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Questions and Answers
What is the primary characteristic of white sponge nevus?
Which biopsy method is recommended for suspected malignancies in children?
What is the most common location for orally lymphoepithelial cysts?
What is the gold standard for diagnosing oral lesions that persist?
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What clinical feature differentiates sialolithiasis from oral lymphoepithelial cysts?
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Which gene mutation is associated with white sponge nevus?
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What is the usual management for a persistent lesion of white sponge nevus?
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What is a common cause of oral burns?
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Which treatment is commonly recommended for median rhomboid glossitis?
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Erythema migrans is also known by which term?
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Which statement is true regarding eruption cysts?
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What appearance is typical of geographic tongue?
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What is a well-known characteristic of oral melanotic macules?
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What might individuals with median rhomboid glossitis experience?
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What is a possible treatment for symptomatic erythema migrans?
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What is the prevalence of erythema migrans in the population?
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What is the most common location for oral melanotic macules?
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Which of the following conditions might multiple oral melanotic macules indicate?
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What is a characteristic feature of a mucocele?
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In which location is a ranula most commonly found?
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What is the recommended treatment for a large melanocytic nevus?
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What can happen to superficial mucoceles spontaneously?
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What type of ranula extends into the neck?
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Which procedure is indicated to manage the risk of recurrence in mucoceles?
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How is an oral melanotic macule typically diagnosed?
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Study Notes
Oral Lesions in Children and Adolescents
- Oral lesions in children and adolescents can affect soft and hard tissues in the oral maxillofacial region.
- Majority of lesions are mucosal conditions, developmental anomalies, or reactive/inflammatory lesions.
- Vigilance during clinical examinations is crucial.
Diagnosing a Lesion
- Requires a thorough patient history, risk assessment, and appropriate clinical documentation.
- Rank order lesions with similar characteristics from most to least likely diagnosis.
- The most likely disease becomes the working diagnosis and guides initial management.
- Definitive diagnosis often requires a biopsy, the gold standard diagnostic test.
- Soft tissue biopsy recommended if a lesion persists for over two weeks despite treatment or if the differential diagnosis includes significant disease/neoplasm.
Types of Biopsies
- Excisional biopsy: Total removal of small lesions ( < 3 years).
- Incisional biopsy: For suspected malignancies.
White Sponge Nevus
- Symmetrical, white, irregular, diffuse plaques that are thickened, velvety, and sponge-like.
- Autosomal dominant, caused by mutations in the KRT4 or KRT13 gene.
- Primarily found on the buccal mucosa & ventral tongue (although it can also be found in other parts of the body, e.g., nose, esophagus).
- Does not disappear when tissue is stretched.
- Promote good oral hygiene, as folds of extra tissue can promote bacterial growth & infection.
- No treatment; condition usually persists into adulthood.
Oral Lymphoeepithelial Cyst
- Rare, well-circumscribed white/yellow developmental cyst, not tender.
- Common Locations: ventral surface and lateral borders of the tongue, floor of the mouth.
- Typically asymptomatic, can mimic an abscess or sialolithiasis; can cause pain if causing partial obstruction of Wharton's duct.
- Treatment: Conservative surgical excision if diagnosis is uncertain or if symptomatic.
- Small, characteristic lesions may be monitored without surgical intervention.
Sialolithiasis
- Aka salivary gland stones.
- Hard, white-pinkish solitary lesion, composed of calcium salt deposits in a salivary duct.
- Most commonly affects the submandibular gland, causing Wharton's duct blockage.
- Can cause episodic pain and swelling during eating.
- Can be identified on panoramic or occlusal radiographs.
- Treatment: Salivary stimulants, or surgical removal.
- Recurrence is possible.
Oral Burns
- Over 90% of oral burns are thermal burns (super-heated solids or liquids).
- Chemical burns also cause painful lesions.
- Tissue may appear necrotic and irregular.
- Treatment: Depends on severity; palliative in most cases.
Median Rhomboid Glossitis
- Smooth, red, flat or raised nodular area on the posterior dorsal midline of the tongue, about 2-3 centimeters long.
- Affected area lacks the normal coating of filiform papilla.
- Usually asymptomatic, often first noticed during a routine dental examination.
- Some patients may experience a burning sensation when eating certain foods.
- Thought to represent a chronic candidiasis in the affected area of the tongue.
- Treatment: Antifungal agents.
- Good oral hygiene.
Erythema Migrans
- AKA geographic tongue or benign migratory glossitis.
- Appearance: Affected tongues have red areas of varying sizes. These areas are typically surrounded by an irregular white border. The appearance is due to the loss of papilla in certain areas.
- Causes: Exact cause is unknown. Proposed factors: stress, allergies, diabetes, hormonal disturbances (no conclusive associations).
- Prevalence: 1-2.5% of the population. Can occur at any age.
- Characteristics: Varies in color, shape, and size. Multiple affected areas are common. Lesions may disappear for a time and then reappear. Commonly occurs with fissured tongue.
- Treatment: None, if asymptomatic. If symptomatic or tender, topical steroids may be prescribed. Advise refraining from spicy/ acidic food.
Eruption Cyst
- AKA eruption hematoma.
- Asymptomatic soft tissue cyst resulting from the separation of the dental follicle from the crown of an erupting tooth.
- Fluid accumulates in the follicular space created by this separation.
- Color ranges from normal to blue-black or brown, depending on the amount of blood in the cystic fluid.
- Treatment: Typically, no treatment is necessary as the tooth erupts through the lesion. If the cyst does not rupture spontaneously or becomes infected, surgical opening of the cyst roof may be required.
Oral Melanotic Macule
- A benign pigmented condition of the mouth.
- Appears as a flat, brown-to-black patch less than a third of an inch in size.
- Resembles a large "freckle" inside the mouth. Unlike freckles, sun exposure does not darken oral melanotic macules.
- Most commonly located on the lips but can also appear on the gums, roof of the mouth, and inside cheeks.
- Diagnosis: Typically diagnosed based on appearance. A biopsy may be needed if the lesion is very large, changes in size, shape, or color, or becomes raised. Laboratory tests may be performed to rule out systemic conditions if multiple macules are present. Multiple oral melanotic macules may indicate more serious conditions such as Addison's disease or Peutz-Jeghers syndrome.
- Treatment: No treatment is necessary. Lesions on the lip may be removed if their appearance is a concern.
Melanocytic Nevus
- Rare lesions derived from nevus cells in the oral mucosa, causing focal hyperpigmentation.
- The most common sites of occurrence are the hard palate, buccal mucosa, gingiva.
- Clinical Presentation: Usually present as small, well-circumscribed macules. They can also appear as slightly raised papules.
- Treatment: Excisional biopsy due to risk of malignant transformation.
- Note: All pigmented lesions in the oral cavity should be cautiously diagnosed and monitored.
Mucocele
- Common in children and adolescents.
- Results from the rupture of a minor salivary gland excretory duct, leading to mucin leakage into adjacent connective tissues, sometimes surrounded by a fibrous capsule.
- Appearance: Well-circumscribed bluish translucent fluctuant swelling. Firm to palpation. Deeper or long-standing lesions may range from normal color to a whitish keratinized surface.
- Common Locations: Most frequently observed on the lower lip, usually lateral to the midline. Can also be found on the buccal mucosa, ventral surface of the tongue, retromolar region, and floor of the mouth (ranula).
- Treatment: Most lesions require treatment to minimize the risk of recurrence. Superficial mucoceles may burst spontaneously, leaving shallow ulcers that heal within a few days.
Ranula
- A fluid-filled cyst (mucocele) under the tongue, formed by saliva leakage from a damaged salivary gland.
- Smooth, translucent red/blue swelling.
- Fluctuates in size, mildly tender.
- Periodic drainage, may elevate the tongue.
- Causes: Trauma to sublingual or submandibular salivary glands. Mucous retention.
- Types: Simple Ranula: Stays under the tongue. Plunging Ranula: Extends into the neck.
- Treatment: Surgical excision. Marsupialization (may recur).
Irritation Fibroma
- Benign reactive lesion resulting from chronic trauma/irritation to the mucosa.
- Firm, pink nodule.
- Composed of fibrous connective tissue.
- Common locations include the buccal mucosa, tongue, and attached gingiva.
- Treatment: Excisional biopsy is recommended. Lesions can recur if the source of irritation is not removed.
Parulis
- AKA Soft tissue abscess.
- Acute inflammatory lesion due to odontogenic infection (necrotic primary or permanent tooth).
- Pinkish-white solitary nodule or red nodule with erythema.
- Fluctuates in size, may be tender or painful and may have pus drainage.
- Can develop into cellulitis if not treated.
- Treatment: Eliminate the source of infection.
Squamous Papilloma
- Benign lesion caused by HPV types 1 and 6.
- Soft, painless, pink to white, pedunculated lesions.
- Surface may have multiple fingerlike projections, resembling a cauliflower.
- Mostly occurs in adulthood; 20% of cases occur before age 20.
- Vertical transmission in children; horizontal transmission in adults.
- Treatment: Thorough patient history. Surgical excision. Recurrence is uncommon.
Verruca Vulgaris (Common Wart)
- Caused by HPV type 2, 4, 6.
- Generally found on the skin of the hand.
- Can develop intraoral lesions due to autoinoculation from finger or thumb sucking.
- Malignant transformation is rare.
- Appearance: Similar to squamous papilloma. Can be sessile (broad based) or pedunculated. Displays a rough, bumpy surface. Common sites in oral cavity include lips, tip of the tongue, and labial mucosa.
- Treatment: Surgical excision. Low recurrence.
Pyogenic Granuloma
- Reactive inflammatory lesion arising from fibrous connective tissue in response to irritation or hormonal changes.
- Smooth to irregular, ulcerated, soft to firm.
- Pedunculated or sessile nodule.
- Usually ulcerated and bleeds easily.
- Can occur at any age; more common in females.
- Causes: Tissue response to local irritation or trauma. Hormonal changes, especially during pregnancy.
- Common Locations: Attached gingiva (maxillary/mandibular anterior labial). Lips, tongue, buccal mucosa.
- Treatment: Excisional biopsy. Removal of local irritant. May recur.
Localized Juvenile Spongiotic Gingival Hyperplasia
- An isolated patch of sulcular/junctional epithelium affected by local factors e.g., mouth breathing, orthodontics.
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Description
This quiz covers the identification, diagnosis, and management of oral lesions in children and adolescents. It emphasizes the importance of clinical examination, patient history, and various biopsy techniques. Test your knowledge on the types of oral lesions and the diagnostic processes involved.
