Developmental Lesions, Reactive Lesions, Benign Epithelial Tumors, ST Cysts Flashcards
1
Q
Developmental lesions
A
- Fissured tongue
- Ankyloglossia
- Lingual thyroid
- Gingival fibromatosis
2
Q
Fissued tongue
A
- Cause
- Hereditary
- Common condition: 2-5% of population
- Incidence increases w/ age
- Clinical Findings
- Multiple grooves & fissures on dorsal surface of tongue
- Sometimes assoc w/ geographic tongue
- Significance & Management
- Variation of normal
- Usually asymptomatic & no tx needed
- Encourage pt to brush tongue to remove debris
3
Q
Ankyloglossia
A
- Cause & Findings
- Short lingual frenum
- Varies from abnormal attachment of frenum to complete fusion of ventral tongue to floor of mouth
- Management & Px
- Usually limited clinical problems, no tx needed
- Severe cases, surgically tx’d
4
Q
Lingual Thyroid
A
- Cause
- Failure of thyroid gland to descend properly
- Clinical Findings
- Vascular-appearing ST enlargement in area of foramen cecum
- Significance
- 70% of cases, this is the pt’s only thyroid tissue
- Management & Px
- Determine functional status of thyroid gland in neck
- May need to excise lingual thyroid tissue and auto-transplant to a different place in the body
5
Q
Gingival Fibromatosis
A
- Slowly progressive gingival enlargement
- Caused by collagenous overgrowth of gingival tissue
- Familial (AD) or idiopathic
- GINGF (HGF1), GINGF2 (HGF2), GINGF3 (HGF3)
- Begins before 20yo, correlating w/ teeth eruption
- Can interfere w/ lip closure and eruption of subsequent teeth
- MX more frequently affected, esp palatal
- Tx: Gingivectomy, rigorous OH
6
Q
ST Enlargements
A
- Lumps, bumps, swellings, masses
- 2 categories of ST enlargements
-
Reactive
- Result of injury
- Sometimes h/o injury
- Sometimes symptomatic or painful
- Relatively rapid growth rate (hrs to wks)
- May fluctuate in size
- Usually regresses
- Sometimes, but not always, associated w/ tender lymphadenopathy and systemic manifestations
- Once determined that an enlargement is reactive, then determine what the lesion is reacting to
- Infections
- Chemical trauma
- Allergy
- Meds
-
Tumor
- Enlargement based on clinical features of being persistent and progressive
7
Q
Parulis/Sinus Track/Periodontal Abscess
A
- Gingival abscess secondary to periapical pathosis
- AKA gum boil, periodontal abscess
- Focus of pus in the gingiva
- Typically white-yellow and assoc w/ pain
- Tx: Tx underlying condition (periodontal pocket or non-vital tooth) achieves resolution of gingival abscess
8
Q
Fibrous Hyperplasia/Irrtation Fibroma
A
- Reactive hyperplasia of fibrous CT
- Caused by chronic irritation or trauma
- One of the most common things we see
- Most in buccal mucosa, along bite line
- Clinical features
- Well-circumscribed, slowly growing
- Smooth-surfaced, sessile, pink nodule
- Typically firm
- May be ulcerated or inflamed
- Tx: Surgical excision
9
Q
Epulis Fissuratum (Inflammatory Fibrous Hyperplasia)
A
- Tumor-like hyperplasia of fibrous CT
- Develops in association w/ an ill-fitting denture or partial
- Fibrous hyperplasia due to irritation from a denture
- MX or MN, esp in anterior
- Rolls of tissue assoc w/ a denture flange
- Slowly growing
- Firm or compressible
- May be ulcerated and/or inflamed
- Microscopic features
- Same as irritation fibroma, but w/ a fissure
- Tx: Reline or remake denture
- Px: Good
10
Q
Drug-Related Gingival Hyperplasia
A
- Abnormal growth of tissue secondary to medsCertain drugs affect collagen remodeling and degradation
- Anticonvulsants: Phenytoin (dilantin); young
- CCB: Nifedipine; middle aged
- Cyclosporine: Broad age range
- Degree of enlargement related to susceptibility & hygiene
- Rigorous hygiene can prevent or limit enlargement
- Cyclosporine-induced least susceptible to hygiene program
- Hyperplasia is higher in smokers
- Tx:
- D/c of medication results in cessation
- Substitution of drug may be beneficial
- Cleaning, frequent visits, rigorous hygiene
- When all else fails, surgery (allow 6-12mo)
11
Q
Inflammatory Papillary Hyperplasia
A
- Represents both fibrous & epithelial hyperplasia
- Another denture-related ST lesion
- Cause
- Reactive process to poorly fitting dentures, wearing dentures 24hr/day
- Clinical features
- Numerous red, edematous papillary projections
- Assoc w/ dentures
-
Tx:
- D/c wearing denture 24hr/day
- Antifungal med if candidosis is present
- Excise large lesions
- Construct new denture or reline/rebase existing denture
- Px: Good
12
Q
Tumor Lesions
A
- Persistent, progressive
- Often asymptomatic early in development
- Growth rate varies from wks to yrs
- If a ST enlargement is a tumor, then determine if benign or malignant
- Benign:
- Well-circumscribed w/ well-defined borders
- Usually slow-growing (mos to yrs)
- Usually asymptomatic
- Malignant:
- Rapidly growing (wks to mos)
- Overlying mucosa may be ulcerated
- Fixed to surrounding structures
- More often symptomatic
13
Q
Benign Warty Tumors of the Squamous Epithelium
A
- Benign, virus-induced, focal hyperplasia of squamous epithelium
- Clinical Features
- Pale (white to tan)
- Firm
- Rough or cauliflower surface
- Fixed to surface but not deep structures
- Non-painful and persistent
- Warty lesions of squamous epithelium are assoc w/ HPV. Up to 80% of adults have HPV in their mouths
14
Q
Papilloma
A
- Clinical Features
- Pale, rough, exophytic
- Pedunculated
- Tx: Excisional biopsy
- Px: Good
15
Q
Verruva Vulgaris
A
- Clinical Features
- Similar to papilloma but verruca has a sessile base
- More common on skin
- Tx:
- Oral: Excisional biopsy
- Skin: Cryosurgery, chemical cautery, laser ablation
- Px: Good
16
Q
Condyloma Acuminatum
A
- Clinical Features
- Usually multiple Lesions
- Most common in anogenital area
- Typically sexually transmitted
- High risk for cancer: HPV 16, 18, 31
- Tx: Excisional biopsy
- Px: Recurrence is common
17
Q
Inflammatory Papillary Hyperplasia
A
- Reactive tissue growth that usually develops beneath a denture
- Pathogenesis is unknown
- Ill-fitting denture
- Poor denture hygiene
- Wearing denture 24hr/day (20% will develop IPH)
- Pathogenesis is unknown
- Usually seen in hard palate (vault than entire palate)
- Rarely, may occur on palate of pts w/o denture
18
Q
Seborrheic Keratosis
A
- Extremely common skin lesion of older people
- Benign proliferation of epidermal basal cells
- Cause is unknown, but correlates w/ chronic sun exposure
- Somatic mutations in the FGFR3 gene
- Does not occur in the mouth
- Skin of face, trunk, extremities
- 4th decade and increase w/ age
- Macules → fissured, verrucous plaques
- “Stuck onto” appearance
20
Q
Gingival cyst of the Adult
A
- Occurs on attached gingiva anterior to M1s
- ST counterpart to lateral periodontal cyst (intrabony cyst)
21
Q
Lymphoepithelial Cyst
A
- (covered in lymphoid lecture)
- Yellow or white in color
- Waldemeyer’s Ring
- Almost always located:
- Lateral and ventral tongue
- Floor of mouth
22
Q
Epidermoid/Dermoid Cyst
A
- Keratin-filled cyst derived from hair follicle
- Most commonly found on the skin, most commonly found in the floor of the mouth
- Nodular, fluctuant subcutaneous mass
23
Q
Thyroglossal Tract Cyst
A
- Arises from remnants of thyroglossal tract which develops in foramen cecum area
- 60-80% cases below hyoid bone
- Occurs in midline of the neck
- Painless, fluctuant, movable swelling
