Soft Tissue Lesions Children Flashcards
Presentation of leukodema
Diffuse, filmy, white wrinkled mucosa
Bilateral
Disappears when tissue is stretched
Asymptomatic
Location and origin of bohns nodules
Junction of hard and soft palate, or vestibular region
Epithelial remnants of minor salivary glands
Location and origin of Epstein pearls
Mid palatal raphe
Epithelium entrapment between palatal shelves
Treatment for dental lamia cyst
Spontaneously resolves, treatment not needed
Location of dental lamina cyst
Crest of alveolar ridge
Describe eruption cyst
Soft Fluctuant Sessile Dome shaped Translucent swelling Overlying erupting tooth May appear blue/blue black when filled with blood
Treatment of eruption cyst
Naturally marsupialises when tooth erupts through gingiva
If symptomatic, simple removal of roof of cyst
Effects of ankyloglossia
Breast feeding difficulties
Restriction of tongue movement
Gingival recession
Controversially, affect speech and malocclusion
2 year old with ankyloglossia has trouble speaking, what should you do
Send to speech therapist
Behaviour of infantile hemangioma
Rapid endothelial cell proliferation in first 3-5 months, rapid involution follows
Infantile vs congenital hemangioma
Congenital hemangioma fully developed at birth, grows proportionally with child vs rapid growth and involution of infantile
capillary malformation over time
Growth commensurately with child
Darkens, may become nodular
Venous malformation common location
Vermillion borders, tongue, face, ears
Describe venous malformation
Non pulsatile
Grow proportionately with child
Blanch under pressure
Easily compressible
What form of lymphatic malformation more common in oral cavity
Microcytic form
Common location for microcytic lymphatic malformation
Tongue, followed by buccal mucosa
Presentation of AV malformation
Warm, pulsatile
Factors that accelerate growth of vascular malformations
Trauma, puberty, pregnancy
Clinical presentation of congenital epulis
Smooth surfaced, mucosal coloured, single, firm, round, mass
Usually on anterior maxillary alveolar ridge
Treatment of congenital epulis
Surgical excision, recurrence unlikely
Target of HSV 1 and 2
Mucoepithelial
HSV 1 - oral
HSV 2 - genital
How is primary herpetic gingivostomatitis spread
Predominantly through contact with infected saliva or active perioral lesions
Timeline of primary herpetic gingivostomatitis
5-7 days incubation —> 1-2 days prodromal (fever, malaise, headache, nausea). Prodromal signs 12-24 hours before oral lesions appear —> vesiculation —> ulceration —> symptoms reduce on the 6th day, fever fall on 3rd day —> heal in 10-14 days
Presentation of primary herpetic gingivostomatitis
Vesicles rupture to form pseudomembranous ulcers which may coalesce to form ulcer crops
Gingiva is enlarged, erythematous, painful
Ulcers on soft palate, buccal mucosa, tongue, floor of mouth, gingiva
Affect keratinised and non keratinised tissue
Management of primary herpetic gingivostomatitis
Symptomatic care — pyretic, analgesics Oral fluids to prevent dehydration Acyclovir within 72 hours of infection for severe cases/immunosuppressed patients Cool food and drinks, soft diet 0.2% chlorhexidine rinse if tolerated
Secondary HSV affects
Keratinised tissue only
What virus causes hfmd
Coxsackie a16, enterovirus 71
Presentation of hfmd
Low grade fever
Anorexia, malaise
Widespread, shallow aphthous like ulcers
Macules, papules, vesicles on extensor surfaces of hands and feet
What virus causes herpangina
Coxsackie a1-a6, a10
Clinical presentation of herpangina
HIGH grade fever
Anorexia, malaise
Widespread shallow ulcers on posterior of oral cavity eg anterior pillars, soft palate, tonsils
Resolves in 7-10 days
Which HPV strains causes oral warts and cancer
Oral warts: 6, 11, 16
Cancer:16, 18, 31
HPV vaccine covers which strains
6, 11, 16, 18
Management of superficial fungal infections
Antifungal therapy eg clotrimazole, nyastatin
OH
Wash utensils carefully after meal and store in antiseptic solution
Address underlying cause eg immunosuppression if any
Presentation of VZV
Painless vesicles that rupture to form ulcers
Fever, malaise, pharyngitis, rhinitis
Complications of VZV
Reye’s syndrome due to concomitant aspirin use in children under 12
Encephalitis
Pneumonia
EBV associated with
Infectious mononucleosis, OHL, BL, NPC, NHL
In immunosuppressed, lesions tend to be
Atypical looking
More widespread
Get systemic spread of infection
Kaposi sarcoma lesions
Brown/reddish purple macular lesions that do not blanch with pressure
Treatment of linea alba
No intervention required
Remove irritation if possible
Presentation of mucocele
Localised Compressible Fluid filled, fluctuant Smooth Translucent to blue surface May be tender
Management of mucocele
Leave alone in <5mm in child, ask child to stop biting it
> 5mm may want to do excisional biopsy
Must remove all salivary glands along line of incision if not mucocele may form again
Types of recurrent aphthous ulceration
Minor 3-10mm
Major 1-3cm
Herpetiform 1-3mm, cluster
Treatment of RAU
Symptomatic treatment
Topical steroids
Eliminate triggering events eg allergies, stress, nutritional deficiencies
Benign migratory glossitis is characterised by
Migrating well demarcated areas of erythema surrounded partially or completely by elevated white scalloped borders. Due to atrophy of filiform papillae
Benign migratory glossitis commonly located at
Anterior 2/3 of tongue
Erythema multiforme is a type what hypersensitivity rxn
III
Erythema multiforme triggered by
Preceding infection eg HSV, mycoplasma pneumoniae
Drugs
Clinical presentation of erythema multiforme
Acute onset
Self limiting
Erythematous patches become large shallow erosions ad ulceration with irregular borders
Target lesions form on skin
4Ps for fibromas/granulomas in the oral cavity
Pyogenic granuloma
Peripheral ossifying fibroma
Peripheral giant cell fibroma
Peripheral fibroma
Medication that can cause gingi cal enlargement
Cyclosporine
Phenytoin
Calcium channel blocker
Behaviour of MNET
Melanotic neuroectodermal tumour of infancy
Rapidly growing, can infiltrate and destroy adjacent structures
