Warts, polyps, epulides and vascular anomalies Flashcards
Fibrous nodules
soft tissue lesion
fibrous nodules aetiology
aetiology –> chronic minor trauma, chronic low grade infection
fibrous nodules pathology
initially inflamed fibrous tissue
once matured, dense collagenous tissue
fibrous nodules cf
well circumscribed
solid and raised
can form on mucosa close to the line of the occlusion
denture-induced
fibrous nodules presentations
- Fibroepithelial polyp
- Fibrous epulis
- Denture induced hyperplasia
fibrous nodules management
remove stimulus
excisional biopsy
Papilloma
oral lesion
Papilloma aetiology
HPV 6 and 11
transmitted from cutaneous or genital warts
Papilloma cf
painless
single/multiple
exophytic
cauliflower like appearance
Papilloma - pathology
SSE
Supported vascular CT
Keratinised
Papilloma - management
not considered to be pre malignant
excision
cryotherapy
if multiple consider potential for underlying immunodeficiency
management of skin lesion elsewhere
Pyogenic granuloma CF
Painless
Pedunculated
Red and inflamed
Commonly on gingiva
assoc with pregnancy epulis
Pyogenic granuloma aetiology
local low grade irritation
hormonal changes
trauma
Pyogenic granuloma pathology
hyperplastic lesion
dilated capillaries in loss ct stroma
mature lesions more fibrous with variable inflammation
Pyogenic granuloma management
excision
remove causative factors
pregnancy epulis : delay excision where possible until post partum
Improve oral hygiene
Giant cell granuloma
uncommon lesion
20-40 yrs
tooth bearing areas – ant mandible
2f;1m
GCG classification
central – reparative granuloma
peripheral – giant cell epulis
GCG CF
Bony swelling
Erode through cortical plate
Loosening of teeth
Purple gingival swelling
Ulceration/inflammation of overlying mucosa
CGCG Radiographic features
extent - large
quality – radiolucent, bubble appearance
margin – localised with ill defined edges
adjacent anatomy – perforate alveolar bone and extend into the mouth. may resorb/displace adjacent roots
CGCG histopathology
Multiple multinucleated giant cells
stroma of plump spindle shaped cells
highly vascular
areas of old and new haemorrhage
large cystic blood filled spaces
new bone deposits at margins
similar in appearance to brown tumour of hyperparathyroidism and aneurysmal bone cyst
CGCG management
excision of soft tissue lesion and curettage underlying bone
recurrence 15%
larger lesions – resection
corticosteroids/calcitonin/interferon alpha/bisphosphonates
may be linked to Noonan syndrome – ptpn11 gene mutation, cardiac abnormalities etc
Central v Peripheral GCG
Peripheral has local irritants for its aetiology whereas central has no known.
Central and Peripheral are both non-neoplastic.
PGCG is located on gingiva and alveolar ridge. CGCG is intra-osseous.
PGCG is a little aggressive whereas CGCG is aggressive.
PGCG is slow growth whereas CGCG is rapid.
Bone resorption occurs CGCG.
Dental involvement involved CGCG.
Treatment is surgical in both conditions.
Hyperparathyroidism
Brown’s tumour
Parathyroid hormone overproduction (mobilise calcium from skeleton/raises plasma calcium)
F>M
Elderly
Incidental finding
Xerostomia
Hyperparathyroidism: RF
Minimal bony changes
Adv cases – reduced bone density/loss of trabecular bone/loss of lamina dura/brown tumour
Brown’s tumour
Cyst like radiolucency
Uni or multilocular
Hyperparathyroidism TX
Correction of underlying lesion
Vascular malformation
seemingly disorganised vessels
vascular malformation aetiology
defects in vasculogenesis/angiogenesis
structural defect in blood vessels
congenital
present at birth but may go unnoticed
M:F
usually grows at a rate proportional to body
vascular malformation cf
raised or flat
soft - may become firm with time due to thrombus or calcification
deep red/bluish colour
size varies
blanch with pressure
affecting tongue may impact on movement
management of vascular malformation
excision
laser surgery
cryotherapy
radiation therapy
corticosteroids - topical/intralesional
vascular malformations - syndromes
Sturge Weber – Encephalotrigeminal Angiomatosis/haemangiomas of face affection trigeminal divisions
Osler rendu weber – hereditary haemorrhagic telangiectasia (HHT)
Haemangioma
similar to vascular malformation
aetiology - benign vascular tumour/abnormal endothelial cell proliferation
classification - central/capillary/cavernous/arterial
Purpura
bleeding into skin or mucous membranes
results in petechia or ecchymoses
spontaneous gingival bleeding
purpura can forma at any site of trauma
underlying platelet disorder
