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Soft Tissue Enlarg. & Salivary Gland (Ch 16) - Coggle Diagram

- - - - A well-defined, firm, pedunculated or sessile, exophytic mass on the attached gingiva; usually smooth surface and covered with normal mucosa; may have a rougher or papillary surface texture; usually less than 1 cm; tendency to become traumatized so may be ulcerated; most are located in interdental papilla area
    - - A reactive lesion; try to identify source of irritation or trauma and eliminate it
    - - Not applicable
    - - Excision; no reoccurrence expected; prognosis is good if source of irritation is removed
    - - Reactive hyperplastic lesion appearing exclusively on the gingiva thought to originate from sub mucosal connective tissue or the PDL
  - - - May be generalized or localized; mild enlargement of interdental papilla or severe so as covering the coronal surfaces; hyperplasia due to hormonal changes is usually more severe; drug induced is more fibrotic
    - - Dental biofilm is associated with exacerbation; oral hygiene instruction is crucial
    - - Not applicable
    - - Stopping medication especially cyclosporine usually resolves hyperplasia; increase hygiene efforts; gingivectomy may be required if no improvement; prognosis depends on cause
    - - Caused by a number of diverse factors including exuberant response to chronic inflammation associated with biofilm or calculus, specific drugs (phenytoin, calcium channel blocker's, cyclosporine) hormone changes in puberty and pregnancy due to exaggerated response to biofilm; leukemia; inherited traits
  - - - Growths are usually nodular and exophytic; maybe pedunculated; smooth surface texture and firm consistency; about the same color or slightly lighter in color than surrounding tissueUsually found in places of frequent trauma such as tongue, buccal mucosa, and lips
    - - Most important is to determine cause of irritation or trauma and remove it; patient with dentures should be advised to seek routine dental care in the form of soft tissue examinations and oral cancer screenings; dentures do not "fit" an individual for the rest of his life; alveolar bone remodels and denture teeth were down, so evaluation routinely for fit and function is important; dentures should always be left out of the mouth for a period of time every day; a problem associated with denture induced fibrous hyperplasia is fungal infection; patient should be shown how to care for their dentures and for the soft tissues that support them
    - - Not applicable
    - - Surgical removal of the fibroma is the treatment of choice; recurrence is likely if source of trauma is not removed; prognosis is excellent if source of irritation is removed
    - - Not considered true neoplasm, rather reactive responses to chronic trauma or irritation; one specific form of this condition is called denture-induced fibrous hyperplasia sometimes called epulis fissuratum
  - - - Present clinically with varying enlargements of lymphoid tissue, may appear bulbous; have a papillary or smooth surface; in most cases are the same color or slightly lighter than surrounding tissue; may affect tonsils or lateral border of tongue mixed with foliate papilla; mostly distinguished by association of areas with lymphoid tissue
    - - Tonsil region should always be included in EOE
    - - Hyperplastic response is not transmissible but it's specific for individual host
    - - Treatment is not necessary unless tissue impedes function; prognosis is good
    - - Proliferation of lymph cells within lymph tissues; caused by infectious agents for foreign substances that invade the body
  - - - Appear as small firm nodules covered by normal mucosa; usually painful when palpated but otherwise may produce no symptoms; found most often on surfaces that are traumatized frequently such as tongue, lower lip, and alveolar ridge
    - - Avoid the area during Dental Hygiene therapy so as not to cause more pain
    - - Not applicable
    - - Surgical removal is the usual treatment; prognosis is excellent
    - - Results from chronic or acute trauma that severs nerve tissue; one common cause is injection of local anesthetics; other causes are surgical procedures such as tooth extraction
  - - - Affects any organ, but respiratory system is main target; manifestations include maculopapular rash on limbs, face, and buttocks; painful inflammation of subcutaneous adipose tissues; granulomas in liver; salivary gland enlargement, especially of parotid gland; xerostomia; other oral lesions present as firm or spongy popular or nodular growths found on gingiva, lips, pallete, buccal mucosa, or tongue
    - - Encourage patient adherence to oral hygiene; aid for xerostomia should be given
    - - Unknown if transmissible; most believe it is not
    - - Resolution is often spontaneous; intermittent exacerbations may present; topical steroids; prognosis is good
    - - Multi system inflammatory disease of unknown at etiology resulting from formation of granulomas within affected organs and tissues; evidence of genetic and environmental factors
- - - - Potentially affect any glandular tissue and body; encephalitis is rare; sex organs, testes, and ovaries can be affected if infection occurs post puberty (orchitis/oophoritis); rarely male sterility; swelling can occur around any major salivary gland but parotid is most affected; classic presentation around parotid gland includes swelling that lifts the ear lobe upward and outward; may see erythema surrounding Wharton/Stenson ducts; pain may occur around ear
    - - Recognition is important so patient can be referred for medical evaluation
    - - Direct contact with the saliva or saliva droplets of infected person
    - - Treatment is focused on relieving symptoms associated with viral infection including bed rest, plenty of fluids, and and analgesics for pain and fever; prognosis is excellent
    - - Paramyxovirus
  - - - Systemically: fever, malaise, and headache; painful swelling of affected gland is the classic clinical features; trismus is common, as is painful chewing; purulent exudate may be present and may express with gentle pressure; inflammation of the salivary duct and presence of purulent exudate are characteristic
    - - Xerostomia is major risk
    - - Not transmitted from person to person
    - - May be difficult to treat; exudate should be cultured to determine specific bacteria responsible so that appropriate antibiotic can be prescribed; pain relief, moist compresses, rehydration, and stimulation of salivary flow are helpful; prognosis is good in most cases
    - - Associated pathogens include staphylococcus aureus, streptococcus viridans, streptococcus pneumoniae, and Haemophilus influenzae
- - - - Solitary neurofibromas may affect skin, major nerve plexuses, and G.I. tract; cutaneous presentation is a soft, nodular, sessile, or pedunculated growth; samll; usually only a few mm to several cm; orally manifests as a slow growing, smooth-surfaced, asymptomatic mass; most commonly found on tongue or buccal mucosa; occasionally may be found within the bone of the maxilla or mandible
    - - Presence of multiple neurofibromas may indicate a relatively common genetic disorder called neurofibromatosis
    - - Not applicable
    - - Surgical excision is the preferred treatment; solitary neurofibromas have a little chance of recurrence; prognosis is excellent
    - - A benign neoplasm originating from Schwann cells or connective tissue cells that support peripheral nerves; it is the most common type of peripheral nerve neoplasm
  - - - Characteristics
        
        Found most often in the head and neck area, extremities, and genitourinary tract; most common sight of involvement in the head and neck is the orbital area; orally found on the hard and soft pallets and the tongue more frequently than in other areas; may present with pain and paresthesia especially if jaw is involved; lesions in jaws appear on radiographs as ill-defined radiolucencies
      - Dental implications
        
        Any soft tissue enlargement that has not been identified and does not resolve over a two-week period should be biopsied; patient should have dental evaluation prior to starting chemotherapy or radiation therapy
      - Method of transmission
        
        Not applicable
      - Treatment and prognosis
        
        Standard treatment is complete surgical removal combined with chemotherapy and radiation therapy; prognosis varies widely, according to location, histology, and metastasis
      - Etiology
        
        Unknown at the orgy; may have association with several genetic syndromes or environmental agents
  - - - Usually appear as small, smooth surface, firm, nodular growths in the head and neck area and on the flexor surfaces of the arms and legs; lesions are normally painless; and oral cavity manifest as smooth surface to sub mucosal masses; most frequently appear on tongue; can also occur within bone of maxilla or mandible where they appear as well defined radiolucencies; bone lesions are often associated with pain and paresthesia
    - - Accurate interpretation of radiographic findings in areas where patient reports pain or paresthesia are essential
    - - Not applicable
    - - Arises from proliferation of Schwann cells of nerve sheath; considered to benign neural neoplasms
    - - Treatment of choice is surgical excision; little chance of reoccurrence or malignancy; prognosis is excellent
  - - - Characteristics
        
        Found most often in parotid gland; asymptomatic; may affect submandibular gland; may appear in bone of maxilla for mandible as a unilocular or multilocular radiolucency
      - Dental implications
        
        Tumors may be present for a very long time before noticed; therefore, oral cancer screening should include palpation of all major salivary glands
      - Method of transmission
        
        Not applicable
      - Treatment and prognosis
        
        Treated by surgical removal; if evidence of metastasis lymph nodes may need to be removed
      - Etiology
        
        Not known
    - - Characteristics
        
        When found in parotid or submandibular gland's, present as slow growing hard masses; may entail facial nerve paralysis; minor salivary gland tumors appear as slow growing masses on palate, buccal mucosa, or lips; pain may be present
      - Dental Implications
        
        The dental hygienist may be the first person to detect during an oral examination
      - Method of transmission
        
        Not applicable
      - Treatment and prognosis
        
        Involvement of parotid gland results in partial or total removal of gland often sacrificing the facial nerve in a total parotidectomy; any gland containing this carcinoma will need surgical excision; prognosis is generally good
      - Etiology
        
        Unknown
    - - Characteristics
        
        Second most common benign parotid gland tumor; present as slow growing, rubbery or firm, painless masses, usually found in tale of parotid gland near angle of mandible; usually bilateral, may complain of tinnitus, pain in the ear, and deafness
      - Dental implications
        
        Smokers have a much higher risk for this neoplasm; if parotid gland has a palpable mass, opposite gland should be thoroughly palpated; smoking cessation counseling should be given
      - Method of transmission
        
        Not applicable
      - Treatment and prognosis
        
        Surgical removal or a parotidectomy with a safety margin is the usual procedure; prognosis is excellent
      - Etiology
        
        Unknown, but studies show strong relationship with smoking; benign, encapsulated tumor
    - - Polymorphous Low-Grade Adenocarcinoma
        
        Characteristics
        
        Hard and soft palate is the most frequent site for PLGA followed by upper lip and buccal mucosa; presents as a slow growing smooth-surfaced, painless mass;
        
        Dental implications
        
        One of the first signs of a pallet of growth might be a denture that start to feel uncomfortable or loose; denture patients should have periodic oral examinations to detect abnormalities in early stages
        
        Method of transmission
        
        Not applicable
        
        Treatment and prognosis
        
        Surgical excision with wide margin is the best treatment; metastasis is an uncommon occurrence
        
        Etiology
        
        May be associated with genetic mutations; one of the more common minor salivary malignancies
      - Adenoid Cystic Carcinoma
        
        Characteristics
        
        Parotid gland tumors present as firm, well defined masses within the gland; slow-growing may be tender; facial nerve involvement may indicate advanced stage; more frequently occur on palate; mucosal surface region is often ulcerated; may see destruction of underlying bone
        
        Dental implications
        
        Radiation therapy is almost always recommended; all dental procedures need to be accomplished prior to radiation therapy; patient needs to be instructed about long-term management of xerostomia and other oral side effects of radiation
        
        Method of transmission
        
        Not applicable
        
        Treatment and prognosis
        
        Surgical excision is the best treatment; removal of tumors within parotid gland may require sacrifice of facial nerve; tumors should be removed with white surgical margins; adjuvant radiation therapy is recommended for most tumors
        
        Etiology
        
        Unknown; some evidence for genetic mutation
    - - Characteristics
        
        Affects parotid gland more often than other major salivary gland's; a painless, slow growing, firm mass, often found in lower superficial lobe of parotid near angle of the mandible; inside mouth appears as firm, nodular growth covered by intact mucosa, most often found on palate
      - Dental implications
        
        Difficult to remove completely; monitoring is necessary
      - Method of transmission
        
        Not applicable
      - Treatment and prognosis
        
        Complete surgical removal is recommended; difficult to preserve facial nerve; prognosis is excellent when completely removed
      - Etiology
        
        Benign neoplasm arising from proliferation of salivary gland cells (ductal and myoepithelial)
  - - - Most common extra oral presentation is on thighbone around knee joint; in the oral cavity usually present as gradually enlarging, painless masses; ulceration of the surface, secondary to trauma may occur; with enlargement, may hear complaints of pain, swelling, paresthesia, and loosening of teeth
    - - Early identification is extremely important for a favorable outcome
    - - Not applicable
    - - Treatment of choice is surgical excision with wide margins; prognosis is guarded; 50 to 75% of cases have a reoccurrence; may metastasize
    - - May be linked to previous radiation therapy and tissue trauma such as a burn
  - - - Growth can occur in any area of body; manifest as a slowly enlarging soft tissue mass in oral cavity; facial asymmetry can be expected as lesions in large; soft tissues surrounding mandible are commonly affected;May appear as ill defined radiolucencies if bone on mandible is affected; expansion of cortical bone may occur
    - - Early diagnosis of any enlarging mass is crucial; hygienist is in an excellent position to examine
    - - Several forms of fibromatosis (myofibromatosis, familial adenomatous polyposis, and multicentric fibromatosis) are considered inherited
    - - Treatment of choice is aggressive surgical excision with wide margins, anti-inflammatory medications, chemotherapy, and radiation therapy, and other forms of local therapy; high rate of reoccurrence; no meta-stasis
    - - Unknown; considered uncommon and locally invasive; occasionally pier at site of previous surgery
- - - - Facial and oral characteristics are first features; individuals are tall, slender, with long arms - a marfinoid body type; aggressive thyroid cancer, adrenal gland tumors, mucosal neuromas and intestinal or neuromas on the eyelids or cornea are observed; patients exhibit a wide-eyed expression and mandibular prognathism; mucosal neuromas can be found on the lips, tongue, and other oral mucosal surface; lips may appear puffy and protuberant; palate may be high arched and narrow; tongue is a common location for lesions
    - - Hygienist may be first detector; neuromas are an early sign of the disorder
    - - Inherited as an autosomal dominant trait or can occur spontaneously as a new mutation
    - - Removal of the thyroid often during infancy; monitoring of blood calcitonin levels; surgical removal of adrenal gland tumors are they will be nine; mucosal neuromas are surgically removed; prognosis is good if disease is identified early and the thyroid is prophylactically removed
    - - MEN syndromes are genetic disorders caused by a mutation of proto-oncogene
  - - - Most common location is the head and neck area; a specific form is cystic hygroma; superficial lymphangiomas present as painless nodules that may be translucent or bluish and have a pebbly or a pubbly surface that looks like cooked tapioca
    - - Patients who have had surgical removal of lymphangioma may have damage to the facial, lingual, or hypoglossal nerve
    - - May have genetic tendency
    - - Surgical removal is the treatment of choice; laser therapy is used for growing lesions; prognosis for small, isolated lesions is excellent
    - - Unknown
  - - - Multiple neurofibromas small large and subcutaneous; flat areas of hyper pigmented skin; freckling within the iris of the eye; short stature and other bone abnormalities; seizures, learning disabilities, and hypertension; neurofibromas and café au lait macules can appear on face and lips; intraoral neuromas are seen in 25% of patients; appear as well-defined, painless, sub mucosal nodules
    - - Problems include impaired mastication, swallowing, and speaking; lesions can become chronically traumatized; growths may complicate attempts for good oral hygiene
    - - Autosomal dominant inheritance pattern or as a new mutation
    - - Genetic, and therefore cannot be treated in district sense; management includes frequent examination and surgical resection of lesions causing problems; neurofibromatosis decrease his life expectancy by about 15 years
    - - Inherited disorder associated with mutation of NF1 gene
- - - - Most of these cysts are found in the midline of the neck where they appear as well circumscribed, nontender, mobile masses, usually between two and 4 cm in diameter; symptoms exhibit pain, dyspnea, dysphagia, and discharge; about 2% of these lesions develop within the tongue itself (lingual thyroid)
    - - Lesions located on the posterior dorsal surface of tongue should not be removed until it is known what they are, because there is a chance that a mass in this location may contain the patients only thyroid tissue
    - - Not applicable
    - - Complete surgical excision is the treatment of choice after determining the presence of other functioning thyroid tissues in the normal location; prognosis is normally excellent if the cyst is completely excised
    - - Proliferation of remnants of epithelial cells that lined the thyroglossal tract during embryonic development
  - - - May involve teratoid cyst; the dermoid cyst develops as a painless, slow growing, soft, Joey, midline mass, primarily in the floor of the mouth; it can be located superior to the mylohyoid muscle and close the tongue to be displaced
    - - If located in the floor of the mouth, it can impair chewing, swallowing, and speaking; patients may present with this reason for seeking dental care
    - - Not applicable
    - - Treatment is surgical excision; prognosis is excellent
    - - Results from the entrapment of epithelial cells along the lines of embryonic closure or fusion; located in the midline in the head and neck region
  - - - Consistent examinations that include palpation of neck and soft tissues of the face are essential
    - - Complete surgical excision is recommended; prognosis is good
    - - Normally located along anterior border of sternocleidomastoid muscle; it is soft and fluctuant when palpated; inside the mouth it is called lymphoepithelial cyst; commonly found in the floor of the mouth and the posterior lateral border of the tongue
    - - Not applicable
    - - Suggestive that it arises from parotid gland epithelium that becomes in trapped within cervical lymph nodes
- - - - Dry eyes (xerophthalmia); sensitivity to light; salivary and lacrimal glands are affected most, but any mucosal surface is at risk; most significant oral manifestation is xerostomia - may cause oral tissues to atrophy and tongue to become more fissured; parotid glands or submandibular glands become enlarged in about 50%; usually bilateral and symmetrical and may reccur and regress
    - - Increased risk for dental caries, periodontal disease, and infections such as candidiasis; periodic management for neoplastic changes in parotid gland should occur
    - - Not applicable
    - - Autoimmune; Second most common connective tissue disorder after lupus erythematosus; 90% of patients are women between ages 30 and 65; activated T cells destroy exocrine glands, especially salivary and lacrimal glands and attack the acinar cells and gland ducts