reactive and benign lesions Flashcards
what is a fibro-epithelial polyp
- localised hyperplastic lesion
- overproduction of granulation and fibrous tissue in responce to damage or trauma
clinical features of fibre-epithelial polyp
- commonly presents in buccal mucosa
- often in areas of trauma
- may be pedunculated or sessile
- firm or soft
- pink appearance
- painless
- can be ulcerated and easily traumatised
- may have associated frictional keratosis
- usually an isolated lesion
histology of fibro-epithelial polyp
- fibrous tissue in core
- thick interlacing collagen fibres
- adjacent normal tissue
- covered with squamous epithelium
- may have hyperkeratosis
- little inflammatory infiltrate
management of fibro-epitheial polyp
- photos
- identify and if appropriate correct traumatic cause
- consider excisional biopsy
benefits and risk of biopsy in fibro-epitheial polyp
benefits
- can confirm diagnoses - useful if the diagnossis isnt certain or patient has SCC risk factors
- can remove lesion
risks
- surgical risks
- altered sensations - can be permanent
- recurrance or incomplete excision
what is this
fibro-epithelial polyps
what is denture associated hyperplasia
- response to denture trauma
- poor denture fit
-leaf fibroma
-denture/papillary hyperplasia
-can make denture fit worse
management of denture hyperplasia
- excision of lesion
- denture hygiene
- candida management
- consider fabrication of new prosthesis
what is an epulis
- refers to reactive hyperplastic lesion on the gingivae
what is fibrous epulis
- a fibro-epiithelial polyp presenting on gingivae
- same coloour as gingiva
- may be ulcerated
- histologically similar to polyps but more likely to have varying amounts of inflammatory infiltrates
what is giant cell epulis
- peripheral giant cell granuloma
- red/purple appearance
-sessile or predunculated - children
- idential histopathological features as a central giant cell lesion and hyperparathyroidism (browns tumour)
- multinucleated osteoclast giant cells
- vascular stroma
- fibrous tissue
management of peripheral giant cell granuloma
- excisional biopsy
- bone profile
- OPT +/- CBCT
- parathyroid hormone assay
what is this
what is vascular epulis
- same as pyohenic granuloma
- if presents in pregnancy termed pregnancy epulis
- increase in size due to hormone change
- soft bright red appearance
- gradual increase in size
- may resolve following birth
- if removed following birth, inflammation may decrease and resemble a fibrous epulis
- may recur if removed during pregnancy
how does vascular epulis appear histologically
- vascular appearance
- variable amounts of inflammatory infiltrate
management of vascular epulis
- keep under observation
- excisional biopsy
- keep under observation with a view to excise following birth
what is this
vascular epulis
what drugs induce gingival overgrowth
- calcium channel blockers
- ciclosporin
- phenytoin
management of gingival overgrowth
- gingivoplasty may be indicated - but will likely bleed due to vascular nature
- ask GP to consider alternative medications
- plaque control
- are there risk factors for other diseases
- consider referral to oral med to exclude other causes
what is squamous cell papilloma
- benign growth (tumour) - can describe as wart
- any aspect of oral mucosa
- pedunculated or sessile
- cauliflower appearance
- often keratinised surface
- result from viral - typically HPV infection (HPV-2,3,6,11 and 40)
- not associated with malignant transformation
- signle or multiple lesions
- may present in immunocompromised
management of squamous cell papilloma
- excisional biopsy
- observation - if no red flags , signs or symptoms , or OSCC risk factors
histology of squamous cell papilloma
- histological examination shows fingers - like processes of hyperplastic squamous epithelium
- thin cores of vascular connective tissue
what is pyogenic granuloma
- reactive vascular lesion
- gingiva most common site - but any oral mucosal tissue can be affected
- typically a responce to locla irritation/trauma
histology of pyogenic granuloma
- vascular proliferation
- oedematous fibrous stroma
- variable inflammatory infiltrate
management of pyogenic granuloma
- remove irritant - plaque/overhanf/denture/other traumatic cause
- excisional biopsy
pathophysiology of black hairy tongue
- hyperplasia of filiform papillae
- build up of commensal bacteria , food debris
- pigment inducing fungi and bacteria
cause of black hairy tongue
- smoking
- antibiotics
- chlorhexidine
- poor OH
management of black hairy tongue
- reassure
- stop smoking
- stay hydrated
- lightly brush tongue
- exfoliate tongue surface - peach stones
- eating fresh pineapple
- other causative factor?
- not caused by fungal infection
what can happen in lingual tonsil
- lymphoid tissue
- postero-lateral aspect of tongue
- may become enlarged following trauma or infection
- can mimic malignancy and is in high risk site.
- no treatment necessary - referral may be inficated if diagnosis is unclear
what are varices
- blood vessels
- become more prominent with age
- may be more prominant in
- smokers
- those with cariodvascular disease
what is hemanginoma
- common, bengin growth made of a collection of small blood vessels that form a lump under the skin
- two histological subtypes
- capillary - smaller capillary vessels
- cavernous - large thin walled vessels
what is vascular malformation
- congenital lesion due to abnormal blood vessel development
- associated with larger arteries and veins
- present at birth but present at different times of life
- can be challenging to manage
- may need extensive secision and free-flap reconstruction
- complications
- trauma/aesthetics/spontaneous bleeding
- sturge-weber syndrome
management of vascular malformation and haemanginoma
- pulsility assessment
- no treatment/monitoring - most lesions - if asymptomatic and no asthetic concerns
- cryotherapy
- ultrasound
- electro-cautery
- CO2 laser excision
- mri +/- angiogram for large lesions
