Lecture 3/4

• Categories of Soft Tissue Lesions

  • Variants of Normal
  • Benign Soft Tissue Lesions
  • Malignant Soft Tissue Lesions
• Benign Soft Tissue Lesions


  • Inflammatory
  • Neoplastic
• Tori/Exostoses


  Bony outgrowths on the palate or mandible
• Foliate Papillae


  Lymphoid aggregates on the posterior tongue
• Fordyce granules


  Ectopic sebaceous glands
• Retrocuspid papilla


  Small papillary projection on the lingual aspect of the mandibular cuspids
• Fimbriated fold


  Folds of mucosa on the underside of the tongue
• Frenal tag


  Fibrous hyperplasia of the frenum
• Sublingual varices


  Dilated veins under the tongue
• Palatine Torus


  Bony outgrowth on the hard palate
• Mandibular Torus


  Bony outgrowth on the mandible
• Buccal Exostoses


  Bony outgrowths on the buccal aspect of the maxilla or mandible
• Lymphoid Aggregates


  Differ from Foliate Papillae and Lingual Tonsils
• Lymphoepithelial cyst


  Remnants of epithelial tissue trapped in lymphoid tissue during embryonic development
• A definitive diagnosis is not possible without histopathology
• Papule


  Lesion less than 5mm in diameter
• Nodule


  Lesion greater than 5mm but less than 2cm in diameter
• Tumor


  Lesion greater than 2cm in diameter
• Inflammatory/Reactive Exophytic Soft Tissue Lesions

  • Irritation Fibroma
  • Fibrous Inflammatory Hyperplasia/Epulis Fissuratum
  • Inflammatory Papillary Hyperplasia
  • Pyogenic Granuloma, Pregnancy Tumor
  • Peripheral Ossifying Fibroma
  • Peripheral Giant Cell Granuloma
  • Reactive Gingival Enlargement
  • Traumatic Neuroma
• Benign Soft Tissue Tumors (Neoplasms)

  • Epithelial Tumors
  • Vascular Tumors & Anomalies
  • Neurogenic Lesions
  • Lipoma
  • Tumors of Muscle
  • Others: fibrous histiocytoma, Solitary fibrous tumor, Myofibroma
• Irritation Fibroma


  Also known as Fibroma or Traumatic Fibroma, composed of dense, scar-like, fibrous connective tissue, occurs due to chronic trauma
• Irritation Fibroma


  • Exophytic lesion, usually less than 1cm in diameter, located on buccal mucosa, tongue, lips, or gingiva, lighter pink than surrounding mucosa
• Giant Cell Fibroma


  Variant of irritation fibroma that occurs on the gingiva
• Cowden Syndrome


  Autosomal dominant disorder affecting multiple organ systems, caused by mutations in the PTEN gene, characterized by multiple papules and papillomatosis in the oral cavity and perioral skin
• Tuberous Sclerosis Complex


  Inherited disorder caused by mutations in the TSC1 or TSC2 genes, characterized by seizures, mental retardation, and hamartomatous lesions in the oral cavity and other organs
• Epulis Fissuratum


  Also known as denture-induced fibrous hyperplasia, caused by ill-fitting dentures, appears as elongated folds of tissue along the denture border

  
• Inflammatory Papillary Hyperplasia of the Palate

  Majority occur with denture stomatitis, characterized by multiple erythematous papillary projections covering the palatal vault
• Chronic Hyperplastic Pulpitis


  Also known as a pulp polyp, an excessive proliferation of chronically inflamed dental pulp tissue, often in teeth with large carious lesions

  
• Pyogenic Granuloma


  Also known as a pregnancy tumor, a response to injury such as calculus, often occurs in pregnant women, appears as a soft, exophytic, ulcerated, red to purple lesion, most commonly on the gingiva
• Clinical Appearance


  A red or pink nodule of soft tissue protruding from the pulp chamber and fills the entire cavity of the tooth

  
• Treatment


  RCT or extraction of tooth
• The 3 P's


  • Pyogenic granuloma/pregnancy tumor
  • Peripheral ossifying fibroma
  • Peripheral giant cell granuloma
• Pyogenic Granuloma


  • Response to injury - calculus
  • Misnomer – not pyogenic and not a true granuloma
  • Often occurs in pregnant women ("pregnancy tumor"), also associated with puberty
  • Excision and removal of irritant (eg calculus, overhanging restorations)
• Pyogenic Granuloma: Clinical Features

  • Usually ulcerated
  • Soft exophytic lesion, either sessile or pedunculated
  • Deep red to purple in color, bleeds easily
  • Most common location is gingiva, also occurs in other areas of the oral mucosa
  • Size: small to large (millimeters to centimeters)
  • Develop rapidly and then remain static
  • Any age
• A parulis is not a pyogenic granuloma it is a proliferation of granulation tissue at the opening of a sinus tract secondary to an infection.
• Peripheral Ossifying Fibroma


  • Well-demarcated, exophytic, sessile or pedunculated lesion that appears to originate from the gingival interdental papilla
  • Occurs exclusively on the gingiva
  • Red or normal tissue color
  • May be ulcerated
  • Derived from cells of the periodontal ligament
  • Age: children and young adults
  • Sex: females more than males
  • Recurrence rate – about 16%
  • Calcifications seen on histopathology ("ossifying" fibroma)
• Peripheral Giant Cell Granuloma

  • Probably a reactive lesion – local irritating factors
  • Location: Gingiva, usually anterior to the molars
  • Age: Most frequently seen between 40-60 years old
  • Exophytic
  • Reddish/Purple
  • Ulcerated
  • Radiographic Features: Usually none, but superficial destruction of the alveolar bone may occur
• All 3 "P" lesions usually occur on gingival interdental papillae
• Since they can look similar clinically, excisional biopsy necessary to determine diagnosis

  
• Treatment


  Complete excision and removal of local irritant (scaling and root planing)