Benign and Reactive Lesions Flashcards
What is a fibro-epithelial polyp?
a localised hyperplastic lesion
fibro-epithelial polyp aetiology
overproduction of granulation and fibrous tissue in response to damage or trauma
fibro-epithelial polyp - clinical features
commonly presents in buccal mucosa
often in areas of trauma
may be pedunculated or sessile
firm or soft
pink appearance
painless
can be ulcerated and easily traumatised
may have associated frictional keratosis
usually an isolated lesion
fibro-epithelial polyps - histology
fibrous tissue in the core
thick interlacing collagen fibres
adjacent normal tissue
covered with squamous epithelium
may have hyperkeratosis
little inflammatory infiltrate
fibro-epithelial polyp - clinical considerations
does it bother patient?
does patient have oral cancer risk factors
differential diagnosis
cause
fibro-epithelial polyp - management
photos
identify cause and correct if appropriate
consider excisional biopsy
fibro-epithelial polyp - benefits and risks of excisional biopsy
benefits
- can confirm diagnosis - useful if uncertain or patient has ssc risk factors
- can remove lesion
risks
- surgical risks
- altered sensation
- recurrence or incomplete excision
denture associated lesions - examples and causes
hyperplastic tissue
- response to denture trauma
- leaf fibroma
- denture hyperplasia
papillary hyperplasia
- granular inflammation of denture bearing surface - usually palate
- may be associated with candida infection
denture associated lesions - management
consider excision
denture hygiene
candida management
consider making new denture
epulis - meaning
a reactive hyperplastic lesion on the gingivae
fibrous epulis - what is it?
a fibro-epithelial polyp presenting on the gingiva
fibrous epulis features
same colour as gingiva
may be ulcerated
histologically similar to polyps
- more likely to have varying amounts of inflammatory infiltrates
Giant cell epulis features
also known as peripheral giant cell granuloma
red/purple appearance
sessile or pedunculated
often inderdentally
more common in children
Giant cell epulis histology
vascular stroma
fibrous tissue
multinucleate osteoclast giant cells
Giant cell epulis - pathogenesis
unknown
reactive to trauma or irritation
Giant cell epulis - management
excisional biopsy
OPT and/or CBCT
bone profile
parathyroid hormone assay
vasular epulis/pyogenic granuloma features
increase in size due to hormonal changes
if pregnant in pregnancy = pregnancy epulis
soft bright red appearance
may resolve during birth
if removed following birth, inflammation may decrease and resemble a fibrous epulis
may recur if removed during pregnancy
vascular epulis histology features
vascular appearance
variable amounts of inflammatory infiltrate
vascular epulis management options
in GDP - refer to oral surgery for further advice
keep under observation
- excise following birth
excisional biopsy
drugs linked to generalised gingival overgrowth
drug induced
- calcium channel blockers
- ciclosporin
- phenytoin
generalised gingival overgrowth management
gingivoplasty may be indicated
- will likely bleed due to vascular nature
ask GP to consider alternative medications
plaque control
risk factors
consider oral med referral to rule out other causes
non drug induced causes of generalised gingival overgrowth
chronic hyperplastic gingivitis
- mouth breathing, pregnancy
hereditary gingival fibromatosis
- enlarged, little inflammation, expansion of the tuberosities
- may require repeated gingivectomies to facilitate oral hygiene
granulomatous disease
- OFG
- Oral crohns etc
haematological malignancy
- gingival swelling/periodontal disease rapidly progressing in the presence of good OH?
squamous cell papilloma features
benign growth - tumpur/wart
any aspect of oral mucosa
pedunculated OR sesile
cauliflower appearance
often keratinised surface
result from viral infection
- typically HPV
not associated with malignant transformation
single or multiple lesions
may present in immunocompromised patients
squamous cell papilloma histology
finger like processes of hyperplastic squamous epithelium
thin cores of vascular connective tissue
squamous cell papilloma - management
excisional biopsy
observation
- if no red flag sign, symptoms or oral cancer risk factors
pyogenic granulomas - features
reactive vascular lesion
gingiva most common site
- any oral mucosal tissue can be affected
typically a response to local irritation or trauma
pyogenic granuloma - histology
vascular proliferation
oedematous fibrous stoma
variable inflammatory infiltrate
pyogenic granuloma - management
remove irritant
- plaque
- overhang
- denture
- other traumatic cause
excisional biopsy
take photos
black hairy tongue pathophysiology
hyperplasia of filiform papillae
build up of commensal bacteria, food debris
pigment inducing fungi and bacteria
black hairy tongue cause
specific cause unknown
linked to
- smoking
- antibiotics
- chlorhexidine mouthwash
- poor oral hygiene
black hairy tongue management
reassure
stop smoking
stay hydrated
lightly brush tongue
gentle exfoliation of tongue surfaces
- peach stones
eat fresh pineapeale
fordyce spots - features
sebaceous glands
- no function in the oral cavity
yellowish bumps
60-75% of adults
found on buccal mucosa and lips
symmetrical distribution
greater prominence later in life
no associated pathology
- normal anatomy
geographic tongue features
1-3% population
associated with psoriasis
loss of filiform papillae
- areas of tongue atrophy and hyperkeratinisation
comes and goes and changes appearance
can affect other areas of oral mucosa
mostly asymptomatic
- sometime sensitive to hot and spicy foods and toothpaste
- SLS free toothpaste?
geographic tongue management
reassurance
doesn’t indicate biopsy
consider difflam mouthwash when needed if symptomatic
ask about skin changes
consider avoiding trigger foods
mucoceles - features
cysts
caused by damage to salivary ducts or minor salivary glands
more common in lower lip
usually response to trauma
blue/translucent sessile lump
more common in over 30s
mucocele - management if in upper lip
manage as malignancy until proven otherwise
term for a mucocele found on floor of the mouth
ranula
mucocele - management
excision
- blunt dissection to remove full capsule of cyst and damaged minor salivary gland
- watchful wait approach in paediatric patients
- increased chance of recurrence if excision incomplete
lingual tonsil - features and management
lymphoid tissue
- found on postern-lateral aspect of tongue
may become enlarged following trauma or infection
can mimic malignancy
- in high risk site
no treatment necessary
- refer if unclear diagnosis
varices - features
blood vessels
become more prominent with increasing age
may be more prominent in
- smokers
- patients with cardiovascular disease
haemoangioma features
disorganised vascular tissue
more common in head and neck
common benign growth made of a collection of small blood vessels that form a lump under the skin
more common in females
very common in females
may resolve
vascular malformation features
congenital lesion due to abnormal blood vessel development
associated with larger arteries and veins
present at birth
can be challenging to manage
may require extensive excision and free-flap reconstruction
haemangiomas and vascular malformations - management
no treatment if asymptomatic with no aesthetic concerns
ultrasound
cryotherapy
cauterisation
MRI and angiogram for larger lesions
tori and exostoses features
translucent white and folded appearance
histological findings
- thicker epithelium
- broad rete process
