Oral Soft Tissue Lesions Diagnosis and Management PDF

DOPA412: ORAL PATHOLOGY 2 PRELIM LECTURED BY: DR. IDA I. BALANAG ORAL SOFT TISSUE LESIONS Vesicle...

DOPA412: ORAL PATHOLOGY 2 PRELIM LECTURED BY: DR. IDA I. BALANAG ORAL SOFT TISSUE LESIONS Vesicle - single or group elevations under DIAGNOSIS AND MANAGEMENT which you find serum, plasma or blood - less than 1cm Bulla - similar to vesicle but more than 1.0cm in size Pustule - a vesicle like lesion CLASSIFICATION OF LESIONS that contains pus Primary – congenital or those that arise as a direct result of a pathologic, traumatic or physical infliction on tissue Secondary – arise due to progressive, degenerative or reparative changes of primary lesions PRIMARY Macule - Flat circumscribe alteration of tissue that varies in size, Tumescence or Tumor color or shape - general term **any color basta flat applied to swelling Patch intraosseous – lesion is inside - Essentially also a the bone macule but larger in size Plaque Hyperplasia - An area with a flat - increase in tissue size surface and raised due to increased edges number of cells hypertrophy – tissue increases in size because of cells ELEVATED LESIONS increase in size also Papule - A raised area of tissue that may be punctate or linear - Size does not SECONDARY exceed 1.0cm Erosion - gradual loss of tissue substances that is Nodule limited to the most - Similar to a papule superficial layer of but larger and more that tissue deep seated - size is greater than 1.0cm **if ask what diagnosis – torus mand. But it appears nodule Ulcer - loss of surface tissue due to a sloughing of necrotic inflammatory tissue extending to lamina promia 1|D M D 4 Y 1 - 5 YANDOC  DOPA412: ORAL PATHOLOGY 2 PRELIM LECTURED BY: DR. IDA I. BALANAG Crust - a reparative proliferation where lost or damaged tissue is replaced by connective tissue Scar - a regenerative tissue composed of fibrous connective tissues INFLAMMATORY SOFT TISSUE LESIONS ULCERS Most common oral soft tissue lesions Etiology o Infectious o Immune related o Neoplastic **if infection u give antibiotic, if viral infection u give antiviral med, if fungal u give antifungal med TYPES OF ULCERS  Aphthous Stomatitis ▪ Aka. Aphthous ulcer, Canker sores ▪ Etiology: immune dysfunction ▪ Trigger History of lesion o Stress 1. How long has the lesion been present? o Trauma 2. Has the lesion change in size, shape or color? o Hormones a. Duration → several yrs – congenital, benign o Depressed immunity b. Changes in size → aggressive enlarging – malignant ▪ Recurring, painful, solitary or multiple Slow growing – benign ulcers c. Changes in character of feature → vesicle to ulcer – ▪ Covered by a white-to-yellow pseudomembrane and viral disease surrounded by an erythematous halo 3. Are there any local intraoral symptoms with the lesions? ▪ Involves nonkeratinizing mucosa 4. Are there any remote signs and symptoms including enlarged ▪ Three forms: lymph nodes or systemic involvement 1. Minor aphthae 5. Are there any predisposing factors 2. Major aphthae a. Parafunctional habit 3. Herpetiform aphthae b. Recent trauma c. Application of medication Minor Major aphthae Herpetiform aphthae aphthae - (+) pregnant - (+) Calcular deposits Size 0.5cm 4 or 5mm recurrence o Submit for microscopic examination Clinical feature o Small KCOT – usually asymptomatic 1. IEE- inner epithelial epithelium o Larger KCOT – may be associated with pain, swelling, or 2. IDE – inner dental epithelium drainage 3. Intermediate o Usually as a single lesion - As these 3 develop it will combine and produced o Multiple lesions are associated with Nevoid Basal Cell reduce enamel epithelium (REE) – located in follicular Carcinoma Syndrome/ Gorlin Syndrome sack o In contrast to other odontogenic cysts, KCOT has a high Differential diagnosis recurrence rate: ranging from 13% - 80% based on the o Ameloblastoma performed treatment o Adenomatoid odontogenic tumor o Most cases recur within the 5 yrs after treatment o Odontogenic keratocyst Mechanism of recurrence o Incomplete removal of the cyst lining o Growth of a new KCOT from satellite cysts **dentigerous cyst can turn into o Development of a new KCOT in an adjacent area tumor which is ameloblastoma Imaging feature o Conventional radiographic imaging such as panoramic views and intraoral periapical films, in most cases are adequate to determine the location and estimate the **3rd molar impacted size 1. Dentigerous cyst o Advance imaging techniques like computerized 2.ameloblastoma tomography and magnetic resonance imaging can be 3. OKC useful in large cases involving the maxillary sinus and the **canine impacted rare cases that extend to the skull base 1.dentigerous cyst Histologically 2. Adenomatoid odontogenic tumor - most common sa max o Epithelial ling is composed of stratified squamous 3. ameloblastoma epithelium of 6-10 cells in thickness 4. okc o Corrugated parakeratinizing surface and palisaded basal cell layer that lacks rete peg formation ERUPTION CYST o Lumen contains clear fluid or may be filled with cheesy Results from fluid accumulation within the follicular space of material an erupting tooth o Capsule wall containing satellite cysts/ daughter cyst Eruption hematoma – appearance of blood within the tissue ODONTOGENIC KERATOCYST (OKC) Named by Philipsen in 1956 A developmental cyst derived from the enamel organ or from the dental lamina GLANDULAR ODONTOGENIC CYST Reclassified as benign odontogenic tumor by the World Aka Sialo-odontogenic cyst Health Organization in 2005 Has some histologic features that Keratocystic Odontogenic Tumor suggest a mucus-producing salivary A benign uni or multicystic, intraosseous tumor of tumor (low-grade mucoepidemoid odontogenic origin, with a characteristic lining of carcinoma) parakeratinized stratified squamous epithelium and potential Location: mandible, especially anterior for aggressive, infiltrative behaviour mandible Basis of reclassification Maxillary lesions tend to be localized to the anterior segment 9|D M D 4 Y 1 - 5 YANDOC  DOPA412: ORAL PATHOLOGY 2 PRELIM LECTURED BY: DR. IDA I. BALANAG Slow growth rate, asymptomatic, jaw expansion not ▪ Radiograph: inverted pear-shaped radiolucency uncommon between vital max lateral incisor and canine Radiographically: multilocular radiolucent with well defined ▪ Associated teeth are vital and sclerotic and scalloped margins ▪ Differential diagnosis Aggressive lesions may show ill-defined peripheral border o Radicular cyst CALCIFIED ODONTOGENIC CYST (COC) o Periapical granuloma Solid variant known odontogenic ghost cell o Lateral periodontal cysts tumor that exhibit more aggressive clinical o OKC behavior o Central giant cell Characterized by ghost cell keratinization granuloma Younger than 40 yrs of age, female, maxilla o COC **Intraosseous sya but meron syang o Odontogenic myxomas extraosseous type PERIPHERAL CALCIFYING ODONTOGENIC CYST 2. Nasolabial Cyst (Purely Soft Tissue) o Extraosseous form of COC that is limited to the peripheral ▪ Aka Nasoalveolar Cyst soft tissue without bony involvement ▪ Fusion line of globular of the lateral nasal and maxillary o On the gingiva are noted in older than 50 yrs and found processes anterior to the first molar region ▪ Female ▪ Soft tissue swelling in the canine region causing elevation of side of the nose **peripheral – soft tissue location overlying a bone Unilocular or multilocular radiolucencies with discrete, well- demarcated margins Scattered, irregularly sized calcifications within the radiolucency – SALT AND PEPPER APPEARANCE ….Nasolabial cyst. Microscopic features exhibiting loose Management is more aggressive than simple curettage connective tissue surrounding a lumen line with ciliated pseudo- Recurrence is not uncommon striated columnar epithelium containing mucus (goblet) cells. Peripheral variant managed conservatively DENTAL LAMINA CYST 3. Median Mandibular Cyst Gingival cyst of the newborn ▪ Extremely rare Epstein’s pearls ▪ Asymptomatic o Nonodontogenic ▪ Seldom produces bone expansion o Cystic, keratin-filled nodules and associated teeth are vital along the midpalatine raphe ▪ Radiograph: unilocular. Well- o Derived from epithelium along circumscribe radiolucency in the the fusion line between the midline of the mandible palatal shelves and nasal processes Bohn’s nodules 4. Nasopalatine Canal Cyst o Keratin-filled cysts scattered over the palate junction of ▪ Incisive canal cyst – occurs within the the hard and soft palate nasopalatine canal GINGIVAL CYST OF THE ADULT Soft tissue swelling within or slightly inferior to the interdental papilla ▪ Cyst of the palatine papilla – occurs Slightly bluish discoloration within the palatal soft tissue at the Less than 1cm point of opening of the canal Equal gender predilection **nasopalatine canal cyst can be intraosseous Histologically: cystic lining containing focal within a canal and give radiolucency between thickening similar to lateral periodontal cyst central incisor but if its purely soft tissue u won’t see radiolucency ▪ Symmetric swelling in the anterior region of the palatal midline NONODONTOGENIC CYST ▪ Male, 3:1 ratio ▪ Radiograph: round, ovoid, or **can be divided into 2 grps heart-shaped radiolucency 1. Retention cyst – affects salivary glands between or above the roots of 2. Fissural cyst – located along fusion line maxillary central incisor FISSURAL CYST 1. Globulomaxillary Cyst ▪ Fusion of globular and maxillary process 10 | D M D 4 Y 1 - 5 YANDOC  DOPA412: ORAL PATHOLOGY 2 PRELIM LECTURED BY: DR. IDA I. BALANAG ▪ A cyst line by respiratory-type ▪ Differential diagnosis: cystic hygroma (anylisis of fluid) epithelium surrounded by a **cystic hygroma – give lymphatic fluid fibrous exhibiting a mild degree of chronic inflammation SOFT TISSUES OF THE NECK 1. Branchial cyst ▪ Due to incomplete obliteration 5. Median Palatal Cyst of the brachial cleft, arches ▪ Midline of the hard palate and pouches with remnant of ▪ Palatal swelling opposite the premolar and molar region epithelial rests undergoing ▪ Radiograph: well-circumscribed radiolucency cystic degeneration ▪ Current theory: epithelium RETENTION CYST entrapped in cervical lymph 3 major salivary glands nodes during embryogenesis 1. Parotid gland **nasa side 2. Submandibular gland 3. Sublingual gland ▪ Cervical lymphoepithelial cyst 1. Mucocele o Lateral portion of the neck, anterior to SCM, close ▪ Mucus extravasation to the mandibular angle phenomena o Submandibular area, adjacent to the parotid gland ▪ Mucus retention cyst or around the SCM ▪ If become infected – PYOCELE /MUCOPYOCELE ▪ Lymphoepithelial cyst o Intraoral counterpart ▪ Etiology: mechanical trauma to o Most common site is floor the minor salivary gland duct → of the mouth, followed by severance → pillage of mucus into surrounding the posterior lateral connective tissue tongue ▪ Pseudocyst – lined by granulation tissue o Yellowish nodule Mucus extravasation phenomena ▪ Most frequent site: lower lip ▪ May be found in buccal mucosa, ventral surface of tongue, Floor of the mouth ▪ Adolescents and children ▪ Painless, smooth surface, bluish hue or translucency …cervical lymphoepithelial cyst. A portion of the cyst wall lined Mucus retention cyst by keratinizing squamous epithelium and containing lymphoid ▪ Etiology: obstruction of salivary tissue flow usually due to a sialolith (precipitation and calcium 2. Dermoid cyst phosphate) ▪ Above the mylohyoid muscle: ▪ True cyst, Lined by an epithelium floor of the mouth ▪ Location: rarely found in lower lip ▪ Below the mylohyoid muscle: ▪ Instead, found in palate, cheek midline swelling of the neck and floor of the mouth ▪ Numerous ectodermal ▪ 50 yrs of age derivatives: teeth, nails, hair ▪ Asymptomatic swelling without history of trauma, follicles, sebaceous glands, mobile, non-tender sweat glands **lined by epithelium 2. Ranula ▪ Mucocele that occur specifically in the floor of the mouth ▪ Sublingual salivary glands ▪ Less commonly, submandibular glands ▪ Location: fluctuant, unilateral, bluish lesion (frog’s belly) ▪ Differential diagnosis: Dermoid Cyst (in midline) ▪ Mucus extravasation through the mylohyoid muscle and along the fascial planes of the neck - Plunging ranula 3. Thyroglossal tract cyst (neck area)- mucin/laway ▪ Most common developmental cyst of the neck 11 | D M D 4 Y 1 - 5 YANDOC  DOPA412: ORAL PATHOLOGY 2 PRELIM LECTURED BY: DR. IDA I. BALANAG ▪ Due to failure of complete descent of thyroid tissue from foramen caecum with subsequent cystification ▪ Midline swelling in the neck above the thyroid gland …thyroglossal tract cyst. Microscopic features reveal thyroid tissue in cyst wall PSEUDOCYSTS (don’t have epithelial lining) 1. Aneurysmal bone cyst ▪ Vascular problem ▪ Anterio-venous malformation causing significant alteration of hemodynamic forces producing an aneurysm ▪ Younger than 30 yrs old. Female ▪ Appear radiographically as cyst like lesion but microscopically exhibit no epithelial lining ▪ Involves the mandible and maxilla, more posterior regions ▪ Pain ▪ Firm, nonpulsatile swelling ▪ Bruit is not heard, indicating that blood is not located within an arterial space ▪ Firm palpation ▪ Crepitus 2. Traumatic Bone Cyst ▪ Aka solitary bone cyst (solitary – one) ▪ Trauma→ bleeding → hematoma → clot breaks down → absorbed in the circulation→ dead space ▪ Seen amon g athletes ▪ Mandible, anterior of posterior regions ▪ Radiograph: unilocular cavity o Posterior region: lesion may project upward into the interradicular septa o Anterior region: outline is regular without indentation 3. Static Bone Cyst ▪ Aka Stafne’s Idiopathic Bone Cavity ▪ Lingual depresseion in the mandible inferior to the alveolar canal ▪ Absence of symptoms ▪ Nonprogressive ▪ Radiograph: round and oval radiolucency 12 | D M D 4 Y 1 - 5 YANDOC