Benign and Reactive Lesions Flashcards by Steven Anjorin

What is a fibro-epithelial polyp?

a localised hyperplastic lesion

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fibro-epithelial polyp aetiology

overproduction of granulation and fibrous tissue in response to damage or trauma

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fibro-epithelial polyp - clinical features

commonly presents in buccal mucosa
often in areas of trauma
may be pedunculated or sessile
firm or soft
pink appearance
painless
can be ulcerated and easily traumatised
may have associated frictional keratosis
usually an isolated lesion

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fibro-epithelial polyps - histology

fibrous tissue in the core
thick interlacing collagen fibres
adjacent normal tissue
covered with squamous epithelium
may have hyperkeratosis
little inflammatory infiltrate

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fibro-epithelial polyp - clinical considerations

does it bother patient?
does patient have oral cancer risk factors
differential diagnosis
cause

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fibro-epithelial polyp - management

photos
identify cause and correct if appropriate
consider excisional biopsy

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fibro-epithelial polyp - benefits and risks of excisional biopsy

benefits
- can confirm diagnosis - useful if uncertain or patient has ssc risk factors
- can remove lesion
risks
- surgical risks
- altered sensation
- recurrence or incomplete excision

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denture associated lesions - examples and causes

hyperplastic tissue
- response to denture trauma
- leaf fibroma
- denture hyperplasia
papillary hyperplasia
- granular inflammation of denture bearing surface - usually palate
- may be associated with candida infection

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denture associated lesions - management

consider excision
denture hygiene
candida management
consider making new denture

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epulis - meaning

a reactive hyperplastic lesion on the gingivae

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fibrous epulis - what is it?

a fibro-epithelial polyp presenting on the gingiva

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fibrous epulis features

same colour as gingiva
may be ulcerated
histologically similar to polyps
- more likely to have varying amounts of inflammatory infiltrates

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Giant cell epulis features

also known as peripheral giant cell granuloma
red/purple appearance
sessile or pedunculated
often inderdentally
more common in children

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Giant cell epulis histology

vascular stroma
fibrous tissue
multinucleate osteoclast giant cells

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Giant cell epulis - pathogenesis

unknown
reactive to trauma or irritation

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Giant cell epulis - management

excisional biopsy
OPT and/or CBCT
bone profile
parathyroid hormone assay

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vasular epulis/pyogenic granuloma features

increase in size due to hormonal changes
if pregnant in pregnancy = pregnancy epulis
soft bright red appearance
may resolve during birth
if removed following birth, inflammation may decrease and resemble a fibrous epulis
may recur if removed during pregnancy

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vascular epulis histology features

vascular appearance
variable amounts of inflammatory infiltrate

vascular epulis management options

in GDP - refer to oral surgery for further advice
keep under observation
- excise following birth
excisional biopsy

drugs linked to generalised gingival overgrowth

drug induced
- calcium channel blockers
- ciclosporin
- phenytoin

generalised gingival overgrowth management

gingivoplasty may be indicated
- will likely bleed due to vascular nature
ask GP to consider alternative medications
plaque control
risk factors
consider oral med referral to rule out other causes

non drug induced causes of generalised gingival overgrowth

chronic hyperplastic gingivitis
- mouth breathing, pregnancy
hereditary gingival fibromatosis
- enlarged, little inflammation, expansion of the tuberosities
- may require repeated gingivectomies to facilitate oral hygiene
granulomatous disease
- OFG
- Oral crohns etc
haematological malignancy
- gingival swelling/periodontal disease rapidly progressing in the presence of good OH?

squamous cell papilloma features

benign growth - wart
any aspect of oral mucosa
pedunculated OR sesile
cauliflower appearance
often keratinised surface
result from viral infection
- typically HPV
not associated with malignant transformation
single or multiple lesions
may present in immunocompromised patients

squamous cell papilloma histology

finger like processes of hyperplastic squamous epithelium
thin cores of vascular connective tissue

squamous cell papilloma - management

excisional biopsy observation - if no red flag sign, symptoms or oral cancer risk factors

pyogenic granulomas - features

reactive vascular lesion gingiva most common site - any oral mucosal tissue can be affected typically a response to local irritation or trauma

pyogenic granuloma - histology

vascular proliferation oedematous fibrous stoma variable inflammatory infiltrate

pyogenic granuloma - management

remove irritant - plaque - overhang - denture - other traumatic cause excisional biopsy take photos

black hairy tongue pathophysiology

hyperplasia of filiform papillae build up of commensal bacteria, food debris pigment inducing fungi and bacteria

black hairy tongue cause

specific cause unknown linked to - smoking - antibiotics - chlorhexidine mouthwash - poor oral hygiene

black hairy tongue management

reassure stop smoking stay hydrated lightly brush tongue gentle exfoliation of tongue surfaces - peach stones eat fresh pineapeale

fordyce spots - features

sebaceous glands - no function in the oral cavity yellowish bumps 60-75% of adults found on buccal mucosa and lips symmetrical distribution greater prominence later in life no associated pathology - normal anatomy

geographic tongue features

1-3% population associated with psoriasis loss of filiform papillae - areas of tongue atrophy and hyperkeratinisation comes and goes and changes appearance can affect other areas of oral mucosa mostly asymptomatic - sometime sensitive to hot and spicy foods and toothpaste - SLS free toothpaste?

geographic tongue management

reassurance doesn't indicate biopsy consider difflam mouthwash when needed if symptomatic ask about skin changes consider avoiding trigger foods

mucoceles - features

cysts caused by damage to salivary ducts or minor salivary glands more common in lower lip usually response to trauma blue/translucent sessile lump more common in over 30s

mucocele - management if in upper lip

manage as malignancy until proven otherwise

term for a mucocele found on floor of the mouth

ranula

mucocele - management

excision - blunt dissection to remove full capsule of cyst and damaged minor salivary gland - watchful wait approach in paediatric patients - increased chance of recurrence if excision incomplete

lingual tonsil - features and management

lymphoid tissue - found on postern-lateral aspect of tongue may become enlarged following trauma or infection can mimic malignancy - in high risk site no treatment necessary - refer if unclear diagnosis

varices - features

blood vessels become more prominent with increasing age may be more prominent in - smokers - patients with cardiovascular disease

haemoangioma features

disorganised vascular tissue more common in head and neck common benign growth made of a collection of small blood vessels that form a lump under the skin more common in females very common in females may resolve

vascular malformation features

congenital lesion due to abnormal blood vessel development associated with larger arteries and veins present at birth can be challenging to manage may require extensive excision and free-flap reconstruction

haemangiomas and vascular malformations - management

no treatment if asymptomatic with no aesthetic concerns ultrasound cryotherapy cauterisation MRI and angiogram for larger lesions

tori and exostoses features

translucent white and folded appearance histological findings - thicker epithelium - broad rete process