Recurrent exophytic growth on maxillary posterior edentulous alveolar ridge – a diagnostic challenge

Recurrent intra-oral exophytic lesions are uncommon.1 Recurrence of a lesion may suggest that the aetiological factor has not been addressed and, therefore, successful management will demand a more accurate diagnosis. Sometimes, a benign inflammatory lesion may be erroneously diagnosed as a serious condition. The clinician must therefore be well aware of all the possibilities that can manifest commonly or atypically.

A 60-year-old male farmer reported to our department with the chief complaint of a growth in the posterior region of the left maxillary residual alveolar ridge of 1½ years' duration. The growth developed after spontaneous exfoliation of two teeth. It was painless and gradually increased in size. He consulted a local dentist a year previously, and complete excision was carried out (histopathological details were not available with the patient). He was apparently asymptomatic thereafter but the growth recurred 8 months later and gradually increased in size to attain the current dimensions. This time it was associated with sharp shooting pain on touching and during mastication. There was no history of bleeding or pus discharging from the growth. The medical and family histories were not contributory. The patient had been a heavy smoker for 30 years. General examination revealed the patient to be in good general health. Intra-oral examination revealed a 3 x 2 cm exophytic growth associated with the left maxillary posterior residual ridge corresponding to the region of missing UL6, UL7 and UL8 (Figure 1). The lesion extended more in the buccal aspect and blended with the mucosa of the ridge on the mesial and distal aspects. It had a distinctly dimorphic appearance; the inferior aspect being creamy white to pale yellow, the buccal and palatal aspects being predominantly red in colour, with visible superficial blood vessels and interspersed blanched areas, with 3–4 areas of ulceration on the buccal surface of the mass. On palpation, the lesion was pedunculated with a broad stalk. It was readily mobile and the inferior aspect was much firmer in consistency. The ulcerations were tender and bled on palpation, but the rest of the mass was not tender.