Sturge-Weber syndrome with pyogenic granuloma
A 12-year-old girl reported to the department of Pedodontics RDC Loni with a complaint of swelling in the lower front gum region since 3 months. Clinically there was an isolated gingival swelling in the lower left anterior region between central and lateral incisors (31 and 32). The swelling was red and shiny in appearance measuring about 2 × 1 cm in size extending from mesial surface of central incisor to the mesial half of canine on the labial side and was extending on the lingual side of incisors measuring 0.8 × 0.5 cm in size. Both the swellings were connected at the interdental area of central and lateral incisors [Figures and ]. On palpation the swelling was a pedunculated mass, soft and easily movable from the base. On probing gently, the lesion showed considerable amount of bleeding. Extraorally the face was asymmetrical with slight enlargement on the right side of the face. Remarkably the enlarged right half of the face was bluish red in color. There was a prominent scar on the right side of the face in upper buccal region []. Parents revealed a history of surgery 7 years ago for a red swelling in the scarred area.\nIntraorally right half of the mouth was markedly red affecting labial and buccal mucosa, buccal vestibule, floor of mouth, tongue and palate while left side did not show any abnormalities. Intraoral periapical radiographs of the 31, 32, and 33 region and OPG were advised to rule out any bony involvement. The radiographs did not reveal any significant problems except presence of initial bone loss from the interdental area of 31 and 32.\nSince the lesion had a pedunculated base with little bony involvement excisional biopsy was carried out carefully followed by bony curettage. The entire procedure was performed under local anesthesia. Histopathological examination of the excised mass showed numerous endothelium lined spaces, abundant fibroblasts, collagen fibers, and polymorphonuclear leucocytes revealing features of pyogenic granuloma []. At the end of 1 month, the lesion had uneventful healing []. Six-month follow-up was quite satisfactory and there was no evidence of any recurrence. During surgery and curettage the amount of bleeding was controllable and no additional steps were required to stop the bleeding. This could have been due to the presence of granuloma on the left side which was not affected by the vascular lesion.