Congenital granular cell epulis (Neumann’s tumor) of the maxillofacial region in newborns

   Neumann’s tumor, or congenital epulis, is an extremely rare benign neoplasm, most commonly localized in the alveolar process of the maxilla and detected at birth.

   Objective: to analyze the results of surgical treatment of congenital epulis in the neonatal period.

   Materials and methods: this paper presents an analysis of data collected during the clinical diagnosis of congenital epulis and the results of surgical treatment performed in the early postnatal period (2–5 days after birth) due to prolonged bleeding. Morphological manifestations of dysembryogenesis were diagnosed in the mucoperiosteal layer of the alveolar process of the maxilla in two cases and in the alveolar ridge of the mandible in one case. Postoperatively, all material was sent for pathological examination.

   Results: in two cases, the neoplasm was diagnosed by obstetricians immediately after birth. Their concern was prompted by ongoing oral bleeding, with no apparent cause related to labor. Given the newborn’s agitation, the increasing risks associated with blood loss, and the inability to feed, consultants were called in. One newborn was diagnosed prenatally based on ultrasound screening at 37 weeks, revealing signs of a soft tissue mass in the left corner of the mouth. The final diagnosis was made after birth, based on intermittent oral bleeding. Given the risks of aspiration and anemia, radical excision of the mass was performed under general anesthesia using a Surgitron high-frequency radio wave scalpel (EMC High-Frequency Radio Wave Surgical Generator, Ellman USA) operating at 3.8 MHz, with immediate definitive hemostasis. The post-operative period was uneventful, and the patients were handed over to their mothers in satisfactory condition.

   Conclusions: early surgical intervention for ongoing bleeding from neoplasms in the oral cavity in newborns is an effective means of preventing predicted hemorrhagic complications, as well as a reliable method for their definitive cessation. The use of radio wave techniques facilitated definitive hemostasis, reduced the risk of aspiration, and the development of posthemorrhagic anemia. The absence of recorded postoperative complications, stable positive dynamics, and favorable clinical outcomes, with minimal rehabilitation time for newborns, indicate the feasibility of the presented algorithm.

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