A firm, persistent lump or patch of tissue inside the cheek, known as the buccal mucosa, is often a source of concern. This localized buildup is scar tissue, frequently called an oral fibroma or fibrous hyperplasia. It develops as the body’s repair mechanism following repeated trauma or irritation. While generally benign, this tissue can interfere with speaking, eating, and oral comfort. Since many oral lesions appear similar, a professional evaluation by a dentist or oral surgeon is the first step to ensure an accurate diagnosis. This overview explores options ranging from self-care techniques to clinical and surgical interventions.
Understanding Buccal Scar Tissue
Scar tissue inside the cheek is structurally distinct from the surrounding soft, flexible lining. Normal buccal mucosa is composed of non-keratinized stratified squamous epithelium, which is highly elastic. The scar tissue, by contrast, is a dense accumulation of connective tissue, primarily collagen fibers, which gives the lesion its characteristic hard, smooth texture. This firm mass forms when the healing process produces an excessive amount of collagen in a disorganized pattern, creating a protective “callous” over a chronically injured area.
The most common cause is repetitive mechanical trauma, such as chronic cheek biting, where the teeth repeatedly injure the same spot. Other sources of irritation include ill-fitting dental restorations, rough edges on teeth, or poorly aligned dentures that persistently rub against the cheek lining. Constant re-injury prevents the tissue from completing a smooth repair cycle, even though the oral cavity heals quickly. The constant movement and microbial exposure trigger a persistent inflammatory response, causing fibroblasts to overproduce dense, fibrous tissue that manifests as the noticeable bump.
Non-Invasive Management Strategies
The first and most effective non-invasive strategy involves identifying and immediately eliminating the source of the chronic irritation. If the cause is cheek biting, stopping the habit is paramount, as the fibroma will continue to enlarge as long as the trauma persists. Addressing sharp dental edges or adjusting a poorly fitting appliance with a dentist can prevent further injury. For newer, milder scarring, self-administered methods can help remodel the tissue and improve its pliability.
Manual Therapy
Manual massage is a practical technique that encourages the realignment of collagen fibers and increases blood flow to the area. Patients should use clean hands and a non-irritating lubricant to apply gentle, deep pressure in circular motions over the scar. This manual therapy, performed for two to five minutes daily, can potentially soften the scar and reduce its prominence over several weeks or months.
Specific stretching exercises should be coupled with massage to maintain the flexibility of the surrounding buccal tissue. Prolonged, low-load stretching, such as gently opening the mouth widely and holding the position, helps lengthen the injured tissues. This approach prevents the scar from causing contracture or tightness, encouraging the dense collagen to become more elastic.
Clinical and Minimally Invasive Treatments
When non-invasive methods do not achieve sufficient reduction, professional treatments offer targeted ways to break down the dense scar tissue without major surgery.
Intralesional Corticosteroid Injections (ICSI)
ICSI is a common approach used by specialists like oral surgeons or dermatologists. This procedure involves injecting a corticosteroid medication, such as triamcinolone acetonide, directly into the scar tissue. The steroid suppresses inflammation, inhibits fibroblast activity, and reduces new collagen deposition, helping to flatten the scar and reduce its bulk. Injections are typically performed every four to six weeks and often include a local anesthetic.
Laser Therapy
Laser therapy represents an effective, minimally invasive option for scar revision. Ablative fractional lasers, such as CO2 or Er:YAG lasers, create microscopic thermal columns in the scar tissue. This controlled damage stimulates the production of new, healthier collagen, allowing the tissue to remodel and resurface. Specialized lasers can also precisely remove the fibrous tissue, which is helpful for scars causing physical limitations like reduced mouth opening. Laser treatment offers the advantage of minimal bleeding and faster healing times compared to traditional cutting methods.
Surgical Removal and Post-Operative Care
Surgical excision remains the definitive treatment for buccal scar tissue that is large, causing significant functional problems, or has failed to respond to less invasive therapies. The procedure involves physically cutting out the fibroma using a scalpel or surgical laser. Surgical removal is often necessary for oral fibromas because they are typically a reactive hyperplasia that will not regress on their own.
Once the scar tissue is removed, the surgeon closes the defect, usually with primary closure where the healthy mucosa edges are stitched together. If a very large section is removed, a local flap or mucosal graft may be required to cover the area and prevent severe contraction.
Post-operative care is crucial to prevent recurrence at the new incision site. Patients should manage pain with medication and maintain meticulous oral hygiene, often using a prescribed rinsing solution to prevent infection. A temporary soft or liquid diet is usually recommended for the first few days to protect the sutures and the healing site from mechanical irritation. Following all post-operative instructions and avoiding new trauma is essential for the best outcome.