Common Soft Tissue Lesion in Children Flashcards
Demographics of Leukoedema
1st and 2nd decades
Clinical Findings of Leukoedema
- Diffuse, filmy white, wrinkled mucosa, bilateral
- Diffuse when tissue is stretched
- Asymptomatic
Treatment of Leukoedema
None
What is ankyloglossia caused by?
Abnormally short and anteriorly positioned lingual frenum that may result in restricted tongue movements
Effects of Ankyloglossia
- Breastfeeding difficulties
- Speech
- Restriction of tongue movement
- Gingival recession
Treatment of Ankyloglossia
Frenectomy shortly after birth if breastfeeding problems or after evaluation with speech therapist
How to perform a frenectomy?
Place thumb between FOM and tongue, cut with very sharp scissors 3mm
2-3 drops of glucose spikes baby endorphin to lessen the pain
What are the palatal cysts of newborn?
Epstein’s pearls midline and Bohn’s nodules scattered over the palate
Treatment of Developmental Cysts of Newborn
No treatment, spontaneously rupture and involute within few months
Clinical Features of Dental Lamina Cysts
- From dental lamina remnants
- Crest of ridge
- White nodule: 2mm
- Single to multiple
What is an Eruption Cyst?
Dental follicle expanded through alveolus causing soft tissue swelling over crown of erupting tooth
Usually burst spontaneously -> Normal eruption
What is the management if eruption cyst fail to resolve?
Elliptical excision of overlying mucosa and cyst wall to encourage eruption
What is infantile hemangioma caused by?
Rapid endothelial cell proliferation in early infancy (1st 3-5months) followed by involution over time
Treatment of Hemangioma
Benign and self-limited but can cause complication e.g. ulceration or life-altering disfigurement
Classification of Vascular Malformations
Low (capillary, venous, lymphatic, combination)
High (arterial, arteriovenous flow)
Features of Vascular Malformations
- Present at birth
- Do not involute spontaneously unlike infantile hemangioma
- Enlarge proportionately with the growth of the child
- Trauma, puberty, and pregnancy can cause accelerated growth
- No gender predilection
Treatment of Vascular Malformations
Pump sclerotic agent into vessel, 2 stops (one at start and one at end) then cut out the isolated section
Features of Lymphatic malformations
- 50% presented at birth,90% diagnosed by aged 2 years old
- Tongue> Buccal mucosa
What is a Cystic Hygroma?
Dilated malformed lymphatic channel or cysts of varying sizes
Etiology of Benign Migratory Glossitis
Immune mediated
Demographics of Benign Migratory Glossitis
1st and 2nd decade
Female predilection
Clinical Presentation of Benign Migratory Glossitis
- Multiple circular red patches with thickened white border
- Loss of filiform papillae,
- Pattern changes
- May be tender
Location: Labial/buccal mucosa, tongue and vermillion border of lip
Mangement of Benign Migratory Glossitis
No treatment, Avoid spicy foods
What is a Congenital Epulis of Newborn?
Fibro-epithelial lesion arising from mesenchymal cells on alveolar ridge
Demographics of Congenital Epulis of Newborn
90% females, present at birth
Etiology of Congenital Epulis of Newborn
Hormonal influence
Clinical Features of Congenital Epulis of Newborn
Firm pedunculated/sessile alveolar mass
Region of Congenital Epulis of Newborn
Maxillary lateral incisor/ canine
Treatment of Congenital Epulis of Newborn
Excision
Occasional spontaneous regression
Timeline of Primary Herpetic Gingivostomatitis
5-7 days of Incubation
1-2 days of prodromal symptoms: fever, malaise, headache and nausea
Vesiculation -> Ulceration -> Symptoms decrease on 6th day
Resolve in 10-14 days
Treatment of Primary HSV
- Symptomatic care: anti-pyretic and analgesic
- Encourage oral fluids to prevent dehydration
- 0.2% chlorhexidine swab
- Acyclovir within 72 hours of infection for severe cases or immunosuppressed patients
Clinical Manifestations of HFMD
- Low-grade fever, anorexia, malaise
- Widespread shallow ulcers
- Macules, papules, vesicles on extensor surfaces of hands and feet
- High contagious but resolves 7-10 days
Resembles herpangina but may not localised to posterior area of oral cavity
Which viruses are associated with HFMD?
Coxsackie A16, Enterovirus 71
Management of HFMD
Self-limiting
HPV types associated with Oral Warts
HPV 6 and 11
HPV types associated with cancer
Types 16 and 18
Oral lesions associated with HPV
- Squamous papilloma
- Verruca vulgaris
- Condyloma acuminatum
Management of Human Papilloma Virus
Excisional biopsy except for Heck Disease
Superficial Fungal Infections in Children
- Pseudomembranous candidiasis
- Angular cheilitis
- Median rhomboid glossitis
Treatment for Superficial Fungal Infections
- Anti-fungal therapy: Nystatin, clotrimazole
- Maintain proper OH
- Wash feeding utensils carefully after meal and store in antiseptic solution
- Identify underlying cause if suspected
What are the impacts of Immunosuppression on infections?
Atypical lesions and systemic spread of infection
Clinical Presentations of Reactive Lesions
Epithelial thickening (like a keloid), sloughing, erosion, ulcer, growth, pigmentation
Reactive Lesions are caused by?
Trauma (Physical, chemical, thermal), foreign body, medications, autoimmune/immune-mediated
Demographics of Linea Alba
1st and 2nd decades
Clinical significance of Linea Alba
- White smooth to shaggy line
- Bilateral coincides with place of occlusion, may be scalloped
Demographics of Recurrent Apthous Stomatitis
- 1st and 2nd decade
- Female predilection
Etiology of RAS
- Immune-mediated
- Stress, trauma, allergies, nutritional deficiencies, genetic disposition
Types of RAS
- Minor
- Major
- Herpetiform
Clinical Presentation of RAS
All areas except attached gingiva, vermillion of lips, hard palate
Treatment of RAS
- Symptomatic treatment
- Topical steroids
- Eliminate triggering events
What is Erythema Multiforme?
Type II Hypersensitivity
Blistering, ulcerative mucocutaneous condition of uncertain aetiopathogenesis
What triggers Erythema Multiforme?
Preceding infection in 50% of cases: HSV, mycoplasma pneumonia
Clinical Presentation of Erythema Multiforme
- Acute onset
- Prodromal S&S common 1 week before onset
- Self limiting: 2-6 weeks
- Recurrent in 20% of patients
- Start as erythematous patches -> Large shallow erosions and ulcerations with irregular borders
- Appear as target lesions on skin
Treatment of Erythema Multiforme
Steroids
Prophylaxis for Erythema Multiforme
Antiviral prophylaxis
Etiology of Gingival Enlargements?
- Inflammation
- Medication-induced
- Developmental: Hereditary gingival fibromatosis
- Systemic causes: Hormonal changes, malignancies, granulomatous diseases
Neoplastic Lesions in Children
- Neuroectodermal tumour of infancy: Expansile lesion of alveolus
- AML: Leukemic infiltrates of gingiva
Treatment of Neuroectodermal tumour of infancy
Excision
15-20% recurrence rate
1% malignant
Radiographic Features of Neuroectodermal Tumour of Infancy
Poorly circumscribed radiolucency with floating teeth