It may lead to mechanical obstruction and blocking the airways, resulting in problems like respiratory distress and feeding difficulties.

Such cases require immediate surgical intervention as they interfere with feeding and have the potential to cause death via lack of oxygen, asphyxia during the perinatal and postnatal period [2].

Kay et al (1970) has also reported in an electron microscopic examination of the congenital epulis, where junctional complexes between some of the granular cells were found.

Furthermore, congenital epulis may have a mesenchymal origin, as indicated by ultrastructural and immunohistochemical results in documented cases, where the cells display characteristics of fibroblasts and histiocytes [6].

Depending on the size, number, and location of the tumor, clinical manifestation could vary from no symptoms to feeding difficulty and rarely airway obstruction.

Clinically, congenital epulis can grossly present as smooth-surfaced lobular or ovoid, sessile or pedunculated, red or pink nodule with a size ranging from several millimeters up to 7.5–10 cm and it is firm in consistency [7].

Congenital epulis is most commonly seen in neonates, with a mass developing from the gingiva and spreading over the maxillary alveolar ridge, generally near the lateral incisors or canines [8].

The most widely accepted theory about the development of these lesions is that they originate from primitive mesenchymal cells that have undergone cytoplasmic and molecular changes resulting from epigenetic factors.

Unlike congenital epulis, rhabdomyosarcoma typically exhibits infiltrative growth, aggressive behavior, and malignant histological features, necessitating early detection and intervention [13].

Melanotic neuroectodermal tumor of infancy is a rare, benign neoplasm characterized by painless, non-ulcerative, expansile, and rapidly growing pigmented lesions [17].

Neurofibroma is a benign nerve sheath tumor that may present as a soft tissue swelling in the oral cavity, including the gingiva [13].

Histopathological evaluation, along with immunohistochemical staining, plays a crucial role in distinguishing congenital epulis from other similar lesions [12].

Fetal ultrasound and magnetic resonance imaging can help differentiate between intrinsic and extrinsic airway obstruction, allowing for optimal delivery planning and management.

For instance, collaboration with ear, nose, and throat (ENT) specialists or pediatric surgery airway teams may be necessary in case of an emergency resection or tracheostomy in the newborn [7].

The vascular and friable nature of the mass increases the risk of significant bleeding, further obscuring visualization of the vocal cords during intubation [5].

Beyond respiratory issues, large congenital epulis tumors may also interfere with feeding or prevent proper closure of the mouth, leading to impaired swallowing of amniotic fluid and resulting in polyhydramnios [19].