Intra Oral Swellings Flashcards
Neoplasm
Abnormal growth of cells
Growth is uncontrolled and progressive
Can be benign or malignant
Hyperplasia
The increase in number of normal cells in a normal arrangement in a tissue
Contrast to hypertrophy, an increase in the size of an organ as a result of increase in cell size
What is a cyst?
An epithelial lined cavity or sac
Localised connective tissue hyperplasias
- epulides
- pyogenic granuloma
- fibroepithelial polyp
- denture induced hyperplasia
- papillary hyperplasia of the palate
Epulis
Localised tumour like gingival swelling
Usually arising from interdental papilla
Interdental form of chronic irritation calculus
Congenital epulis
- found in newborns
- soft tissue growth on edentulous alveolus
- effects F > M
- anterior maxilla
- pink, soft, compressible and pedunucleated
- treatment - complete excision
- recurrence unlikely
Fibrous epulides
- pedunculated or sessile mass
- firm in consistency
- colour similar to surrounding tissues
- 65% of epulides are fibrous
- caused by low grade chronic irritation (eg plaque, calculus, trauma)
Pregnancy epulis
- soft, deep, reddish, purple swelling
- often ulcerated
- anterior dental papillae
- haemorrhage on minor trauma spontaneously
- onset at end of first trimester
- gradually increase in size during pregnancy
Pregnancy epulis
Histology?
Treatment?
Histology- vascular proliferation
Treatment
- OHI
- resolution after pregnancy
- excision should be delayed till after birth
Peripheral giant cell granuloma
(Giant cell epulis)
- 7% of epulides
- dark red
- ulcerated
- may involve underlying bone - central giant cell lesion
(Radiograph required to confirm in involvement of underlying bone)
(Confirm bone involvement prior to extractions - risk of bleeding +)
Pyogenic granuloma
Histologically and clinically identical to pregnancy epulis
Pregnancy epulis is pyogenic granuloma occurring in pregnancy
Together they make up 28% of epulides
May occur on other sites than gingiva (tongue, labial/buccal mucosa)
Aetiology - minor trauma
Other causes of generalised gingival swelling
Drug induced gingival overgrowth
Gingival fibromatosis
Acute leukaemia
Chronic plaque induced gingivitis (hyperplasticity form)
Fibroepithelial polyp
- common lesion
- pink, firm, painless, pedunculated or sessile polypoid swelling
- size 2-3mm - 1cm diameter
- mainly located in cheeks along occlusal line, lips and tongue
- treatment - excision if symptomatic / doubt in diagnosis
- aetiology - minor trauma
Denture induced hyperplasia (denture granuloma)
- common
- reactive inflammatory fibrous hyperplasia
- smooth pink swelling, may be grooved
- caused by chronic inflammation - poorly fitting denture flange
- usually asymptomatic, may be ulcerated
- treatment - relieve denture flange and excision
- failure to relieve denture leads to recurrence
Papillary hyperplasia of the palate
- multiple small papillary projections on palate (bubbly appearance)
- related to ill fitting dentures
- often there is an associated candidiasis
- aetiology - minor trauma from denture
Connective tissue neoplasms
- Tumours of fibrous tissue
- rare in mouth - Tumours of adipose tissue
- lipoma - Tumours of vascular tissue
- haemangioma
- lymphangioma - Malignant tumours of all types of connective tissue are rare intra-orally
Lipoma
- soft elastic yellowish coloured swelling
- mostly cheek and tongue
- filled with fats
- NB flats when placed in the fixative after excision
Types of cysts
Dermoid
Eruption
Mucocele
Nasopalatine/incisive canal
Dermoid cyst
Aetiology - developmental
Rare
Site - painless swelling floor of mouth
Eruption cyst
Appearance
- domed shapes bluish swelling, filled with blood or serum, eruption will break cyst
- arises from dental follicles
- treatment - incision of lesion if symptomatic
Mucocele
Appearance?
What is it and cause?
Dome shaped, bluish, fluctuant, painless
Prone to rupture
Frequently return
Common site - lower lip
- common
- retention of mucous in sub epithelium tissues
Causes
- blockage in salivary duct - mucus retention cyst
- severance of a salivary duct - mucus extravasation cyst (common)
Ranula - large Mucocele in the floor of mouth, may involve sublingual gland
Ranula
- unilateral
- 2-3cm in diameter
- soft, fluctuant, bluish
- mostly painless
- can interfere with speech and mastication
- removal
Salivary gland neoplasms
- rare
- can involve major and minor salivary glands
- 46% of minor gland tumours are malignant
- most tumours in sublingual gland are malignant
- usually grow rapidly, cause pain, may ulcerate, may involve nerves
Oral tori
Bony modular growths
- tori, exostoses and osteomas
Benign lesion of compact bone
Name depends on site
- exostoses - facial aspect of mandibular and maxillary alveolus
- tori - palatal mid-line maxilla and lingual in the mandible
