Common ST Lesions in Children Flashcards
What are the main effects associated with ankyloglossia for newborns?
- Breast feeding difficulties
- Restriction of tongue movt (ice cream, wind instrument)
What is the treatment for ankyloglossia?
Frenotomy for newborns w breastfeeding problems
What are some examples of palatal cysts of newborn and where are they usually found?
- Bohn’s nodules (on palate)
- Epstein pearls (mid-palatal raphe)
What is the treatment for palatal cysts of the newborn?
No treatment, spontaneously rupture & involute within few months
What is an eruption cyst?
Soft tissue swelling over crown of erupting tooth, originating from REE
What is the clinical presentation of an eruption cyst?
- Sessile, dodome-shaped, translucent swelling
- Soft, fluctuant
- Pink/blue (if traumatised => filled w blood)
- Location: overlying erupting tooth
- Painless, unless infected
What is the management for eruption cyst?
No tx, will burst spontaneously as tooth erupts
- If failure to resolve/cause discomfort: removal of roof of cyst to encourage eruption
What is infantile hemangioma?
Vascular tumor due to rapid endothelial cell proliferation in early infancy (3-5 months)
F>M
What is the difference between vascular malformations and vascular tumors (infantile hemangioma)?
- Infantile hemangioma involute over time while vascular malformations do not – they enlarge proportionately w growth of child
What are the classifications of types of vascular malformations?
Low flow: capillary, venous, lymphatic
High flow: arteriovenous
What syndrome is associated with vascular malformations?
Sturge-Weber syndrome
What is the clinical description of lymphangioma?
- Pebbly surface resembling “frog eggs” or sago
- 40-50% of cases on tongue
What is the tx for lymphangioma?
Observation, usually no surgery
What is the clinical presentation of benign migratory glossitis (geographic tongue?
- Multiple oval/circular red patches
- Surrounded by white, slightly elevated border
- Atrophy/loss of filiform papillae
- Pattern changes
- Seen on tongue, labial & buccal mucosa and vermillion border of lip
What is the treatment for benign migratory glossitis?
No tx. Avoid spicy foods – may feel burning sensation
What is congenital epulis?
- Fibro-epithelial lesion arising from mesenchymal cells
- Present at birth
- F > M (90% in females)
Where is congenital epulis commonly found?
Max anterior alveolar ridge (area of
developing lateral incisor & canine)
What is the treatment for congenital epulis?
Occasional spontaneous regression
If no regression, surgical excision under GA
Recurrence unlikely
What is the clinical presentation of leukoedema?
- Diffuse, filmy white wrinkled mucosa due to intracellular oedema of superficial epithelial cell
- Disappears when stretched
- Location: bilateral buccal mucosa
- Asymptomatic
What is the timeline of clinical presentation of Primary Herpes Gingivostomatitis?
Timeline (incubation 5-7 days before)
- Day -2 to 0: prodromal symptoms – fever, malaise, nausea
- Day 1 to 4: vesicles that can rupture → ulceration, fever ↓
- Day 5: start to feel better
- Day 10 to 14: resolution
Where do the vesicles of primary herpes gingivostomatitis usually form?
Keratinised & non-keratinised gingiva
(Secondary only keratinised mucosa)
What is the treatment for primary herpes gingivostomatitis?
- Self-limiting, resolves in 1-2 weeks
- Symptomatic care: anti-pyretic & analgesic
- Hydration & nutrition: encourage fluid intake, cool foods/drinks, soft diet
- Anti-virals (e.g acyclovir): within 72h for severe/immunocompromised cases
Which viruses causes HFMD?
Coxsackie A16, Enterovirus 71
What are the clinical manifestations of HFMD?
- Prodromal symptoms (flu-like): fever, anorexia, malaise
- Oral lesions: multiple widespread shallow ulcers
- Skin lesions: non-pruritic macules, papules, vesicles on
extensor surfaces of hands & feet
What is the treatment for HFMD?
- Self-limiting, resolves in 1 week
- Highly contagious => avoid spread to others
- Symptomatic care
What is the difference in clinical presentation of HFMD and herpangina?
Herpangina localised to posterior area of oral cavity only (oropharynx)
Which types of HPV can cause SCC?
HPV 16, 18, 31
What oral lesions result from HPV?
- Squamous papilloma
- Verruca vulgaris
- Condyloma acuminatum
- Heck’s disease
What is the management for HPV lesions?
- Excisional biopsy (for all except Heck’s)
- Avoid self-inoculation
- Vaccine for HPV 6, 11, 16, 18
- CA associated w sexual abuse in kids => investigate
What superficial fungal infection occur in children?
- Pseudomembranous candidiasis
- Angular cheilitis
- Median rhomboid glossitis
What is the treatment for superficial fungal infections?
- Anti-fungal therapy (e.g nystatin, clotrimazole)
- Maintain proper OH
- Wash feeding utensils carefully & store in antiseptic solution
- Identify underlying cause if suspected (e.g diabetes, appliance/
prosthesis, antibiotics, immunosuppressive therapy)
What is the presentation of linea alba?
- Bilateral
- White smooth to shaggy line
- May be scalloped
- Location: buccal mucosa, along occlusal plane
What is another name for mucocele?
“Mucous retention phenomenon”
What is the etiology of mucocele?
- Trauma of minor salivary gland => mucous pooling in CT + inflammation
What are the common locations for mucoceles?
Lower labial mucosa, buccal mucosa, ventral tongue
What is the treatment for mucocele?
Excisional biopsy (excise minor salivary gland)
What is the etiology for recurrent aphthous ulcers?
- Immune-mediated
- Stress, trauma, allergies, nutritional deficiencies,
genetic deposition - F>M
What is the clinical presentation for recurrent aphthous ulcers?
- Ulceration w yellow-white fibrinopurulent membrane
- Encircled by erythematous halo
What are the common locations for recurrent aphthous ulcers?
- Non-keratinised mucosa buccal & labial mucosa, ventral
tongue, soft palate, floor of mouth) - Does NOT affect keratinised mucosa (e.g attached gingiva,
vermillion of lips, hard palate)
What are the classifications for recurrent aphthous ulcers?
- Minor: 3-10mm (no.: 1-5)
- Major: 1-3cm (no.: 1-10)
- Herpetiform: cluster of 1-3mm ulcers (no.: up to 100)
What is the treatment for recurrent aphthous ulcers?
- Symptomatic treatment
- Topical steroids
- Eliminate triggering events
What is erythema multiforme?
- Blistering, ulcerative mucocutaneous
condition of uncertain aetiopathognesis - Probably immune-mediated
What is the clinical presentation of erythema multiforme?
Oral Lesions
- Erythematous patches undergo necrosis
- Form large shallow ulcers w irregular borders
Skin Lesions
- Concentric circular erythematous rings
- Look like target/bull’s-eye lesions
What is the treatment for erythema multiforme?
- Self-limiting, resolves in 2-6 weeks
- Recurrence rate: 20%
- Symptomatic tx: steroids
- Antiviral prophylaxis
What are the triggers for erythema multiforme?
- Preceding infection in 50% of cases (e.g HSV,
mycoplasma pneumonia) - Drugs (less common)
What are the 5 Ps of lumps and bumps?
- Pyogenic granuloma
- Peripheral giant cell fibroma
- Peripheral ossifying fibroma
- Peripheral fibroma
- Papilloma (has papillary surface)
Remaining 4 Ps require biopsy to differentiate
What are some etiology for gingival enlargements?
Reactive
- Inflammatory
- Medication induced (e.g cyclosporine, nifedipine, phenytoin)
Developmental
- Hereditary gingival fibromatosis
Systemic Causes
- Hormonal changes
- Malignancies
- Granulomatous diseases
What is Neuroectodermal Tumour of Infancy?
- Rapidly growing
- Can infiltrate & destroy surrounding structures (e.g nasal septum) => locally aggressive although benign
- Rare
- Usually occurs in children ≤1 y/o
- Majority benign (1% malignant)
- Neural crest origin
What is the clinical presentation of Neuroectodermal Tumour of Infancy
- Non-ulcerative, smooth-surface swelling
- Firm, sessile
- Location: max anterior alveolar ridge
- Painless
What is the treatment for Neuroectodermal Tumour of Infancy?
- Surgical intervention
- Recurrence rate: 10-60%
What clinical presentation is usually associated with Acute myeloid leukemia (AML)?
Leukemic infiltrates of gingiva
