Soft Tissue Swellings

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Soft Tissue Swellings
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Parulis

• Gum Boil

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ParulisClinical Features

• A parulis (gum boil) represents a mass of
  subacutely inflamed granulation tissue at the
  opening of the intraoral sinus tract.
• It appears as a red tumescence (or yellow if pus
  filled) which occurs more frequently on the
  buccal gingiva of children and young adults. It
  is often asymptomatic.

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ParulisCause

• It is caused by inflammation arising from a
  periodontal or periapical abscess.

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Parulis Treatment

• Treatment of the periodontal or periapical
  condition generally leads to the resolution of
  the parulis occasionally surgical excision is
  required.

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Parulis Significance

• Cyclic drainage occurs until the underlying
  condition is resolved.

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Pyogenic Granuloma

• Pregnancy Tumor

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Pyogenic Granuloma

• Pyogenic ???
• Granuloma???
• Pyogenic granulomas of the gingiva frequently
  develop in pregnant women and therefore the terms
  pregnancy tumor or granuloma gravidarium are
  often used.

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Pyogenic Granuloma Clinical Features

• This common oral tumor usually appears as an
  asymptomatic, red tumescence, which may be
  secondarily ulcerated. As the lesion ages it
  becomes more collagenized and less vascular and
  thus more pink than red in color.
• It is composed of granulation tissue.
• The site predilection is the gingiva but may be
  seen anywhere in the oral cavity and, in fact,
  anywhere in the body.
• The pyogenic granuloma can exhibit rapid growth
  and many early lesions bleed easily. These
  features often create alarm in both the patient
  and dentist.

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Pyogenic Granuloma Cause

• The pyogenic granuloma is a reactive lesion to
  trauma or chronic irritation. It is neither a
  granuloma nor a neoplasm.
• The size of a pyogenic granuloma may be modified
  by hormonal changes.

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Pyogenic Granuloma Treatment

• Excision is the treatment of choice.

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Pyogenic Granuloma Significance

• If untreated a pyogenic granuloma will remain
  indefinitely although its appearance may change
  as it ages.
• Recurrence may occur if it is incompletely
  excised or if the cause is not removed.
• A reduction in size may occur if the cause alone
  is removed or after pregnancy.

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Traumatic (Irritation) Fibroma
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Traumatic (Irritation) Fibroma Clinical Features

• Traumatic fibromas appear as firm, asymptomatic
  nodules covered by epithelium unless secondarily
  traumatized.
• They usually occur along the line of occlusion in
  the lower lip or buccal mucosa they may,
  however, be found anywhere in the oral cavity.
• These lesions, which are reactive hyperplasias
  rather than true neoplasms as suggested by the
  term fibroma, are very common oral lesions.

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Traumatic (Irritation) Fibroma Cause

• It is a reactive lesion to trauma or chronic
  irritation.
• Although rare according to research studies,
  clinically similar lesions may be true neoplasms
  (fibromas).

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Traumatic (Irritation) Fibroma Treatment

• Surgical excision is the treatment of choice.

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Traumatic (Irritation) Fibroma Significance

• This lesion is a reactive one which has limited
  growth potential.
• No malignant transformation has been reported.

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Epulis Fissuratum

• Denture Injury Tumor
• Inflammatory Fibrous Hyperplasia
• Denture Epulis

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Epulis Fissuratum Clinical Features

• Tumor-like hyperplasia of fibrous connective
  tissue associated with denture flange.
• Presents as fold (s), usually two, with flange
  fitting in between.
• The lesion is usually firm and fibrous but may
  show erythema and ulceration.
• Most common on facial aspect in the anterior of
  either jaw.
• It is more common in middle-aged and older
  females
• (two-thirds to three-fourths of the cases are
  in females).

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Epulis Fissuratum Cause

• Chronic irritation or trauma from denture flange
  making the lesion a reactive hyperplasia.
• The denture is typically ill-fitting.

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Epulis Fissuratum Treatment

• Treatment consists of surgical removal of excess
  tissue with microscopic examination and.
• The poorly fitting denture should be remade or
  relined.

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Epulis Fissuratum Significance

• Lesion will recur (or remain) if ill-fitting
  denture is not remade or relined.

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Papillary Hyperplasia

• Inflammatory Papillary Hyperplasia
• Palatal Papillomatosis
• Denture Papillomatosis

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(Inflammatory) Papillary Hyperplasia Clinical
Features

• Papillary hyperplasia is a reactive tissue growth
  that usually, but not always, develops beneath a
  denture.
• It typically appears as a painless,
  papillomatous, cobblestone lesion of hard
  palate although occasionally it occurs on the
  edentulous mandibular ridge or in association
  with epulis fissuratum.
• The lesion is usually asymptomatic and red
  because of inflammation.
• It is a common lesion in denture wearers.

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Papillary Hyperplasia Cause

• Soft tissue reaction to ill-fitting denture and
  probable fungal overgrowth.
• Patients generally have poor oral/denture
  hygiene.
• One study indicated approximately 20 of the
  patients wore their dentures 24 hours per day.

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Papillary Hyperplasia Treatment

• In cases of very early inflammatory papillary
  hyperplasia, removal of the denture may allow the
  erythema and edema to subside and the tissues may
  resume a more normal appearance.
• Lesions may show some improvement after topical
  or systemic antifungal therapy.
• For advanced cases, excision of the lesion is
  treatment of choice prior to the fabrication of a
  new denture.
• Partial and full-thickness surgical blade
  excision, curettage, electrosurgery and
  cryrosurgery have all been used with success in
  particular cases.

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Papillary Hyperplasia Significance

• The lesion is not premalignant.
• Following surgery the old denture can be lined
  with a temporary tissue conditioner that acts as
  a dressing and promotes healing.
• After healing, the patient should be encouraged
  to leave the new denture out at night and to
  practice good denture hygiene.

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Peripheral Giant Cell Granuloma

• Giant Cell Epulis

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Peripheral Giant Cell Granuloma Clinical
Features

• Appears as an asymptomatic red tumescence of the
  gingiva composed of fibroblasts and
  multinucleated giant cells.
• It is most commonly discovered in adult patients
  in the former areas of the primary teeth.
• As the term peripheral indicates, it is a soft
  tissue lesion overlying the bone however PGCGs
  may produce a cupping radiolucency of the bone
  superficially particularly in edentulous areas of
  the jaw.
• Unlike the pyogenic granuloma, which PGCGs
  resemble, this is an uncommon lesion.

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Peripheral Giant Cell Granuloma Cause

• This is a reactive lesion associated with chronic
  trauma or irritation.

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Peripheral Giant Cell Granuloma Treatment

• Excision is the treatment of choice down to the
  underlying bone.
• Adjacent teeth should be carefully scaled to
  remove any source of irritation thus minimizing
  the risk of recurrence.

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Peripheral Giant Cell GranulomaSignificance

• These lesions will remain indefinitely if not
  treated.
• Remember, it is a reactive lesion similar in
  clinical appearance to the pyogenic granuloma.

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Peripheral Ossifying Fibroma

• Ossifying Fibroid Epulis
• Peripheral Fibroma with Calcification
• Calcifying Fibroblastic Granuloma

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Peripheral Ossifying Fibroma (POF)

• The POF is a common reactive gingival growth.
• Its pathogenesis is best describe as uncertain
  some POFs have been suggested to develop from
  pyogenic granulomas.
• It should be noted that POFs are not the same as
  peripheral odontogenic fibromas and they are not
  the soft tissue counterpart of the central
  ossifying fibroma.

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Peripheral Ossifying Fibroma (POF) Clinical
Features

• This lesion occurs exclusively on the gingiva.
• It appears as a nodular mass usually arising from
  the interdental papilla area.
• It is red to pink in color and the surface is
  often ulcerated.
• POFs are more common in young adults and females.
• There is a slight predilection for the maxilla
  and the anterior region of the jaws.

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Peripheral Ossifying Fibroma Treatment and
Prognosis

• The treatment of choice is local surgical
  excision down to the periosteum to prevent
  recurrence.
• The adjacent teeth should be scaled to eliminate
  irritants such as calculus.
• A recurrence rate of 16 has been reported in
  the literature.

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Hemangioma and Vascular Malformations
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Hemangioma and Vascular Malformations

• The term hemangioma has traditionally been used
  to describe a variety of developmental vascular
  anomalies.
• Currently, hemangiomas are considered to be
  benign tumors of infancy that are characterized
  by a rapid growth phase with endothelial cell
  proliferation, followed by a gradual involution.
  Most cannot be recognized at birth but make their
  appearance in most instances during the first 8
  weeks of life.
• Vascular malformations are structural anomalies
  of blood vessels without endothelial
  proliferation and are present at birth and
  persist throughout life.

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Hemangioma

• Hemangiomas are the most common tumors of
  infancy.
• They have a female gender predilection (31) and
  are most common in the White population.
• 60 of the hemangiomas occur in the head and neck
  region with 80 of them occurring as single
  lesions. Multiple lesions may be part of a
  syndrome.
• About 50 of all hemangiomas will show complete
  resolution by 5 years of age.

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Vascular Malformations

• These lesions are present from birth and persist
  throughout life.
• As with hemangiomas, these lesions tend to darken
  with age.
• Low-flow venous malformations typically have a
  blue color and are easily compressible.
• Arteriovenous malformations are high-flow lesions
  that result from persistent direct arterial and
  venous communications. A palpable thrill or
  bruit is often noticeable and the overlying skin
  typically feels warmer to the touch.

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Hemangioma and Vascular Malformations

• Because most hemangiomas undergo involution,
  management often consists of watchful neglect.
  For problematic hemangiomas, surgical resection
  or pharmacologic therapy may be indicated
  (systemic steroids or interferon-a-2a).
  Flashlamp-pulsed dye lasers can be effective in
  treating port wine stains.
• Management of vascular malformations depends on
  their size, location and associated
  complications. Sclerotherapy and surgical
  excision are the mainstays.
• Treatment of arteriovenous malformations is more
  challenging and may involve surgical resection or
  embolization.
• Central vascular malformations of the jaws are
  potentially dangerous lesions because of severe
  bleeding. Needle aspiration of any undiagnosed
  intrabony lesion before biopsy is a wise
  precaution to rule out these lesions.

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Sturge-Weber Angiomatosis

• Encephalotrigeminal Angiomatosis
• Sturge-Weber Syndrome

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Sturge-Weber Angiomatosis

• This is a rare, non-hereditary developmental
  condition that is characterized by a
  harmartomatous vascular proliferation involving
  the tissue of the brain and face.

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Sturge-Weber Angiomatosis Clinical Features

• Patients are born with a dermal capillary
  vascular malformation of the face known as port
  wine stain or nevus flammeus because of its deep
  purple color. The port wine stain is usually
  unilateral. It should be noted that not all
  patients with port wine stain have Sturge-Weber.
  Only patients with involvement of the ophthalmic
  branch of the trigeminal nerve were at risk for
  the full condition.

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Sturge-Weber Angiomatosis Clinical Features
Continued

• In addition to the port wine stain, affected
  individuals also have leptomeningeal angiomas
  that overlie the ipsilateral cerebral cortex.
  These angiomas are often associated with a
  convulsive disorder and may result in mental
  retardation or contralateral hemiplegia.
• Skull radiographs may demonstrate tranline
  calcifications on the affected side.
• Ocular involvement includes glaucoma and
  vascular malformations.
• Intraoral involvement is common and manifests
  itself as vascular involvement of the affected
  tissue.

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Sturge-Weber Angiomatosis Treatment and
Prognosis

• Treatment and prognosis depends upon the severity
  of the case.
• Port wine nevi have been removed by laser.
• Symptomatic leptomeningeal lesions are
  neurosurgical cases.
• Laser therapy has also been used for intraoral
  lesions one should beware of surgery in the
  affected areas because of the possibility of
  severe hemorrhage.

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Lymphangioma
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Lymphangioma

• Lymphangiomas are benign, hamartomatous tumors of
  lymphatic vessels.
• There are three types of lymphangiomas
• 1) lymphangioma simplex (capillary size vessels)
• 2) cavernous lymphangioma (larger vessels)
• 3) cystic lymphangioma (cystic hygroma) with
  large macroscopic cystic spaces
• Lymphangiomas have a predilection for the head
  and neck with about half of all lesions present
  at birth.

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Lymphangioma Clinical Features

• Oral lymphangiomas occur most frequent on the
  anterior 2/3 of the tongue where they may produce
  macroglossia.
• They appear as a spongy, diffuse, painless mass
  which usually has a pebbly surface. Their
  appearance is one of a cluster of translucent
  vesicles having a red-blue hue.
• Small lymphangiomas may appear on the alveolar
  ridges of neonates and are more common in
  African-Americans. These often occur
  bilaterally, have a male gender predilection and
  spontaneously resolve.

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Lymphangioma Treatment and Prognosis

• Treatment usually consists of surgical excision
  although total removal may not be possible in all
  cases.
• Lymphangiomas generally do not respond to
  sclerosing agents although recent studies
  indicate some success with OK-432.
• The prognosis is good for most patients although
  large tumors (cystic hygromas) may cause airway
  obstruction.

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Giant Cell Fibroma
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Giant Cell Fibroma Clinical Features

• Giant cell fibromas usually present as
  asymptomatic, sessile or pedunculated nodules
  less than one centimeter in size.
• While they may have a smooth surface, they often
  have a papillary surface.
• Sixty percent are diagnosed during the first
  three decades with a slight female gender
  predilection.
• Fifty percent occur on the gingiva and the
  mandible is more commonly site of this lesion
  (21).

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Giant Cell Fibroma Histological Features

• The mass is composed of vascular, loosely
  arranged fibrous connective tissue.
• The hallmark of the lesion is the presence of
  large, stellate fibroblasts, which may contain
  several nuclei, within the fibrous connective
  tissue.
• The covering epithelium is often thin and atropic
  and the rete ridges may be elongated and narrow.
• Lesions with a similar histological appearance
  found on the lingual mandibular gingiva in the
  region of the mandibular canine, have been called
  retrocuspid papillae.

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Giant Cell Fibroma Treatment and Prognosis

• Treatment consists of conservative surgical
  excision.
• If properly excised, the lesion rarely recurs.

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Fibromatosis and Myofibromatosis
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Fibromatosis and Myofibromatosis Introduction

• Fibromatoses are a broad group of fibrous
  proliferations with a biological behavior ranging
  from benign to malignant.
• Myofibromatosis is a similar but less aggressive
  proliferation of myofibroblasts.

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Fibromatosis and Myofibromatosis Clinical
Features

• Fibromatosis presents as a firm, painless mass,
  which may grow rapidly or slowly.
• Fibromatosis is more common in children and young
  adults with a mean age between 8 and 11 years.
• The site predilection for fibromatosis is the
  paramandibular soft tissues.
• These lesions can grow to a large size and can
  destroy bone.

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Fibromatosis and Myofibromatosis Clinical
Features Continued

• Myofibromatosis is seen most commonly in neonates
  and infants.
• It commonly arises as a firm mass in the dermis
  or subcutaneous tissues of the head and neck.
• Cases of intraosseous myofibromatosis have been
  reported.
• While these lesions are usually solitary,
  multiple lesions in the same patient have been
  reported.

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Fibromatosis and Myofibromatosis Treatment and
Prognosis

• Fibromatosis is treated by wide surgical excision
  because these lesions are typically locally
  aggressive.
• Oral/paraoral fibromatosis has approximately a 23
  recurrence rate.
• Myofibromatosis can be treated by local excision
  cases of spontaneous regression have been
  reported.
• Multicentric lesions of myofibromatosis have a
  less favorable outcome.

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Fibromatosis
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Myofibroma
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Fibrous Histiocytoma

• Dermatofibroma
• Sclerosing Hemangioma
• Fibroxanthoma
• Nodular Subepidermal Fibrosis

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Fibrous Histiocytoma

• Fibrous histiocytomas are a diverse group of
  tumors that exhibit both fibroblastic and
  histocytic differentation.
• They can occur anywhere in the body but those of
  the skin are most common and in this location are
  called dermatofibromas.
• They are uncommon in the oral/perioral region,
  with the buccal mucosa being the most common
  intraoral site.

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Fibrous Histiocytoma

• Most oral tumors are seen in middle-age and older
  adults.
• They typically appear as painless nodular masses
  and can range in size, with the deep tumors being
  larger.
• Local surgical excision is the treatment of
  choice and recurrence is uncommon.

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Fibrous Histiocytoma
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Fibrous Histiocytoma
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Lipoma
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Lipoma Clinical Features and Cause

• Clinical Features Lipomas appear as
  asymptomatic, slow-growing, well-circumscribed,
  yellow to yellow-white benign neoplasms of fat.
• While common elsewhere in the body, lipomas are
  uncommon intraorally.
• The cause of lipomas is unknown.

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Lipoma Treatment and Prognosis

• Excision is the treatment of choice for the oral
  lipoma.
• Oral lipomas seem to have a limited growth
  potential and recurrence is not expected after
  removal.

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Traumatic Neuroma

• Amputation Neuroma

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Traumatic Neuroma(Amputation Neuroma)

• This lesion is a reactive proliferation of neural
  tissue following transection or damage to the
  nerve bundle.

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Traumatic Neuroma Clinical Features

• These lesions generally present as smooth,
  non-ulcerated nodules.
• Predilection sites include mental foramen,
  tongue and lip.
• There is often a history of trauma.
• They may produce a RL defect if bone is involved.

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Traumatic Neuroma Clinical Features Continued

• They may occur at any age but most cases occur in
  middle-aged adults and there is a slight female
  gender predilection.
• Only 25-33 are reported to be painful. If
  painful, the pain can be constant or intermittent
  and mild to severe.
• Lesions involving the mental foramen are most
  often painful especially if there is contact by a
  denture.

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Traumatic Neuroma Histological Features

• Presents as a haphazard proliferation of mature,
  myelinated nerve bundles within a fibrous
  connective tissue stoma.
• The lesion may have an associated chronic
  inflammatory cell infiltrate.

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Traumatic Neuroma Treatment and Prognosis

• Surgical excision is the treatment of choice with
  the excision to include a small portion of the
  involved nerve bundle.
• Most lesions do not recur.

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Traumatic Neuroma
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Palisaded Encapsulated Neuroma
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Palisaded Encapsulated Neuroma Clinical Features

• The etiology of this lesion is unknown but trauma
  has been suggested as a cause.
• The lesion usually appears as a solitary, smooth,
  painless, dome-shaped papule or nodule.
• It occurs more commonly in adults and there is no
  gender predilection.
• Common sites include the face, palate and lip.

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Palisaded Encapsulated Neuroma Histological
Features

• As the name suggests the lesion is typically
  well-circumscribed and often encapsulated.
• The tumor consists of interlacing fascicles of
  spindle cells, which are probably Schwann cells.
• The nuclei are wavy and pointed.
• While there is palisading there are no Verocay
  bodies of Antoni A tissue.

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Palisaded Encapsulated Neuroma Treatment and
Prognosis

• Treatment consists of conservative local excision
  and recurrence is rare.
• This lesions is not associated with
  neurofibromatosis, multiple endocrine neoplasia
  syndrome and it does not undergo malignant change.

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Palisaded Encapsulated Neuroma
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PEN VS Schwannoma
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Neurilemoma

• Schwannoma

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Neurilemoma (Schwannoma)

• This lesion is a benign neural neoplasm of
  Schwann cell origin.
• It is a relatively uncommon lesion, although
  25-48 of all cases occur in the head and neck
  region.

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Neurilemoma Clinical Features

• The neurilemoma is a slow-growing, encapsulated
  tumor associated with the nerve trunk.
• It is usually asymptomatic but pain may occur.
• Most lesions occur in young to middle-aged
  adults.
• The tongue is the most common oral site. The
  lesion may occur in bone where it may cause
  expansion, radiolucency, pain or paresthesia.

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Neurilemoma Histological Features

• The neurilemoma is an encapsulated tumor composed
  of varying amounts of Antoni A and Antoni B
  tissue.
• Antoni A tissue appears as streaming fascicles of
  spindle-shaped Schwann cells. These cells often
  form a palisaded arrangement around an acellular
  eosinophilic area known as a Verocay body.

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Neurilemoma Histological Features Continued

• Verocay bodies represent reduplicated basement
  membrane and cytoplasmic processes.
• Antoni B tissue is less cellular and less well
  organized.
• Neurites can not be demonstrated within the mass.
• Ancient neurilemomas

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Neurilemoma Treatment and Prognosis

• Surgical excision is the treatment of choice and
  the lesion should not recur.
• Extremely rare malignant transformation.

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Neurofibroma/Neuro-fibromatosis
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Neurofibroma/Neuro-fibromatosis Clinical
Features

• These lesions are soft, single or multiple,
  asymptomatic nodules covered by epithelium.
• Intraorally, they may appear as the same color as
  or lighter in color than the surrounding mucosa.
• Most frequently they are found on the tongue,
  buccal mucosa and vestibule but may occur
  anywhere.
• They may occur at any age and there is no gender
  predilection.

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Neurofibroma/NeurofibromatosisCause

• Unknown for the solitary neurofibromas while
  neurofibromatosis is an autosomal dominant
  disease entity.
• Approximately 50 of cases of neurofibromatosis
  present no family history and are considered the
  result of spontaneous mutation.
• Neurofibromatosis is associated with NF1 and NF2
  genes.

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Neurofibroma/NeurofibromatosisTreatment and
Prognosis

• The treatment of solitary neurofibromas is
  excision and recurrence is not expected.
• Multiple neurofibromas should suggest
  neurofibromatosis (von Recklinghausen disease),
  which consists of multiple neurofibromas with
  malignant potential, cafè au lait spots, optic
  gliomas, Lisch nodules (iris hamartomas) and bony
  lesions as outlined in the next slide.

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Box 12-1 Diagnostic Criteria for
Neurofibromatosis Type I

• The diagnostic criteria are met if a patient has
  two or more of the following features
• 1. Six or more café au lait macules over 5 mm in
  greatest diameter in prepubertal persons and
  over 15 mm in greatest diameter in postpubertal
  persons
• 2. Two or more neurofibromas of any type or one
  plexiform neurofibroma
• 3. Freckling in the axillary or inguinal regions
• 4. Optic glioma
• 5. Two or more Lisch nodules (iris hamartomas)
• 6. A distinctive osseous lesion such as sphenoid
  dysplasia or thinning of long bone cortex with
  or without pseudoarthrosis
• 7. A first-degree relative (parent, sibling, or
  offspring) with neurofibromatosis type I, based
  on the above criteria

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Multiple Endocrine Neoplasia Type 2B (MEN Type 2B
or III)

• Multiple Endocrine Neoplasia Type III
• Multiple Mucosal Neuroma Syndrome

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MEN 2B Clinical Features

• Multiple neuromas may be associated with this
  syndrome and are more common on the lips, tongue
  and buccal mucosa. These neuromas are usually the
  first sign of the condition.
• The oral neuromas present as soft, painless
  papules or nodules.
• Patients usually have a marfanoid body build,
  characterized by thin, elongated limbs with
  muscle wasting. While the face is typically
  narrow, the lips are usually thick because of the
  proliferation of nerve bundles. Of greatest
  significance is the development of medullary
  carcinoma of the thyroid. These patients may
  also develop a pheochromocytoma and an associated
  hypertensive problem.

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MEN 2B Cause and Treatment

• The exact cause of MEN 2B is unknown although it
  has an autosomal dominant pattern of inheritance.
• While the oral neuromas may be excised, treatment
  focuses on the prevention of the medullary
  carcinoma of the thyroid and the observation of
  the patient for the development of the
  pheochromocytoma and its accompanying
  hypertension.

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MEN 2B Significance

• Given the serious nature of the medullary thyroid
  carcinoma, some investigators advocate
  prophylactic removal of the thyroid gland at an
  early age as the cancer is almost certain to
  occur.
• The hypertension associated with the development
  of a pheochromocytoma may be life-threatening.

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Mucosal Neuroma of MEN III
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Neural Tumors Comparative Features
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Granular Cell Tumor
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Granular Cell Tumor Clinical Features

• These lesion typically appear as painless,
  elevated tumescences covered by an intact
  epithelium.
• Their color may be the same as or lighter than
  the surrounding tissue.
• There is a strong predilection for the dorsum of
  the tongue but may be found anywhere.
• Granular cell tumors are rare in children and
  there is a 21 female gender predilection.

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Granular Cell Tumor

• The cause of the granular cell tumor is unknown
  and the cell of origin is undetermined.
• Originally, it was considered to be of skeletal
  muscle origin but current research suggests
  origin from Schwann cells or neuorendocrine
  cells.
• Treatment consists of surgical excision and the
  lesion does not recur.
• The lesion must be differentiated from other
  lesions of the tongue particularly squamous cell
  carcinoma as a superficial biopsy of a granular
  cell tumor with PEH may be confused with this
  cancer.

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Congenital Epulis

• Congenital Epulis of the Newborn
• Congenital Granular Cell Lesion

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Congenital Epulis Clinical Features and Cause

• The congenital epulis generally appears as a firm
  pedunculated or sessile mass attached to the
  gingiva of infants.
• It may be the same color as or lighter than the
  surrounding tissue.
• The cause of the congenital epulis is unknown.

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Congenital Epulis Treatment and Prognosis

• Surgical excision is the treatment of choice.
  Some lesions undergo spontaneous regression.
• The lesion is not expected to recur.

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Osseous and Cartilaginous Choristomas
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Osseous and Cartilaginous Choristomas

• A choristoma is a tumor-like growth of
  microscopically normal tissue in an abnormal
  location.
• Choristomas of the mouth have included gastric
  mucosa, glial tissue and masses of sebaceous
  glands.
• The most frequently observed choristomas of the
  oral cavity are those composed of bone or
  cartilage or both.

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Osseous and Cartilaginous Choristomas Clinical
Features

• These lesions have a marked predilection for the
  tongue (approximately 85 of the cases).
• Most occur near the foramen cecum.
• These choristomas usually present as firm,
  smooth, sessile or pedunculated nodules.
• Occasionally patients will complain of gagging or
  dysphagia.
• More than 70 of these choristomas have been
  reported in women.

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Osseous and Cartilaginous ChoristomasTreatment
Prognosis

• Local surgical excision is the treatment of
  choice.
• Recurrence has not been reported.

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Soft Tissue Sarcomas

• Soft tissue sarcomas are rare malignant tumors of
  the oral and maxillofacial region accounting for
  less than 1 of the cancers in this area.

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Fibrosarcoma

• Fibrosarcomas are malignant tumors of
  fibroblasts.
• They were once considered the most common soft
  tissue sarcoma but are considered uncommon today
  (and only 10 of them occur in the head and neck
  region).

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Fibrosarcoma Clinical Features

• Fibrosarcomas most often present as slow-growing
  masses which may reach considerable size before
  producing pain.
• They can occur anywhere in the oral region. A
  number of cases have been reported in the nose
  and paranasal sinuses where obstructive symptoms
  are the chief complaint.
• They can occur at any age but are more common in
  children and young adults.

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Fibrosarcoma Treatment and Prognosis

• Surgical excision with wide margins is the
  treatment of choice.
• The 5-year survival rates range from 40-70 .

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Malignant Fibrous Histiocytoma

• This sarcoma, which has both fibroblastic and
  histiocytic features, is now considered to be the
  most common soft tissue sarcoma in adults.

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Malignant Fibrous Histiocytoma Clinical Features

• This is primarily a tumor of older age groups.
• The most common complaint is an expanding mass
  that may or may not be ulcerated or painful.
• Tumors of the nasal cavity or paranasal sinuses
  usually produce obstructive symptoms.

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Malignant Fibrous Histiocytoma Treatment and
Prognosis

• This is an aggressive tumor that typically
  requires radical surgical resection.
• Approximately 40 of patients have local
  recurrences with a similar number developing
  metastases within 2 years of initial diagnosis.
• The survival rate for patients with oral tumors
  seems to be worse that for those with the tumor
  at other body sites.

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Metastases to the Oral Soft Tissues

• This is an uncommon but very serious event.
• Most common site is the gingiva followed by the
  tongue.
• Lesions usually present as nodular masses often
  resembling hyperplastic or reactive growths.
• Occasional lesions show ulceration and the
  adjacent teeth may become loose.

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Metastases to the Oral Soft Tissues

• This occurs more commonly in middle-aged and
  older adults.
• There is a male gender predilection.
• In males, the most common sites of the primary
  tumors are the lung, kidney and skin (melanoma).
  Prostate cancer has an affinity for bone rather
  than soft tissue.

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Metastases to the Oral Soft Tissues

• In females, the most common sites for the primary
  tumors are the breast, genital organs, lung,
  bone and kidney.
• In most cases the primary tumor is know before
  the oral metastases are discovered indicating we
  need a good medical history.
• The metastases should resemble the primary tumor
  microscopically and this has been helpful in
  detecting undiscovered tumors.
• Prognosis is generally poor. The management of
  the oral lesion is usually only palliative.

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