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Soft Tissue Lesions - Coggle Diagram
Soft Tissue Lesions
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Infections
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Method of transmission: Mumps is transmitted by direct contact with the saliva or saliva droplets of an infected person
Epidemiology: 200,000 cases were reported, and the number dropped when a vaccination against the virus was introduced.
Pathogenesis: Has an incubation period of 14 to 25 days; then, nonspecific symptoms of low-grade fever, malaise, headache, and chills occur and last anywhere from 3 to 5 days. After patient may experience swelling of the salivary glands.
Extraoral characteristics: Affects any glandular tissue within the body. Tissues that may be affected include the liver, pancreas, kidney, and nervous system.
Perioral and intraoral characteristics: Swelling can occur in any major salivary glands, but the parotid gland is affected more often than the others.
Distinguishing characteristics: Swelling in the salivary glands, in addition to systemic manifestations associated with viral infections, strongly suggests this condition.
Significant microscopic features: Can be isolated from urine, blood, and nasopharyngeal and buccal swabs for up to 7 days before and 9 days following the appearance of salivary gland swelling.
Dental implications: Important to recognize the manifestations of this infection so that the patient can be referred for medical evaluation.
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Treatment and prognosis: Treatment is focused on relieving the general symptoms associated with a viral infection and includes bed rest, plenty of fluids, and analgesics.
Oral medicine considerations: Anesthesia mumps/postoperative sialadenitis that is caused by the administration of anesthesia causing a mump like appearance.
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Epidemiology: This infection tends to appear in older, debilitated patients because this population group has more of the risk factors than any other age group.
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Pathogenesis: Bacterial sialadenitis develops from an overgrowth of bacteria in a gland that is not producing adequate amounts of saliva to keep the bacterial population under control.
Extraoral characteristics: Systemic manifestations of fever, malaise, and headache are present.
Perioral and intraoral characteristics: Painful swelling of the affected gland is the classic clinical feature of this infection.
Distinguishing characteristics: Inflammation of the salivary ducts and the presence of purulent exudate are characteristic of this infection.
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Treatment and prognosis: May be difficult to treat. The exudate coming from the gland should be cultured to determine the specific bacteria responsible, so that the appropriate antibiotic can be prescribed.
Oral medicine considerations: The rate of mortality involving bacterial sialadenitis has been reported to be as high as 20 to 40%.
Immune system disorders
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Pathogenesis: Destruction of the exocrine glands, especially the salivary and lacrimal glands, is caused by activated T cells that infiltrate the glands and attack the acinar cells and the gland ducts.
Extraoral characteristics: Changes in the lacrimal gland cause keratoconjunctivitis sicca, which is associated with blurring of vision, burning, and itching. Most complain of sever photophobia and a feeling that there is something in their eyes.
Perioral and intraoral characteristics: Xerostomia, which varies in severity from individual to individual.
Distinguishing characteristics: Triad manifestation of rheumatoid arthritis, xerostomia, and keratoconjunctivitis.
Significant microscopic features: Heavy lymphocyte infiltration that replaces major salivary gland tissue is characteristic.
Dental implications: Xerostomia increases the patient’s risk for dental caries, periodontal disease, and infections.
Differential diagnosis: Papillary cystadenoma lymphomatosum, alcoholism, diabetes, eating disorders, and salivary neoplasms.
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Soft tissue neoplasms
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Etiology: No known etiology, but they are considered uncommon and locally invasive tumors.
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Epidemiology: These neoplasms are more frequent in those under the age of 40, with children and young adults.
Pathogenesis: Fibromatosis represents a group of lesions that exhibit a somewhat aggressive behavior.
Extraoral characteristics: These growths can occur in any area of the body. In the head and neck area, these lesions appear as enlarging masses that are firm to palpation when found in soft tissues.
Perioral and intraoral characteristics: Manifests as a slowly enlarging soft tissue mass when observed in the oral cavity.
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Dental implications: Early diagnosis of any enlarging mass is crucial to obtaining a favorable treatment outcome.
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Treatment and prognosis: Treatment of choice is aggressive surgical excision with wide margins, anti-inflammatory medications, chemotherapy, and radiation therapy.
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Epidemiology: The rare neoplasm occurs more often in young adults and children and slightly more often in males.
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Perioral and intraoral characteristics: Gradually enlarging, painless masses. Ulceration of the surface, secondary to trauma, may occur as the lesion enlarges.
Significant microscopic features: Proliferating spindle cells are arranged in a herringbone pattern, and mitotic figures are commonly observed.
Dental implications: Early identification of enlarging soft tissue masses is of utmost importance in obtaining a favorable treatment outcome.
Differential diagnosis: Fibromatosis, leiomyosarcoma, melanoma, and spindle cell carcinoma.
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Extraoral characteristics: Usually appear as small, smooth-surfaced, firm, nodular growths in the head and neck area and on the flexor surfaces of the arms and legs.
Perioral and intraoral characteristics: Intraoral neurilemmomas manifest as smooth-surfaced submucosal masses.
Significant microscopic features: Mass of spindle-shaped cells surrounded by a fibrous capsule composed of residual nerve fibers and the connective tissue that forms the support structure for the peripheral nerves.
Dental implications: Accurate interpretation of radiographic findings in areas where a patient reports pain and or paresthesia may be essential to detect this neoplasm, when it arises in bone.
Differential diagnosis: Neurofibroma, leiomyoma, traumatic fibroma, and lipoma.
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Oral medicine considerations: Consider various locations along with the tongue for the schwannomas, such as palatal areas when encountering minor salivary gland tumors.
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Etiology: Benign neoplasm that originates from the schwann cells and or connective tissue cells that support the peripheral nerves.
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Pathogenesis: May be found on any nerve, where it presents as a slow-growing, painless mass.
Extraoral characteristics: Affect skin, major nerve plexuses, and the GI tract.
Perioral and intraoral characteristics: Tumor manifests as a slow-growing, smooth-surfaced, asymptomatic mass.
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Differential diagnosis: Neurilemmoma, leiomyoma, traumatic fibroma, and lipoma.
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Neoplasms of fat tissue
Lipoma is a benign neoplasm of adipose cells. Considered the most common soft tissue tumor in the body, and can occur in any tissue or organ. Intraorally, lipoma appears as a superficial, smooth-surfaced, soft, palpable mass that often imparts a yellowish color to the overlying mucosa. Surgical excision is the treatment of choice.
Salivary gland neoplasms
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Etiology: Benign neoplasm that arises from the proliferation of two different types of salivary gland cells, ductal and myoepithelial.
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Pathogenesis: Arise as slow-growing, firm masses that are slightly compressible, pleomorphic adenomas have a tendency to recur.
Perioral and intraoral characteristics: Affects the parotid gland more often than any of the other major salivary glands.
Significant microscopic features: Have a wide range of histologic presentations with varying amounts of ductal versus myoepithelial cells and various patterns of growth.
Dental implications: Difficult to remove, essential to monitor periodically.
Differential diagnosis: Lymphoma, sarcoidosis, lymphadenopathy, peripheral nerve sheath tumors, mucoepidermoid carcinoma, and metastatic disease states.
Treatment and prognosis: Complete surgical removal is recommended, with enough adjacent tissue removed with the tumor to ensure that there are no remaining nests of cells.
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Pathogenesis: Unknown, but several observations have been made to its etiology.
Perioral and intraoral characteristics: Present as slow-growing, rubbery or firm, painless masses, usually found in the tail of the parotid gland near the angle of the mandible.
Distinguishing characteristics: Bilateral. Patient may complain of tinnitus, pain in the ear, and deafness depending upon the stage of growth.
Significant microscopic features: Cystic spaces contain papillary projections that are lined by columnar cells.
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Differential diagnosis: Pleomorphic adenoma, lymphoma, and mucoepidermal carcinoma.
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Pathogenesis: Unknown, but several observations have been made to its etiology.
Perioral and intraoral characteristics: Present as slow-growing, rubbery or firm, painless masses, usually found in the tail of the parotid gland near the angle of the mandible.
Distinguishing characteristics: Bilateral. Patient may complain of tinnitus, pain in the ear, and deafness depending upon the stage of growth.
Significant microscopic features: Cystic spaces contain papillary projections that are lined by columnar cells.
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Differential diagnosis: Pleomorphic adenoma, lymphoma, and mucoepidermal carcinoma.
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Perioral and intraoral characteristics: Found most often in the parotid gland, where it manifests as an asymptomatic swelling.
Significant microscopic features: Composed of a combo of mucus-secreting cells and epidermoid cells.
Dental implications: Present for several years before they are noticed by the patient; oral cancer screening is important.
Differential diagnosis: Mucocele, neurofibroma, neurilemmoma, and lymphoma.
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Dental implications: Slow-growing, DH may be the first to detect.
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Treatment and prognosis: Removal of parotid gland, and surgical excision.
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Etiology: Associated with various genetic mutations and the over production of specific gene products.
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Pathogenesis: Proliferation of salivary duct cells results in a slow-growing, submucosal mass.
Perioral and intraoral characteristics: Hard and soft palate is the most frequent site followed by the upper lip and buccal mucosa.
Significant microscopic features: Ductal cells of this malignant neoplasm display different growth patterns.
Dental implications: One of the first signs of a palatal growth might be a denture that starts to feel uncomfortable or loose.
Differential diagnosis: Lymphoma, fibroma, neurofibroma, adenoid cystic carcinoma, and mucoepidermoid carcinoma.
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Oral medicine considerations: Follow-up at scheduled visits is important to monitor the oral tissues.
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Pathogenesis: High-grade malignant tumor. Arises within the minor salivary glands, followed by the parotid gland and the submandibular gland.
Perioral and intraoral characteristics: Present as firm, well-defined masses within the gland. Slow growing palpation. Facial nerve involvement.
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Significant microscopic features: Composed of cystic spaces and clusters of cells that form duct-like structures.
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Differential diagnosis: Lymphoma, necrotizing sialometaplasia, and traumatic fibroma.
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Oral medicine considerations: Immunotherapy, in addition to surgery and radiation therapy, may prove useful in the future.
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Citations
DELONG, L. (2020). GENERAL AND ORAL PATHOLOGY FOR THE DENTAL HYGIENIST. S.l., PA: JONES & BARTLETT LEARNING.
Pgs. 395-424