20. Polyp in the upper alveolar mucosa

A 57-year-old woman was referred for evaluation of a soft polypoid lesion in her upper left alveolar mucosa that had been present for 2 months. There was slight tenderness over the left maxillary sinus, a salty taste and occasionally nasal bloody discharge, but no pain, eye problems or regional lymphadenitis. Her medical history was clear.

On extra-oral examination there was slight tenderness on palpation over the left maxillary sinus.

On oral examination, a polypoid, soft, non-tender mass was seen in the area of the left maxillary first molar, which had been extracted 3 months previously (Figure 1). The lesion had a whitish-yellowish colour and was easily lifted from the alveolar mucosa and bled with slight pressure. Radiography showed a hazily radio-opaque maxillary left sinus with a bony discontinuity of its floor at the area of the extracted molar.

(a) Parulis is a soft erythematous lesion that appears on the gingiva in association with a non-vital tooth at the site of the intra-oral drainage of a dental abscess. This lesion has a red colour as it is a granulation tissue. Although pus or blood can exude from the lesion, taste changes and nasal discharge are rare. These findings, together with the absence of a non-vital tooth in this patient, and with the clinical and radiographic characteristics, allow exclusion of a parulis.