12- Exophytic Lesion Flashcards
What are exophytic lesions?
They are the majority of soft connective tissue “tumors” presenting in the mouth are benign.
* they may represent growths that are reactive to an inflammatory stimulus, hamartomatous growths, or neoplasms.
What is a harmartoma?
It is an overgrowth of mature cells & tissues which are normally presented in the affected tissue (abnormal growth of tissue in a normal location)
What is a neoplasm?
They are new & abnormal growth of tissue in some part of the body, especially as a characteristic of cancer.
What are the lesion descriptions used?
LDS SCC:
Location: Gingiva, buccal mucosa, hard palate etc
Distribution: Single, multiple
Size/Shape: Give measurement in mm or cm
Surface texture: Smooth, papillary, verruciform
Colour: Uniformly one colour, multiple different colours
Consistency: Cannot assess based on clinical photograph, hard, soft, firm, doughy
What is pedunculated?
Think of it like a skin tag. Almost has a narrow base to it.
What are the common soft tissue growths?
1.) Pyogenic granuloma
2.) Peripheral ossifying fibroma
3.) Peripheral giant cell granuloma
4.) Fibrous hyperplasia (fibroma)
What is a pyogenic granuloma?
It is a reactive vascular proliferation due to chronic irritation + represents granulation tissue.
what is a granulation tissue?
connective tissue & microscopic blood vessels that form on the surfaces of a wound from the healing processes.
Where can we typically find a pyogenic granuloma?
the lips, tongue & buccal mucosa + 75% on gingiva
What are the clinical features of a pyogenic granuloma?
- It has a erythematous, hemorrhagic mass
- may have ulcerated or pedunculated appearance
-often known with pregnancy (pregnancy tumour)
What is a treatment of pyogenic granuloma?
- Surgical excision
- Clean/scale adjacent teeth
- May recur if cause not removed
What is a peripheral ossifying fibroma?
It is an inflammatory proliferation fibrous tissue which has a component of bone or cementum `
Why are peripheral ossifying fibromas only derived from periodontal fibers?
Because they can only occur on the gingiva
Who is most likely to see a peripheral ossifying fibroma?
Females + teenagers
What are some of the treatments used for peripheral ossifying fibroma?
1.) Surgical removal
2.) Clean/scale adjacent teeth
3.) Clow follow-up due to high recurrence.
What are some clinical features of peripheral ossifying fibroma?
Painless red/pink mass.
May be ulcerated. p.20
What is a peripheral giant cell granuloma?
It is a reactive fibrous lesion
How are peripheral giant cell granulomas formed?
Due to local irritation:
- overhanging restorations
- plaque/calculus buildup
Who is most prone to acquiring peripheral giant cell granuloma?
Females > males
What are the clinical findings of a peripheral giant cell granuloma?
Dark blue + purple nodule.
What are the radiograph features of a peripheral giant cell granuloma?
May cause resorption of underlying bone.
What are the treatments needed for a peripheral giant cell granuloma?
- Surgical excision
- Cleaning/scaling adjacent teeth
What is ruled out if a peripheral giant cell granuloma is intraosseous?
hyperparathyroidism
What is fibrous hyperplasia?
It is formation of fibrous connective tissue due to chronic low grade irritation.
How does a fibrous hyperplasia appear clinically?
It is usually seen as a pink mass.
What are the different names of a fibrous hyperplasia?
- Epulis fissuratum
- Leaf fibroma
What is an epulis fissuratum?
It is a fibrous hyperplasia in context of an impinging denture
What is a leaf fibroma?
It is a flattened, exophytic palatal lesion found under a denture
What is fibroma?
A mass of collagen formed as a creative response which is often from acute or repeated trauma
- cheek biting is common
- forms a cycle of trauma, & further growth
Who is affected by fibroma? & at what age?
men + women. Around the 4th=6th decade most common, but can affect any age.
Where can we typically find the fibroma?
In the buccal mucosa, lip, tongue, in site predilection
What are the clinical appearances of Fibroma?
- They are smooth surfaces
- Pink/normal colour
- may be secondarily ulcerated
What kind of treatment is needed for fibroma?
Surgical removal
How can leaf fibroma’s arise?
From irritation under a denture
Who is prone to obtain a leaf fibroma?
Females > males
Older patients (with dentures) are more common.
Where can typically find a leaf fibroma
On the hard palate
What is the clinical appearance of leaf fibroma?
pink + pedunculated lesion: narrow base.
What are treatments needed for leaf fibroma?
Surgical removal + denture adjustments may be required.
In what individual can we commonly see an Epulis Fissuratum?
- Middle aged & older patients
Where can we commonly see Epulis Fissuratum?
On the anterior vestibule than posterior vestibule (p.37)
What are the clinical appearances of an Epulis Fissuratum?
Multiple folds of pink linear tissue.
What are the treatments needed for an Epulis Fissuratum?
Surgical removal + remake of dentures
What are Giant cell Fibroma?
They are like normal fibromas, BUT are NOT related to trauma or irritation.
Where can we commonly see giant cell fibroma?
On the gingiva.
How does a giant cell fibroma differ from a normal fibroma histologically?
Giant cell fibroma has the presence of LARGE fibroblasts hence “Giant Cells” (p.39)
What is a giant cell fibroma often mistaken for?
For a papilloma
What is a retrocuspid papilla?
It is a small fibrous gingival nodule (p.41)
Where are the retrocuspid papilla typically found on ?
Found on the lingual gingiva + behind mandibular canines (often bilateral + histologically identical to giant cell fibroma)
What kind of treatment is needed for a retrocuspid papilla?
No treatment required + reinforce to patient the benign nature of condition.
