CHAPTER 2: PART 3

Soft tissue abscess (parulis)

Solitary pinkish white or deep red nodule; purulence; fluctuates in size; tender to painful; may progress to cellulitis

location of Soft tissue abscess (parulis)

Gingiva and alveolar mucosa are most common sites

treatment-prognosis of Soft tissue abscess (parulis)

Manage source of infection; local debridement; usually antibiotics are not indicated; recurs if infection is not eliminated

Cellulitis

Diffuse erythematous swelling of sudden onset; soft to board-like; warm and painful tissues; fever, headache, airway obstruction, and leukocytosis may be present

location of Cellulitis

Upper or lower face and neck

treatment-prognosis of Cellulitis

Manage source of infection; antibiotic therapy; incision and drainage in severe cases

Ludwig angina and cavernous sinus thrombosis may be life threatening

Angioedema

Diffuse swelling of sudden onset; soft and nontender; may be associated with respiratory and gastrointestinal problems

location of Angioedema

Lips, tongue, soft palate and face, and other cutaneous sites

treatment-prognosis of Angioedema

Allergic forms are treated by antihistamines, steroids, or epinephrine; other drugs are used for the hereditary forms; may be life threatening

Mucocele

Fluid-filled nodule with a smooth, translucent, red or blue surface; sudden onset; fluctuates in size; tender if traumatized; periodically drains

location of Mucocele

Lower labial mucosa, buccal mucosa, and anterior ventral tongue

Treatment and Prognosis of Mucocele

Excisional biopsy with removal of underlying minor salivary glands; may recur with incomplete removal or repeated trauma

Ranula

Fluid-filled swelling with smooth, translucent to blue surface of recent onset; fluctuates in size; mildly tender; periodically drains; may elevate tongue

location of Ranula

Floor of mouth, lateral to midline; plunging variant results in diffuse swelling of the submandibular region and neck

treatment-prognosis of Ranula

Excisional biopsy of sublingual gland or marsupialization; recurrences are common with marsupialization

Irritation fibroma

Nodule with pink smooth surface; firm and nontender; limited growth potential

location of Irritation fibroma

Buccal and labial mucosa, tongue, and attached gingiva

treatment-prognosis of Irritation fibroma

Conservative excisional biopsy; may recur if irritation continues

Peripheral ossifying fibroma

Nodule with pink to red surface; frequently ulcerated; firm and nontender; may resorb alveolar bone; limited growth potential

location of Peripheral ossifying fibroma

Emanates from interdental papilla of attached gingiva; most common site is anterior region

treatment-prognosis of Peripheral ossifying fibroma

Excisional biopsy down to periosteum and remove local irritation; 16% recurrence rate

Peripheral giant cell granuloma

Nodule with red or purple-blue surface; may be ulcerated; firm and nontender; resorb alveolar bone; limited growth potential

location of Peripheral giant cell granuloma

Attached gingiva or alveolar mucosa

treatment-prognosis of Peripheral giant cell granuloma

Excisional biopsy to periosteum and remove local irritation; 10%–18% recurrence rate

Pyogenic granuloma

Nodule with smooth to irregular, red surface; usually ulcerated; bleeds freely; soft and friable; nontender; limited growth potential

location of Pyogenic granuloma

Most occur on attached gingiva; other sites include lip, tongue, and buccal mucosa; also occurs on skin

treatment-prognosis of Pyogenic granuloma

Excisional biopsy and remove local irritation; recurrence rate is 3%–15%

Gingival fibromatosis

Localized or generalized gingival enlargements; pink, smooth to stippled surfaces; firm and nontender; affects both dentitions

location of Gingival fibromatosis

Attached gingiva and maxillary tuberosity

treatment-prognosis of Gingival fibromatosis

Gingivectomy and good oral hygiene; high recurrence rate

Hemangioma

Localized to diffuse, red, blue, or purple lesion, flat or nodular, soft and compressible; may blanch; bleeds freely; 20% are multiple

location of Hemangioma

60% occur in head and neck region; lips, tongue, and buccal mucosa are most common sites; rarely occurs in jaws

treatment-prognosis of Hemangioma

Involution of lesion within first decade; surgery for select cases and scar revision, laser ablation, corticosteroids, propranolol; does not recur

Lymphangioma (lymphatic malformation)

Localized to diffuse, translucent to red or purple swelling; smooth or pebbly surface; soft and compressible; crepitus may be palpated

location of Lymphangioma (lymphatic malformation)

Up to 75% occur in head and neck; common oral sites include the tongue, lip, and buccal mucosa

treatment-prognosis of Lymphangioma (lymphatic malformation)

Surgical excision; recurrences are common; airway obstruction and death may occur with large neck or tongue lesions

Congenital epulis

Pedunculated or sessile nodule; pink to red smooth surface; may be ulcerated; 10% are multiple

location of Congenital epulis

Anterior alveolar ridge; usually maxilla

treatment-prognosis of Congenital epulis

Surgical excision; occasional spontaneous regression; no recurrence; normal tooth development

Neurofibroma

Single or multiple nodules with smooth surface; discrete or diffuse; soft to firm on palpation; nontender

location of Neurofibroma

Tongue, buccal mucosa, and palate; rarely within mandible; syndromic lesions occur at any site, especially skin

Treatment and Prognosis of Neurofibroma

Surgical excision if solitary lesion; selective excision of syndrome type; 5% malignant transformation of syndrome type

Mucosal neuromas (multiple endocrine neoplasia syndrome, type 2B)

Multiple, pink papules and nodules; soft and nontender; marfanoid body type; narrow face with full lips

location of Mucosal neuromas (multiple endocrine neoplasia syndrome, type 2B)

Labial and buccal mucosa, anterior tongue, gingiva; also on conjunctiva and eyelid

Treatment and Prognosis of Mucosal neuromas (multiple endocrine neoplasia syndrome, type 2B)

Surgical excision of neuromas for cosmetics; aggressive thyroid cancer develops in second decade

Pleomorphic adenoma (benign mixed tumor)

Pink, dome-shaped enlargement with smooth surface; slowly growing; firm and nontender

location of Pleomorphic adenoma (benign mixed tumor)

Parotid gland is most common site; palate is most common oral site

treatment-prognosis of Pleomorphic adenoma (benign mixed tumor)

Surgical excision with adequate margins; recurrence is low; malignant transformation rate of <4%

Juvenile aggressive fibromatosis

Rapidly growing, pink, firm mass with an irregular surface; may be ulcerated; painless; large in size; facial disfigurement; destruction of adjacent bone

location of Juvenile aggressive fibromatosis

Head and neck region; paramandibular soft tissues are common intraoral sites

treatment-prognosis of Juvenile aggressive fibromatosis

Surgical excision with wide margins; adjunctive chemotherapy and radiotherapy may be indicated; high recurrence rate

Rhabdomyosarcoma

Rapidly growing, infiltrative and destructive mass; painless

location of Rhabdomyosarcoma

Head and neck region is the most common site; face, orbit, nasal cavity, maxillary sinus, palate

treatment-prognosis of Rhabdomyosarcoma

Surgical excision, multiagent chemotherapy with or without radiation therapy

Pediatric prognosis is 70% 5-year survival rate

Dentigerous cyst

Well-defined, unilocular, radiolucency around crown of unerupted tooth; may displace teeth, cause cortical expansion and root resorption; asymptomatic unless infected

location of Dentigerous cyst

Mandibular and maxillary third molar and canine regions

treatment-prognosis of Dentigerous cyst

Enucleation; marsupialization if extensive; orthodontic treatment to assist tooth eruption; seldom recur; ameloblastoma and carcinoma are rare complications

Odontogenic keratocyst (keratocystic odontogenic tumor)

Well-defined, unilocular or multilocular radiolucency with corticated margins; expansile; 25%–40% associated with unerupted tooth; may resorb and displace teeth; may be painful

locations of Odontogenic keratocyst (keratocystic odontogenic tumor)

Posterior body and ramus of mandible; maxillary third molar and canine regions

Treatment and Prognosis of Odontogenic keratocyst (keratocystic odontogenic tumor)

Surgical excision; may include peripheral ostectomy or chemical cautery; may treat by decompression of cyst; recurrence rate of 30%

Ameloblastic fibroma

Well-defined unilocular or multilocular lesion with sclerotic margins; expansile; 75% associated with unerupted tooth

location of Ameloblastic fibroma

Posterior mandible (70%)

treatment-prognosis of Ameloblastic fibroma

Surgical excision; recurrences are common (18%); long-term follow-up is recommended

Ameloblastoma

Well-defined, unilocular or multilocular radiolucency; cortical perforation; expansile; slow growing; root displacement and resorption; usually asymptomatic

location of Ameloblastoma

Mandibular molar and ramus areas

treatment-prognosis of Ameloblastoma

Aggressive odontogenic tumor requires marginal or en bloc resection; 50%–90% recurs with curettage; rarely undergoes malignant transformation

Melanotic neuroectodermal tumor of infancy

Rapidly expanding bony lesion; may exhibit blue-black pigmented surface; ill-defined, unilocular radiolucency; displacement of tooth buds; “floating tooth” appearance

location of Melanotic neuroectodermal tumor of infancy

Anterior maxilla

treatment-prognosis of Melanotic neuroectodermal tumor of infancy

Surgical excision or curettage; 20% recurrence rate; reported cases of metastasis

Central giant cell granuloma

Well-defined, unilocular or multilocular radiolucency with scalloped border; expansile; may displace teeth and cause root resorption; pain and paresthesia may be noted

location of Central giant cell granuloma

Most frequently in mandible; anterior to first molar; may cross midline

treatment-prognosis of Central giant cell granuloma

Thorough curettage; alternative treatments include intralesional corticosteroids, calcitonin, interferon, bisphosphonates; recurrence rate of 20%

Cherubism

Chubby face appearance; bilateral, symmetric, painless enlargement of jaws; extensive, multiple, well-defined, multilocular radiolucencies

location of Cherubism

Maxilla and mandible; in particular, angles of mandible; all four quadrants frequently involved

treatment-prognosis of Cherubism

Treatment is controversial; spontaneous regression with onset of puberty; surgery may improve function and cosmetics

Simple bone cyst (traumatic bone cyst)

Well to poorly delineated, unilocular radiolucency with thin, sclerotic border; scalloping between roots of teeth; 20% are expansile; teeth are vital

location of Simple bone cyst (traumatic bone cyst)

Posterior and anterior body of mandible and ramus; bilateral lesions are uncommon

treatment-prognosis of Simple bone cyst (traumatic bone cyst)

Surgical exploration and curettage; low recurrence rate of 1%–2%

Aneurysmal bone cyst

Painful swelling with rapid growth; unilocular or multilocular radiolucency with ballooning distention of buccal cortex; may be painful; tooth displacement

location of Aneurysmal bone cyst

Posterior mandibular region

treatment-prognosis of Aneurysmal bone cyst

Curettage or enucleation; hemorrhage control; 2-year recurrence rate is approximately 13%; incomplete removal is common

Periapical abscess

Nonvital, mobile tooth; soft tissue swelling with purulence; sinus tract may be present; painful; widening of periodontal ligament space or poorly defined radiolucency

location of Periapical abscess

Alveolus; primary dentition is most frequently affected in children

treatment-prognosis of Periapical abscess

Endodontic treatment or tooth extraction; antibiotics and analgesics may be needed; serious complications include cavernous sinus thrombosis and Ludwig angina

Periapical granuloma and cyst

Nonvital tooth; usually asymptomatic unless acute exacerbation of the lesion; well or poorly defined radiolucency at the root apex; loss of lamina dura; root resorption

location of Periapical granuloma and cyst

Alveolar bone adjacent to root apex and bifurcation

treatment-prognosis of Periapical granuloma and cyst

Endodontic treatment or tooth extraction and gentle curettage to avoid disturbing permanent tooth bud, if present

Acute osteomyelitis

Diffuse radiolucency with poorly defined margins; sequestra; fever, swelling, pain, lymphadenopathy, leukocytosis, and draining sinus tracts

location of Acute osteomyelitis

Posterior mandible in children; anterior maxilla in infants

treatment-prognosis of Acute osteomyelitis

Incision and drainage with culture and sensitivity testing; antibiotic coverage; may develop into chronic osteomyelitis

Langerhans cell histiocytosis (histiocytosis X)

Lymphadenopathy, rash, oral pain, gingivitis, ulcers, mobile teeth, multiple punched-out radiolucencies with “floating tooth” appearance; premature tooth loss

location of Langerhans cell histiocytosis (histiocytosis X)

Skull, mandible, ribs and vertebrae are most often involved; jaws affected in 20% of cases

treatment-prognosis of Langerhans cell histiocytosis (histiocytosis X)

Multiagent chemotherapy, low-dose radiotherapy, surgical curettage, and stem cell transplantation are used, depending on form of disease and location; children younger than 2 years have worst prognosis

Burkitt lymphoma

Lymphadenopathy, facial swelling, tenderness, tooth mobility, extrusion and premature loss; patchy loss of lamina dura, irregular radiolucencies, “floating tooth” appearance

location of Burkitt lymphoma

Posterior mandible is most common site; may involve all four quadrants; African (endemic) form affects the jaws in 50%–70% of cases

treatment-prognosis of Burkitt lymphoma

Treatment includes multiagent chemotherapy; aggressive malignancy with 5-year survival rate of 75%–95%, depending on disease stage

Calcifying odontogenic cyst (Gorlin cyst)

Well-defined, unilocular radiolucency with irregular calcifications or toothlike structures; expansile; 33% associated with unerupted teeth; asymptomatic

location of Calcifying odontogenic cyst (Gorlin cyst)

Most develop in incisor-canine region of maxilla and mandible; may occur as gingival lesion

treatment-prognosis of Calcifying odontogenic cyst (Gorlin cyst)

Enucleation; minimal risk of recurrence; rarely manifests aggressive or malignant behavior

Adenomatoid odontogenic tumor

Well-defined, unilocular radiolucency with fine snowflake calcifications; most associated with unerupted tooth (canine); root divergence; asymptomatic expansion