Особливості хірургічного лікування і морфологічні аспекти епуліда й папіломи в дітей

Abstract

Представлено результати дослідження щодо особливостей хірургічного лікування й морфологічної структури епулідів і папілом ЩЛД у дітей. Клінічний розділ роботи стосується 123 дітей з епулідами і 185 з папіломами, які протягом 10 років перебували на лікуванні в клініці кафедри дитячої хірургічної стоматології УМСА. Гістологічну структуру новоутворів для визначення остаточного діагнозу верифікували співробітники кафедри патологічної анатомії з секційним курсом УМСА. Згідно з отриманими результатами зроблено такі висновки: 1. Епуліди й папіломи трапляються частіше в дівчат, ніж у хлопців, у 2,3 і 2,5 рази відповідно, з піком захворюваності в молодшій і старшій шкільних вікових групах: 60,3% і 36,6% – при епулідах і 47,0% і 31,4% – при папіломах. 2. Епуліди й розташовані в порожнині рота папіломи мають певну схожість за клінічною симптоматикою, що потребує ретельної диференційованої діагностики, а враховуючи їхню своєрідну морфологічну структуру, остаточний діагноз необхідно встановлювати з обов’язковим урахуванням результатів патогістологічного дослідження, адже невідповідність клінічного й патогістологічного діагнозів при епулідах сягає 18,7%. 3. Лікування пацієнтів має бути досить виваженим: у кожному конкретному випадку слід ретельно планувати вид і обсяг оперативного втручання, умови його проведення й визначатися з різновидом знеболювання.

The clinical aspect of the paper concerns 123 children with epulis and 185 with papillomas, who were treated at the clinic of the Department of Pediatric Oral Surgery for the period of 10 years. Verification of the histological structure of neoplasms to determine the final diagnosis was performed by the faculty staff of the Department of Pathological Anatomy with Autopsy Course. Statistical processing of the digital data and analysis of the findings of the study showed that epulis and papillomas are more common in girls than in boys (in 2.5 and 2.3 times higher, respectively). A clear pattern of their diagnosis by age was established. Thus, the peak incidence of epulis was recorded in young adolescents of lower and higher secondary school ages (60.3% and 36.6%, respectively). Papilloma was also found quite often in the same age groups (47.0% and 31.4%, respectively). After comprehensive examination, the clinical diagnosis of the giant cell epulis was established in 21.1% of cases, and the share of its fibrous and angiomatous forms accounted for 35.0% and 43.9%, respectively. Neither patients with epulis of all its types nor their relatives could clearly determine the time periods of the appearance of the first clinical signs of the disease. All patients with papillomas and their relatives complained of the presence of newly formed masses on the oral mucosa or skin, which caused some discomfort, growing slowly, rarely reaching large sizes. The exact time periods of their occurrence could not be specified. Treatment of epulis, provided outpatiently for all patients under local anesthesia, was aimed at elimination of the etiological factor (if detected) and surgery. No recurrences were noted after removal of fibrous epulis and in cases of treatment of angiomatous epulis recurrence occurred in 1 girl. Among patients with giant cell epulis, recurrence after surgical removal was observed in 4 patients, 3 of whom underwent repeated surgery with preservation of teeth. In 1 child recurrence occurred for the third time and tooth extraction and partial resection of the alveolar ridge was made as part of the inpatient treatment. Treatment of papillomas involved surgical removal of neoplasms at the border of healthy tissue up to the submucosal layer using an electrocoagulator or radio knife. Depending on the clinical situation and localization of the tumor, manipulations were performed under local (161 cases - 87.0%) anesthesia at the polyclinic, and in 24 children (13.0%) with labile mental health and localization of papilloma on the soft palate, uvula, palatal arches, anesthesia was performed at inpatient. No complications during surgery and in the postoperative period were observed. The surgical material was always sent for histological examination, the results of which allowed determining one of the mentioned nosological forms. Morphological study has established, that the clinical diagnosis did not coincide with the morphological one in 5 cases (4.1%) in fibrous epulis, in 8 - 6.5% in angiomatous and in 10 - 8.1% in giant cell forms, which together made their discrepancy in 23 observations (18.7%). Thus, epulis and papillomas located in the oral cavity have a certain similarity in clinical symptoms and require careful differential diagnosis, and given their unique morphological structure, the final diagnosis must be established taking into account the findings of histopathological examination, as inconsistency of clinical and histopathological examinations, for example, in epulis, reaches 18.7%. When planning the treatment, in an every single case the type, extent and site of surgery, as well as type of anesthesia should be carefully considered. The presented material can serve as the basis for further in-depth scientific and practical research on comparison of clinical manifestations and immunohistochemical features of epulis and papillomas depending the age of patients.