapy in focal epithelial hyperplasia.

Focal epithelial hyperplasia (FEH) is an uncommon benign disorder affecting the oral mucosa. It is primarily associated with human papillomavirus (HPV) infection and presents as multiple white or pink soft papules or nodules. Typically, FEH is asymptomatic. Conventional treatment approaches for FEH include topical medication, surgical excision, CO2 laser ablation, cryotherapy, etc., but their efficacy varies. Photodynamic therapy (PDT) is a non-invasive and selective photochemotherapy method widely utilized in clinical practice. By employing specific light wavelengths to activate photosensitizers and induce the generation of reactive oxygen, PDT exerts cytotoxic effects. However, the application of PDT in treating FEH has not been previously documented. In this study, we present a case demonstrating the complete remission of FEH lesions using PDT, with no recurrence observed over a period of 9 months. This compelling outcome suggests that PDT may be a preferred treatment modality for FEH.

Oral Human Papillomavirus Benign Lesions and HPV-Related Cancer in Healthy Children: A Systematic Review.

The present systematic review aimed to assess the prevalence of oral HPV-related lesions, categorized as benign (verruca vulgaris "VV", squamous cell papilloma "SP", condyloma acuminata "CA", and focal epithelial hyperplasia "FEH") and malignant (oral squamous cell carcinoma "OSCC"), in descending order of occurrence in pediatric subjects (≤18 years of age). The secondary objectives were to evaluate the frequency and types of oral lesions described in relation to HPV genotypes and the HPV vaccine type (if any). The study protocol, compliant with the PRISMA statement, was registered at PROSPERO (CRD42022352268). Data from 60 studies, of which quality was assessed using the ROBINS-I tool, were independently extracted and synthesized. Along with seven poorly described benign HPV-related oral lesions that could not be categorized, a total of 146 HPV-related oral lesions, namely 47.26% (n = 69) VV, SP, and CA, 51.37% (n = 75) FEH, and 1.37% (n = 2) OSSC, were diagnosed in 153 pediatric subjects (M:F ratio = 1:1.4) with a mean age of lesion onset of 8.46 years. The viral genotypes detected were HPV-13 (30.61%), -6 (20.41%), -11 (16.33%), HPV-2 (12.24%), -32 (10.20%), -57 (6.12%), and -16 (4.08%). No HPV vaccination was reported in any case. Further studies should be conducted to evaluate the prevalence of HPV-related benign and malignant lesions and the potential role of HPV and associated vaccination in oral carcinogenesis in pediatric subjects.

Diode Laser Excision of Focal Epithelial Hyperplasia (Heck's Disease): A Case Report.

Introduction: Focal epithelial hyperplasia (FEH), also known as Heck's disease, is a human papilloma virus induced proliferation of epithelial cells, which causes asymptomatic lesions in the oral mucosa. Heck's disease is more prevalent among children or in a family. Despite the self-limitation of lesions, they may progress or cause esthetical and functional discomforts. Hence, early diagnosis is necessary. Case Presentation: A middle-aged man with a peripheral multiple soft, elevated, sessile, smooth, lobulated surface and nodular lesions in his right buccal mucosa was referred. The dimensions of the lesions varied from 5 to 25 mm. Through clinical and histopathological examinations, Heck's disease was diagnosed. The diode laser (wavelengths of 980 nm), 1-W power using continuous waves) was applied serially (in 2 sessions with a 1-week interval) for surgically removing the lesions. The patient was followed up for 6 months with no lesion recurrence, and gradual healing was observed. Conclusion: The laser is an effective treatment with no scar remaining after the procedure and brings satisfaction to patients.

Useful cytological confirmation of HPV 13 in lesional mucosa enhances diagnosis of focal epithelial hyperplasia.

An 11-year-old female presented with multiple oral lesions for several months. Histopathological findings suggested focal epithelial hyperplasia (FEH), also known as Heck disease. FEH is strongly associated with Human papillomavirus (HPV), especially genotypes 13 and 32. An oral swab of a mucosal lesion was subsequently obtained for cytology, immunohistochemistry and in situ hybridization. In addition, in situ hybridization and immunohistochemistry were also performed retrospectively on the biopsy specimen for correlation. The cytology specimen showed squamous cells with enlarged, slightly atypical nuclei and rare perinuclear halos. The histology findings included papillomatosis with acanthosis, mild nuclear atypia and focal perinuclear halos. The immunohistochemistry for the consensus HPV L1 capsid protein was found in both the cytology and biopsy specimens indicating that the lesion was HPV-related. High viral copy numbers of HPV 13 were detected by in situ hybridization in both the cytology and histology specimens. Although histologic features of FEH have been well characterized in the literature, to our knowledge, this is the first case to describe in FEH with adjunct immunohistochemistry and in situ hybridization results. Furthermore, these findings assisted in our diagnosis since the patient's clinical presentation was a diagnostic challenge with smooth dome-shaped papules instead of the typically described flat-topped verrucous lesions seen in FEH. In summary, our case reveals that there is a high concordance between the HPV 13 detection in the cytology and histology of FEH, and that performing cytology in addition to histology can be used to optimize diagnostic evaluation towards appropriate patient care.

Hiperplasia epitelial focal: relato de caso clínico / Focal epithelial hyperplasia: case report

Introdução: a hiperplasia epitelial focal (HEF) ou doença de Heck, caracteriza-se por ser uma lesão benigna rara da mucosa bucal. Geralmente, está associada a proliferação do epitélio pavimentoso atribuída principalmente ao papiloma vírus humano (HPV) dos subtipos 13 e 32. Objetivo: relatar o caso de um paciente, com suspeita diagnóstica de HEF, descrever suas manifestações clínicas bucais e histopatológicas. Metodologia: homem, 38 anos, melanoderma, compareceu no Serviço Universitário com queixa de ardência em mucosa bucal. Ao exame clínico, apresentava múltiplas lesões papulares, firmes à palpação, de coloração rósea, com pápulas aglomeradas ou isoladas, localizadas em rebordo alveolares, gengiva inserida e livre da arcada superior e inferior, mucosas jugais e labiais, compatíveis com lesões causadas por HPV. Realizou-se biópsia incisional das lesões bucais, o laudo histopatológico descreveu o fragmento de mucosa bucal que estava revestida por epitélio pavimentoso estratificado paraceratinizado com acantose proeminente, projeções focais confluentes para o tecido conjuntivo, confirmando a suspeita diagnóstica clínica. Conclusão: a HEF é uma patologia rara, benigna da mucosa, indolor e que pode se resolver espontaneamente. Portanto, é necessário o diagnóstico adequado através da biopsia e laudo histopatológico.

Introduction: focal epithelial hyperplasia (FEH) or Heck's disease is characterized as a rare benign lesion of the oral mucosa. It is usually associated with proliferation of the squamous epithelium, mainly attributed to human papillomavirus (HPV) subtypes 13 and 32. Objective: to report the case of a patient with a diagnostic suspicion of HEF, to describe its oral clinical and histopathological manifestations. Methodology: hale, 38 years old, black, attended the University Service with a complaint of burning in the oral mucosa. On clinical examination, she presented multiple papular lesions, firm to palpation, pink in color, with agglomerated or isolated papules, located in the alveolar ridge, inserted gingiva free from the upper and lower arch, jugal and labial mucosa, compatible with lesions caused by HPV. An incisional biopsy of the oral lesions was performed, the histopathological report described the fragment of oral mucosa that was lined with parakeratinized stratified squamous epithelium with prominent acanthosis, focal projections confluent to the connective tissue, confirming the clinical diagnostic suspicion. Conclusion: FEH is a rare, benign mucosal pathology, painless and can resolve spontaneously. Therefore, proper diagnosis through biopsy and histopathological report is necessary.

Focal Epithelial Hyperplasia.

Focal epithelial hyperplasia (FEH) or Heck's disease is a rare, benign, oral condition that is associated with infection by human papillomavirus type 13, 32 or both. The whiteish to mucosal-colored, soft, papular or nodular elevated lesions in the oral cavity are normally asymptomatic but can grow to a size or at a location where treatment is needed. The diagnosis is often based on clinical presentation and histopathology, and the HPV genotype can be determined using PCR utilizing specific primers or DNA sequencing. While FEH was reported to often affect several members of the same family and exist primarily among indigenous populations around the world, the number of reported cases within the European region is increasing. This contemporary review summarizes the main findings in relation to HPV genotypes, impact of superinfection exclusion and vaccination, transmission, diagnosis, geographical and ethnical distribution, comorbidities and treatment of FEH with an emphasis on including the most recent case reports within the field. Furthermore, we describe for the first time a FEH lesion infected with the low-risk HPV90.

Fibroma traumático en mucosa labial superior: Reporte de caso / Fibróide Traumática na Mucosa do Lábio Superior: Relato de Caso / Traumatic Fibroid in Upper Lip Mucosa: Case Report

Resumen El Fibroma traumático es una alteración caracterizada por una producción exagerada de tejido conjuntivo fibroso, producida por traumas crónicos. Generalmente se encuentra en mucosa oral como carrillos o lengua. En este caso en particular debido a que la paciente tiene dentición en el maxilar inferior y edentulismo total superior, se puede apreciar como progresó la lesión en la mucosa labial. La paciente de ochenta años acudió por renovación de su prótesis total superior debido a que dejo de usarla porque estaba desadaptada. Al examen clínico se observa un agrandamiento a nivel de mucosa labial superior izquierda, no dolorosa a la palpación y de coloración ligeramente blanquecina. Se decide tomar una biopsia excisional para establecer el diagnóstico definitivo debido a que existen varias lesiones con presentación clínica similar, la lesión fue compatible con un fibroma traumático, este trabajo se presenta con el objetivo de presentar las características clínicas e histopatológicas de un fibroma traumático, enfatizando la importancia de un diagnóstico temprano y oportuno para efectuar un tratamiento eficaz. Es importante considerar que, si la intervención quirúrgica no se acompaña con la rehabilitación protésica oral, pudiera aparecer una recidiva de la lesión.

Resumo Fibroma Traumático é uma alteração caracterizada por uma produção exagerada de tecido conjuntivo fibroso, produzido por traumas crónicos. É geralmente encontrada na mucosa oral, como bochechas ou língua. Neste caso particular, devido ao fato do paciente ter dentição no maxilar inferior e edentulismo total no maxilar superior, pode-se ver como a lesão na mucosa labial progrediu. A paciente de 80 anos veio para a renovação da sua prótese total superior porque deixou de a usar por ser inapta. Ao exame, foi observado um aumento da mucosa do lábio superior esquerdo, que não era doloroso à palpação e tinha uma cor ligeiramente esbranquiçada. Foi decidido fazer uma biópsia excisional para estabelecer o diagnóstico definitivo, pois existem várias lesões com apresentação clínica semelhante, a lesão era compatível com um fibróide traumático, este trabalho é apresentado com o objetivo de apresentar as características clínicas e histopatológicas de um fibróide traumático, enfatizando a importância do diagnóstico precoce e oportuno para o tratamento eficaz. É importante considerar que se a intervenção cirúrgica não for acompanhada por uma reabilitação protética oral, teria surgido uma recidiva da lesão.

Abstract Traumatic Fibroma is a disorder characterized by an exaggerated production of fibrous connective tissue, produced by chronic trauma. It is usually found in oral mucosa such as cheeks or tongue. In this particular case, due to the fact that the patient has dentition in the lower jaw and total edentulism in the upper jaw, it can be seen how the lesion in the lip mucosa progressed. The eighty year old patient came for renewal of her upper total prosthesis because she stopped using it because she was unfit. On examination, an enlargement was observed at the level of the upper left lip mucosa, which was not painful on palpation and was slightly whitish in colour. It was decided to take an excisional biopsy to establish the definitive diagnosis because there are several lesions with similar clinical presentation, the lesion was compatible with a traumatic fibroid, this work is presented with the aim of presenting the clinical and histopathological characteristics of a traumatic fibroid, emphasizing the importance of early and timely diagnosis for effective treatment. It is important to consider that if the surgical intervention is not accompanied by oral prosthetic rehabilitation, a recurrence of the injury would have appeared.

Heck's disease occurring after Epstein-Barr virus-associated smooth muscle tumors in an immunosuppressed child.

A 10-year-old Guatemalan girl with past medical history of Epstein-Barr virus-associated smooth muscle tumors (EBV-SMT) and combined immunodeficiency presented for evaluation of painful intraoral lesions. On examination, she was noted to have multiple, white to flesh-colored, soft, flat-topped papules, and plaques on the buccal and labial mucosa. Human papillomavirus type 13 was detected on PCR with PGMY primers of previously biopsied buccal tissue, confirming a diagnosis of Heck's disease (multifocal epithelial hyperplasia). We present an immunosuppressed, pediatric patient with two rare, virus-associated neoplastic disorders that have not been previously reported to occur in the same individual.

Unusual oral multifocal epithelial hyperplasia in an adult African-American lung transplant patient.

Oral multifocal epithelial hyperplasia (MEH), or Heck's disease, is a rare benign proliferation of the oral mucosa associated with human papillomavirus (HPV). It clinically presents as multiple asymptomatic papules and nodules that mostly affect the lips, buccal mucosa, and tongue. MEH is predominantly found in children and young adults while relatively few cases have been reported in the elderly population. Here, we report a case of oral MEH in a 65-year-old man with history of lung transplantation. This case highlights the potential susceptibility of organ transplant recipients to the development of MEH. Since MEH that does not require treatment unless the lesion bothers the patient, clinicians should promptly establish a definitive diagnosis to rule out other HPV-related precancerous lesions.

Disease Manifestation and Viral Sequences in a Bonobo More Than 30 Years after Papillomavirus Infection.

Pan paniscus Papillomavirus 1 (PpPV1) causes focal epithelial hyperplasia (FEH) in infected animals. Here, we analyzed the present disease manifestation and PpPV1 genomic sequence of an animal that was afflicted by an FEH epizootic outbreak in 1987 for which the sequence of the responsible PpPV1 was determined. The animal displayed FEH more than 30 years after the initial diagnosis, indicating persistence or recurrence of the disease, and evidence for active PpPV1 infection was obtained. Moreover, the sequences of the viral genomes present in the late 1980s and in 2018 differed at 23 nucleotide positions, resulting in 11 amino acid exchanges within coding regions. These findings suggest that PpPV1-induced FEH might not undergo complete and/or permanent remission in a subset of afflicted animals.

Enfermedad de Heck en niño nativo amazónico / Heck disease in native amazonian child

La enfermedad de Heck o hiperplasia epitelial focal es una enfermedad que afecta la mucosa oral de niños y adolescentes principalmente, caracterizada por presentar pápulas que tienden a confluir y formar lesiones papilomatosas, cuyo origen está asociado al virus del papiloma humano. Se presenta en la comunidad Kukush-Yamanunca, parroquia Limoncocha, ciudad de Shushufindi, provincia de Sucumbíos en la Amazonia del Ecuador, el caso de un infante indígena, etnia Shuar, de 9 años de edad, quien acude al puesto de salud Yamanunca por presentar desde hace aproximadamente 10 meses de evolución lesiones papilomatosas en cavidad oral y lengua que corresponden clínicamente con hiperplasia epitelial focal. El conocimiento de las características clínicas y factores de riesgo son pilares importantes para el diagnóstico clínico de esta afección.

Heck's disease or focal epithelial hyperplasia is a disease that affects the oral mucosa of children and adolescents mainly, characterized by presenting papules that tend to converge and form papillomatous lesions, whose origin is associated with the humanpapillomavirus. It is presented in the Kukush-Yamanunca community, Limoncocha parish, Shushufindi city, Sucumbios province in the Amazon of Ecuador, the case of an indigenous infant, 9-year-old Shuar ethnicity, who comes to Yamanunca health post for presenting Approximately 10 months of evolution papillomatous lesions in oral cavity and tongue that correspond clinically with focal epithelial hyperplasia. The knowledge of the clinical characteristics and risk factors are important pillars for the clinical diagnosis of this condition

Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i.e. without clinical attachment loss or bone loss, and on a reduced periodontium in either a non-periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable. Clinical gingival health can be restored following treatment of gingivitis and periodontitis. However, the treated and stable periodontitis patient with current gingival health remains at increased risk of recurrent periodontitis, and accordingly, must be closely monitored. Two broad categories of gingival diseases include non-dental plaque biofilm-induced gingival diseases and dental plaque-induced gingivitis. Non-dental plaque biofilm-induced gingival diseases include a variety of conditions that are not caused by plaque and usually do not resolve following plaque removal. Such lesions may be manifestations of a systemic condition or may be localized to the oral cavity. Dental plaque-induced gingivitis has a variety of clinical signs and symptoms, and both local predisposing factors and systemic modifying factors can affect its extent, severity, and progression. Dental plaque-induced gingivitis may arise on an intact periodontium or on a reduced periodontium in either a non-periodontitis patient or in a currently stable "periodontitis patient" i.e. successfully treated, in whom clinical inflammation has been eliminated (or substantially reduced). A periodontitis patient with gingival inflammation remains a periodontitis patient (Figure 1), and comprehensive risk assessment and management are imperative to ensure early prevention and/or treatment of recurrent/progressive periodontitis. Precision dental medicine defines a patient-centered approach to care, and therefore, creates differences in the way in which a "case" of gingival health or gingivitis is defined for clinical practice as opposed to epidemiologically in population prevalence surveys. Thus, case definitions of gingival health and gingivitis are presented for both purposes. While gingival health and gingivitis have many clinical features, case definitions are primarily predicated on presence or absence of bleeding on probing. Here we classify gingival health and gingival diseases/conditions, along with a summary table of diagnostic features for defining health and gingivitis in various clinical situations.

Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i.e. without clinical attachment loss or bone loss, and on a reduced periodontium in either a non-periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable. Clinical gingival health can be restored following treatment of gingivitis and periodontitis. However, the treated and stable periodontitis patient with current gingival health remains at increased risk of recurrent periodontitis, and accordingly, must be closely monitored. Two broad categories of gingival diseases include non-dental plaque biofilm-induced gingival diseases and dental plaque-induced gingivitis. Non-dental plaque biofilm-induced gingival diseases include a variety of conditions that are not caused by plaque and usually do not resolve following plaque removal. Such lesions may be manifestations of a systemic condition or may be localized to the oral cavity. Dental plaque-induced gingivitis has a variety of clinical signs and symptoms, and both local predisposing factors and systemic modifying factors can affect its extent, severity, and progression. Dental plaque-induced gingivitis may arise on an intact periodontium or on a reduced periodontium in either a non-periodontitis patient or in a currently stable "periodontitis patient" i.e. successfully treated, in whom clinical inflammation has been eliminated (or substantially reduced). A periodontitis patient with gingival inflammation remains a periodontitis patient (Figure 1), and comprehensive risk assessment and management are imperative to ensure early prevention and/or treatment of recurrent/progressive periodontitis. Precision dental medicine defines a patient-centered approach to care, and therefore, creates differences in the way in which a "case" of gingival health or gingivitis is defined for clinical practice as opposed to epidemiologically in population prevalence surveys. Thus, case definitions of gingival health and gingivitis are presented for both purposes. While gingival health and gingivitis have many clinical features, case definitions are primarily predicated on presence or absence of bleeding on probing. Here we classify gingival health and gingival diseases/conditions, along with a summary table of diagnostic features for defining health and gingivitis in various clinical situations.

Verruca vulgaris of the buccal mucosa: A case report.

Oral verruca vulgaris is caused by human papillomavirus (HPV) infection. Verruca vulgaris most frequently occurs on the fingers, toes, soles, and dorsal surfaces of hands and is mostly asymptomatic. Varieties of verrucous and papillary lesions affect the skin as well as oral mucosa which may be either benign or reactive. Common wart is one of the most commonly observed skin growths and a lesion of childhood. Intraoral warts can occur at any age with equal incidence in both genders but are most commonly seen in the third to fifth decade. It is found commonly on the palate followed by lip, tongue, buccal mucosa, and rarely seen on gingiva. Surgical excision with adequate margins is the treatment of choice.

Laser Excision of Focal Epithelial Hyperplasia (Heck's Disease): A Rare Case Report.

Heck's disease or focal epithelial hyperplasia is a rare, benign and asymptomatic lesion of oral mucosa that is characterized by the presence of soft, sessile papules, white to pinkish in colour that occur diffusely in oral cavity. Prevalence rate of this disease greatly varies from one geographic region to another. It is found to be closely associated with human papilloma virus (HPV). This paper reports an Indian case of focal epithelial hyperplasia in a 5-year-old boy that is diagnosed according to both clinical and histopathological features, where human poillomavirus (HPV) subtype 32 was found associated with disease through polymerase chain reaction analyses. A dental practitioner should be aware of this disease and must perform a careful evaluation both clinically and histopathologically for setting the diagnosis with other diseases. HOW TO CITE THIS ARTICLE: Nallanchakrava S, Sreebala N, Basavaraj, Sindgi F. Laser Excision of Focal Epithelial Hyperplasia (Heck's Disease): A Rare Case Report. Int J Clin Pediatr Dent, 2018;11(6):526-528.

Efectividad de la terapia con ácido tricloroacético en el tratamiento de lesiones en la hiperplasia epitelial focal / Effectiveness of trichoroloacetic acid in treatment of focal epithelial hiperplasia lesions

Propósito: El propósito del estudio fue evaluar la efectividad de la terapia con el ácido tricloroacético en el tratamiento de las lesiones orales producidas en la hiperplasia epitelial focal. Material y métodos: Se incluyeron 11 pacientes que presentaron características clínicas e histopatológicas de hiperplasia epitelial focal y que aceptaron participar en el estudio, se aplicó muestreo por conveniencia, en pacientes que asistieron a consulta de la clínica odontológica de la Corporación Universitaria Rafael Núñez y la Universidad de Cartagena, se les realizó biopsia excisional en una de las lesiones para establecer diagnóstico anatomopatológico, posteriormente se aplicó ácido tricloroacético al 80% sobre las lesiones cada quince días hasta que desaparecieron. Resultados: De un total de 11 pacientes pediátricos el 63.64% fueron de género femenino, promedio de edad fue nueve años, los sitios de mayor afección en cavidad bucal fueron mucosa labial superior e inferior representando un 100%, en el estudio anatomopatológico se describió la presencia de acantosis epitelial, papilomatosis y coilocitosis en todos los casos, el mayor número de aplicaciones con el ácido fue tres y cuatro veces con un 27%, el promedio de desaparición de las lesiones fue de 61.3 días, no se ha presentado recidiva en el 100% de los casos. Conclusión: La aplicación del ácido tricloroacético en la hiperplasia epitelial focal es una técnica efectiva, consiguiendo la resolución de las lesiones en forma rápida, poco traumática, sin generar ansiedad y temor en los pacientes.

Objective: The aim of the present study was to assess effectiveness of trichloroacetic acid therapy in the treatment of oral lesions produced in focal epithelial hyperplasia cases. Material and methods: In the present study 11 patients were included. Patients exhibited clinical and histopathological characteristics of focal hyperplasia and were willing to participate in the study. Convenience sampling was executed in patients attending clinical consultation at the Dental Clinic of the Rafael Nuñez University Corporation and the University of Cartagena. Patients underwent excision biopsy in one of the lesions so as to establish anatomical-pathological diagnosis. Subsequently, 80% trichloroacetic acid was applied every two weeks on the lesions, until lesions disappeared. Results: Out of 11 pediatric patients 63.64% were female, average age nine years. Locations of greater involvement in the mouth were upper and lower labial mucosa (representing 100%). Anatomical-pathological study revealed in all cases presence of epithelial acanthosis, papillomatosis and koilocytiosis. The greatest number of acid applications was three and four episodes with 27%, average time for lesion disappearance was 61.3 days. No relapse was observed in 100% of cases. Conclusion: Trichloroacetic acid application in focal epithelial hyperplasia cases is an effective technique which achieves rapid, atraumatic stress-free lesion resolution which did not generate fear in involved patients.

Hiperplasia epitelial focal o enfermedad de Heck. Presentación de un caso / Epithelial Focal Hyperplasia or Heck Disease. Case presentation

La hiperplasia epitelial focal o enfermedad de Heck es una enfermedad poco frecuente de la mucosa bucal. Afecta principalmente a niños, sin distinguir sexo o grupo étnico. Clínicamente se caracteriza por la presencia de pápulas blancas o de igual coloración que la mucosa oral, de pequeño tamaño, asintomáticas y con tendencia a confluir y formar lesiones papilomatosas. Esta enfermedad se ha asociado con infección por virus del papiloma humano y a factores genéticos. Se presenta el caso de una paciente de ocho años, que acudió a consulta de Dermatología en el Hospital Andino de Chimborazo, por lesiones en mucosa bucal con correspondencia clínica e histopatológica con la enfermedad de Heck.

Epithelial Focal Hyperplasia or Heck disease is an infrequent disease of the oral mucosa. It mainly affects children, without distinguishing sex or ethnic group. It is clinically characterized by the presence of white papules or of similar colour of the oral mucosa, small size, asymptomatic and with the tendency to converge and form papillomatous lesions. This disease has been associated with infection by human papilloma virus and genetic factors. A case of an eight year old girl is presented, who came to the Dermatology consultation at Andino Hospital Chimborazo Ecuador, with lesions in the oral mucosa with clinical and histopathological correspondence with Heck disease.