soft tissue lesions Flashcards
features of congenital epulis, clinical presentation and tx
- fibro epithelial lesion arising from mesenchymal cells
- present at birth
- F>M (90% in females)
clinical presentation
- single, pink, smooth mass
- can be sessile or pedunculated
- firm
- mostly 2cm or less
- location usually at max anterior alveolar ridge (area of LI and canine)
mx:
- occasional spontaneous regression
- if no regression then can surgically excise under GA
- recurrence unlikely
what are features and clinical presentation of leukoedema
is intracellular oedema of superficial epithelial cells
affecting 1st and 2nd decades
no gender predilection
clinical presentation:
- diffuse, filmy white wrinkled mucosa
- disappears when stretched
- located on bilateral buccal mucosa
- asymptomatic
aetiology, demograhics, clinical presentation and tx for infantile hemoangioma
- is a vascular tumour
- caused by rapid endothelial cell proliferatin in early infancy (3-5months), followd by involution over time
- F>M
clinical presentation
- flat/raised, smooth surface, soft consistency
- dark red/ purple
- location: predilection for head and neck eg lips
tx:
- none, benign and self limiting
- but sometimes can cause complications like ulcerations
notes on vascular malformations
aetiology/ demographics/ clinical presentation and tx
- these are present at birth, enlarge proportionately with growth of child
- does not involute spontaneously
- trauma, puberty and pregnancy can accelerate growth
- no gender predilection
classifications
1) simple
- low flow (capillary, venous, lymphatic)
- high flow (arteriovenous)
2) combined
3) anomalies of major named vessels
4) associated with other anomalies eg sturge weber syndrome
clinical presentation:
occur as either
- isolated problem eg port wine stain
- associated with syndromes eg capillary type associated with Sturge Weber syndrome
tx:
- persists throughout life so need to observe
- larger lesions can do surgical excision, laser therapy or sclerotherapy
notes on lymphatic malformations
aka lymphangiomas
they are dilated malformed lymphatic channels/ cysts of varying sizes
- 50% present at birth
- 90% diagnosed by 2 yo
classification
based on size, <2cm is miro
- microcystic (also usually small multiple tiny honeycomb like and macrocystic is large, well defined)
- macrocystic (eg cystic hygroma)
clinical features:
- usually microcystic form in oral cavity
- cluster of translucent vesicles -> pebbly surface resembling frog eggs
- if have secondary hemorrhage then it will be a purple surface
- location usually 40-50% of the time on tongue, sometimes buccal mucosa
tx:
- observation, usually no surgery
frenotomy vs frenectomy
frenotomy is where frenulum is partially incised or released to improve movement whereas frenectomy is where entire frenulum is removed, including its attachment to underlying tissue
frenotomy used for mild cases of ankyloglossia whereas frenectomy is for severe cases, or where there are ortho concerns like diastema
method of frenotomy
should aim for the middle of the frenum as there will be minimal bleeding due to fibrous tissue
- if cut near the FOM, may cut submand duct
- if cut near the tongue may cause significant bleeding
what is ankyloglossia, clinical presentation and indications & timing of tx
abnormally short and anteriorly positioned lingual frenum
- present at birth
- M> F
possible effects
- breastfeeding and speech problems
- restricted tongue movement
- diastema
- gingi recession
timings of tx:
- breastfeeding problems should cut shortly after birth
- speech problems rarely indicated for treatment unless it is severe and evaluation is done by speech therapist
- diastema: only after complete eruption of incisors and orthodontic work up
what types of oral manifestations can HPV give, and what is the mx
types
1) oral warts: HPV 6, 11
2) cancer: HPV 16, 18, 31
oral lesions:
- verruca vulgaris, is the common wart, smoother than squamous papilloma
- squamous papilloma
- condyloma acuminatum
all contagious, skin to skin contact
mx:
- excisional biopsy
- avoid self inoculation
- vaccine for HPV 6, 11, 16, 18
clinical presentation, timeline and tx for primary herpes gingivostomatitis
incubation 5-7 days
day -2 to 0: prodromal symptoms like fever, malaise, nausea
day 1-4: pinhead vesicles rupture to form ulcers
day 5: start to feel better
day 10-14: resolution
location: keratinised and non keratinised mucosa
(if it were secondary, then only keratinised mucosa affected)
tx:
- self limitng, resolves in 1-2 weeks
- symptomatic care: anti pyretic and analgesic
- hydration and nutrition: encourage fluid intake, cool foods an drinks
- 0.2% CHX mouthwash to prevent ulcers from getting infected with bacteria
- anti virals like acyclovir to be prescribed within 72h for severe/ immunocompromised cases
dosage of acyclovir for kids
20mg per kg up to 800mg, 4x a day for 5 days
cause of HFMD, clinical presentation and tx
virus: coxsackie a16 and enterovirus 71
clinical presentation
- 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 and feet
treatment:
- self limiting, rsolves in 1 week
- highly contagious so should avoid spread to others
- symptomatic care
notes on palatal cysts of newborn (aetiology/ clinical presentation/ tx)
Bohns nodules: from epithelial remnants from development of minor salivary glands of palate. location is scattered over palate
Epstein pearls: from epithelial entrapment between palatal shelves. location is mid palatal raphe
clinical presentation:
- usually multiple
- white/yellow white nodules (cysts are filled with keratin)
tx:
- none
- will spontaneously rupture and involute within few months
notes on dental lamina cysts
aka gingival cyst of newborn
- arise from dental lamina remnants (cell rests of Serres)
clinical presentation:
- single to multiple
- white nodules about 2mm
- location on crest of ridge
tx:
- none, spontaneously rupture and involute within few months
notes on eruption cyst
- is a soft tissue variant of dentigerous cyst
- develops from separation of reduced enamel epithelium from crown of tooth
clinical presentation
- sessile, dome shaped, translucent swelling
- soft, fluctuant
- pink/blue if traumatised bc its filled with blood
- located over erupting tooth
- is painless unless infected
tx:
- none, naturally marsupialises as tooth erupts through gingiva
- if symptomatic then can remove root of cyst to encourage eruption (the discomfort is probably coming from the pressure of blood)
aetiology, clinical presentation, tx of RAU
Aetiology:
- immune mediated
- stress, trauma, allergies, nutritional deficiencies, genetic deposition
presentation:
- 1st and 2nd decades
- F>M
- ulceration with yellow white fibrinopurulent membrane
- encircled by erythematous halo
- location: non keratinised mucosa, does NOT affect keratinised mucosa
types:
- minor (3-10mm, about 1-5 ulcers)
- major (1-3cm, about 1-10 ulcers)
- herpetiform: cluster of 1-3mm ulcers, up to 100
tx:
- symptomatic tx like oracort (consists of triamcinolone acetonide and lidocaine)
- topical steroids
- eliminate triggering events
notes on geographical tongue
aka benign migratory glossitis
- benign chronic recurring inflammatory condition of unclear etiology
- 1st and 2nd decades
- F>M
clinical presentation:
- well demarcated erythema due to atrophy of filiform papillae
- surrounded by white, slightly elevated scalloped border
- pattern changes
- located most commonly on anterior 2/3 of dorsal tongue, but can also be on labial/buccal mucosa/ FOM
- may be tender
mx:
- none
- avoid spicy foods if it is a trigger because might feel burning sensation
notes on erythema multiforme
- blistering ulcerative mucocutaneous condition of uncertain aetiopathogenesis
- probably immune mediated
triggers
- preceding infection in 50% of cases eg HSV, mycoplasma pneumonia
- drugs (less common)
clinical presentation
- prodromal s/s 1 week before onset
- acute onset with wide spectrum
oral lesions
- erythematous patches undergo necrosis
- form large shallow ulcers with irregular borders
skin lesions
- concentric circular erythematous rings
- look like target/ bulls eye lesions
tx:
- self limiting, resolves in 2-6 weeks
- recurrence rate: 20%
- symptomatic tx: steroids
- antiviral prophylaxis
notes on neuroectodermal tumour of infancy
- rapidly growing
- can infiltrate and destroy surrounding structures eg nasal septum (is locally aggressive although benign)
- rare
- usually occurs in children 1 yo or less
- majority benign (1% malignant)
- neural crest origin
clinical presentation
- non ulcerative, smooth surface swelling
- firm, sessile
- location usually on max anterior alveolar ridge
- painless
- might look similar to congenital epulis but congenital epulis is usually pedunculated (has a stalk)
dx:
- by clinical presentation
- high vanillylmandelic acid
- histo
tx:
- surgical intervention
- recurrence rate 10-60%
