Lip Lesions

Question 1

UPPER LIP

Answer 1

Irritation Fibroma
Canalicular Adenoma (>40 yo)
Pleomorphic Adenoma (<40 yo)
Salivary Duct Cyst
Oral Juvenile Xanthogranuloma
Other Mesenchymal Tumors

Question 2

LOWER LIP

Answer 2

Mucocele
Irritation Fibroma
Squamous Cell Carcinoma
Varicosities / Venous Lake
Salivary Gland Tumor (Mucoepidermoid
Carcinoma)
Other Mesenchymal Tumors

Question 3

Irritation Fibroma

Answer 3

Reactive hyperplastic tissue due to chronic trauma
Commonly occur on buccal mucosa (in occlusal plane), inner labial mucosa, gingiva and lateral
borders of tongue → Related to areas for increased trauma incidence
Pink, smooth nodule that is nontender to touch
Sessile or pedunculated appearance, NOT self limiting
TX: Surgical excision for definitive diagnosis, clinical history helpful

Question 4

Canalicular Adenoma

Answer 4

a (>40 yo)
◦ Benign, epithelial salivary gland neoplasm
◦ Very rare salivary gland tumor
◦ Presents in patients over 40 yo, but increased in 70 yo populations

Question 5

Pleomorphic Adenoma (

Answer 5

(<40 yo)
◦ More common, benign salivary gland neoplasm
◦ Most common type of salivary gland tumor
◦ Most common tumor of the parotid gland
◦ Contains epithelial and myoepithelial elements
◦ Slower growth, firm, painless, singular nodular mass
◦ Mobile mass when palpated and can be diagnosed with fine needle aspiration,
prior to excision
◦ Facial nerve damage can occur during removal and must be carefully addressed
◦ Can present on palate as well

Question 6

Salivary Duct Cyst

Answer 6

Non-neoplastic cyst that is less common
Lined by epithelium
◦ Mucocele is lined with granulation tissue
More common in major vs. minor salivary glands
◦ 80% occur in parotid gland
Cystic dilation that is often associated with ductal obstruction
◦ Sialadenitis is very frequently associated

Question 7

Oral Juvenile Xanthogranuloma

Answer 7

Rare non-Langerhans cell histiocytosis
Painless, yellowish papule or nodule that can appear on lip, gingiva and tongue
Typically effect other parts of head and neck, upper trunk and extremities
◦ Rarely seen in oral area, only about 40 cases reported

Question 8

Mucocele

Answer 8

Occur from trauma to minor salivary gland and duct
NOT a true cyst – granulation tissue lined
Mucin from gland collects in surrounding tissue or duct is unable
to drain
Lower lip&raquo_space;> Upper lip
◦ Can also occur on palate, tongue, floor of mouth (ranula) and buccal
mucosa
May be fluid filled (bluish and translucent color)
Fluctuates in size and can be larger or deflated, history of
fluctuation
TX: Excisional biopsy to remove gland, may resolve spontaneous

Question 9

Angioedema

Answer 9

2 Subtypes exist
◦ Allergic – TX w/ antihistamines, steroids, epinephrine
◦ Hereditary – TX w/ androgens and esterase-inhibiting drugs

Acute onset of swelling and itching
Swelling of lips, face, tongue, pharynx and extremities are all common
Non-pitting in nature, thicker/firmer welt
Painful and swelling occurs BELOW the skin, can be itchy
◦ Urticaria, in contrast, is not painful, occurs on the skin and is itchy
Can be life-threating is larynx is involved or airway is compromised