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Soft Tissue Enlargements, Citation: pg. 396-423 Delong, L & Burkhart,…
Soft Tissue Enlargements
Traumatic or Inflammatory Lesions
Traumatic Neuroma
Etiology: chronic or acute trauma that severs nerve tissue
Method of Transmission: N/A
Characteristics: small; firm nodules covered by normal mucosa, painful when palpitated, lesions found most often on surfaces that are traumatized frequently such as the tongue and lower lip
Dental Implications: careful avoidance of the area during dental or dental hygiene therapy is indicated to reduce the chance of eliciting pain
Treatment/prognosis: surgical removal, excellent prognosis
Fibroma
Etiology: response to chronic trauma or irritation, results from wearing an ill-fitting denture
Method of Transmission: N/A
Characteristics: growths are usually nodular and exophytic, pedunculated, surface of lesion may be ulcerated if continually traumatized
Dental Implications: determining the cause of irritation or trauma and removing it
Treatment/prognosis: surgical removal
Peripheral Ossifying Fibroma
Etiology: reactive hyperplastic lesion
Method of Transmission: N/A
Characteristics: well-defined, firm, pedunculated, exophytic mass on the attached gingiva; smooth-surfaced, usually less than 1cm in size, located in interdental papilla areas
Dental Implications: identifying source of irritation or trauma and eliminating it
Treatment/prognosis: local excision with no recurrence, good prognosis if underlying local factors are removed
Generalized Ginigval Hyperplasia
Etiology: exuberant response to chronic inflammation associated with dental biofilm or other local factors such as calculus
Method of Transmission: N/A
Characteristics: enlargement of interdental papilla, associated with hormonal changes
Dental Implications: clinician should obtain thorough medical history and identify risk factors associated with this condition
Treatment/prognosis: discontinuance of offending drug, especially cyclosporine
Ranula
swelling in the floor of the mouth that resembles a frog's belly, caused by obstruction of the submandibular or sublingual salivary glands, can be associated with trauma or with a salivary duct stone, called a "plunging ranula" is lesion herniates through the mylohyoid muscle, growth may appear circumscribed; firm; with a blu-to-reddish color. surgically removed and has differential diagnosis of lymphangioma
Soft Tissue Neoplasms
Fibrosarcoma
Etiology: may be linked to previous radiation therapy and tissue trauma such as a burn injury
Method of Transmission: N/A
Characteristics: gradually enlarging, painless
Dental Implications: early identification
Treatment/prognosis: surgical excision
Fibrostomatosis (Desmoid Tumor)
Etiology: unknown
Method of Transmission: inherited condition
Characteristics: growths can occur in any area of the body, in the head and neck lesions appear as enlarging masses, firm, facial asymmetry can be expected, affects soft tissues surrounding the mandible, expansion of cortical bone may occur
Dental Implications: early diagnosis is crucial to obtain a favorable treatment outcome
Treatment/prognosis: aggressive surgical excision with wide margins, anti-inflammatory medications, chemotherapy, and radiation therapy
Rhabdomyosarcoma
Etiology: unknown
Method of Transmission: N/A
Characteristics: often found in area of the head and neck, growths may be palpable if superficially located, found on hard and soft palates and the tongue intraorally, paresthesia may be present (especially if jaws are involved), appear radiographically as ill-defined radiolucencies when lesion are within the jaws
Dental Implications: any soft tissue enlargement that has not been identified and does not resolve over a 2-week period should be biopsied, patients should have dental evaluations prior to starting chemotherapy and/r radiation therapy
Treatment/prognosis: complete surgical removal combined with chemotherapy and radiation therapy, prognosis varies widely according to location of tumor and its histologic characteristics
Neurofibroma
Etiology: Schwann cells and/or connective tissue cells
Method of Transmission: N/A
Characteristics: usually small, slow-growing, smooth-surfaced, asymptomatic mass, commonly located on tongue or buccal mucosa, tumor occasionally found within the bone of the maxilla or mandible that can cause extensive expansion and destruction of bone
Dental Implications: presence of multiple neurofibromas may indicate a relatively common genetic disorder called neurofibromatosis
Treatment/prognosis: surgical excision, excellent prognosis
Neurilemmoma (Schwannoma)
Etiology: proliferation of the Schwann cells of the nerve sheath
Method of Transmission: N/A
Characteristics: slow-growing, encapsulated, small, smooth-surfaced, firm, nodular, in the head and neck area, also on flexor surfaces of arms and legs, lesions are normally painless unless very large in size, can cause tinnitus and deafness
Dental Implications: accurate interpretation of radiographic findings in areas where patient reports pain
Treatment/prognosis: surgical excision, excellent prognosis
Infections
Mumps
Etiology: Paramyxovirus
Method of Transmission: direct contact with saliva or saliva droplets of an infected person
Characteristics: orchitis (inflammation of testes), swelling in major salivary glands, erythema surrounding salivary ducts, pain occurring in and around the ear because of pressure from swelling
Dental Implications: important to recognize manifestations of this infection so that patient can be referred for medical evaluation
Treatment/prognosis: bed rest, plenty of fluids, analgesics for pain and fever, excellent prognosis
Bacterial Sialadenitis
Etiology: S. aureus, S. viridans, S. pneumoniae
Method of Transmission: not transmitted from person to person
Characteristics: fever, malaise, headache, painful swelling of affected gland, painful chewing, purulent exudate may be present at duct orifice
Dental Implications: xerostomia
Treatment/prognosis: appropriate antibiotic, analgesics to alleviate discomfort, prognosis good is most cases
Soft Tissue Developmental Cysts
Dermoid Cyst
Etiology: entrapment of epithelial cells along lines of embryonic closure
Method of Transmission: N/A
Characteristics: painless, slow-growing, soft, primarily in floor of the mouth, can be located superior to mylohyoid muscle
Dental Implications: can impair chewing, swallowing, and speaking if lesion is located in floor of the mouth
Treatment/prognosis: surgical excision, excellent prognosis
Thyroglossal Tract Cyst
Etiology: proliferation of remnants of epithelial cells that lined the thyroglossal tract during embryonic development
Method of Transmission: none
Characteristics: most are found in the midline of the neck, appear as well-circumscribed; nontender; mobile masses, usually between 2-4cm in diameter, dysphagia and dysphonia accompany larger lesions, airway constriction
Dental Implications: lesions located on the posterior dorsal surface of the tongue should not be removed until it is known what they are (mass in this location may contain patient’s ONLY thyroid tissue)
Treatment/prognosis: complete surgical excision using the Sistrunk procedure (removal of midsection of hyoid bone), recurrence is associated with history of repeated infections, prognosis excellent if cyst is completely excised, very slight risk of malignant transformation
Immune System Disorders
Sjogren Syndrome
Etiology: autoimmune disease
Method of Transmission: N/A
Characteristics: xerostomia, parotid and/or submandibular glands are enlarged, enlargement is bilateral and symmetrical, rheumatoid arthritis
Dental Implications: xerostomia increases patient risk for dental caries, periodontal disease, and infections such as candidiasis
Treatment/prognosis: artificial saliva and tears, extensive use of fluoride, diet modifications
Citation: pg. 396-423 Delong, L & Burkhart, N. (2019). General and Oral Pathology for the Dental Hygienist. Third Edition. Philadelphia: Wolter Kluwer.