P2B240: Maxillary Mass in a Newborn: Congenital Epulis

Introduction: A congenital epulis is an extremely rare benign tumor of the oral cavity that is selectively observed in newborns. Most masses measure less than 2 cm, however some can range up to several centimeters in diameter. These larger growths are of highest concern due complications associated with feeding and risk of airway obstruction. The mass is primarily found on the anterior maxillary alveolar ridge in the area of the primary lateral incisor and canine on either side, followed by the anterior mandibular alveolar ridge, and very rarely on the ventral tongue. Clinically, the mass is most often flesh colored and firm, with a smooth surface, and either pedunculated or sessile. The most accepted treatment of a congenital epulis is surgical excision under local or general anesthesia.

Case Description: A healthy African-American female presented to the neonatal intensive care unit (NICU) for a dental consult hours after delivery regarding an oral mass identified on the maxillary alveolar ridge. Past family history included maternal hypertension, but no other contributory factors. A physical exam revealed a well appearing, hydrated, comfortable newborn with a large mass in the oral cavity hindering feeding ability. The mass appeared pedunculated with a large stalk from anterior maxillary alveolus to anterior hard palate. Radiographic imaging in the form of a MRI with contrast was completed to rule out a possibility of a vascular lesion such as an arteriovenous malformation, congenital hemangioma, and/or a non-vascular melanotic neuroectodermal tumor of infancy (MNTI). Surgery under general anesthesia was performed without complications two weeks after birth to completely excise the lesion. A two-week post-operative exam confirmed that all structures in the area of the surgery appeared to be healing, and the mother denied any difficulty with baby’s ability to feed.

Discussion: The etiology of congenital epulis is unknown. Theories such as origin from epithelial rests, undifferentiated mesenchymal cells, pericytes, fibroblasts, smooth muscle cells, nerve related cells, and odontocytes have been proposed. The most widely accepted theory based on the female predilection of congenital epulis is that of an endogenous hormonal stimulus. It is known that the lesion develops late in utero as it is often not detected on antenatal ultrasound, but rather identified at birth. Appropriate follow-up appointments at two weeks post-op, and every six months after the first tooth erupts with a dentist are important to determine impact, if any, on the developing dentition.

Conclusion: A newborn infant with congenital epulis can be difficult for parents to comprehend due to how remarkably large the mass can be and the negative implications it lends such as airway obstruction and impaired feeding. Most often, it is the dentist who will determine a diagnosis and provide information to parents and other practitioners regarding treatment of these lesions.