Warts, polyps, epulides and vascular anomalies

Question 1

Fibrous nodules

Answer 1

soft tissue lesion

Question 2

fibrous nodules aetiology

Answer 2

aetiology –> chronic minor trauma, chronic low grade infection

Question 3

fibrous nodules pathology

Answer 3

initially inflamed fibrous tissue
once matured, dense collagenous tissue

Question 4

fibrous nodules cf

Answer 4

well circumscribed
solid and raised
can form on mucosa close to the line of the occlusion
denture-induced

Question 5

fibrous nodules presentations

Answer 5

1. Fibroepithelial polyp
2. Fibrous epulis
3. Denture induced hyperplasia

Question 6

fibrous nodules management

Answer 6

remove stimulus
excisional biopsy

Question 7

Papilloma

Answer 7

oral lesion

Question 8

Papilloma aetiology

Answer 8

HPV 6 and 11
transmitted from cutaneous or genital warts

Question 9

Papilloma cf

Answer 9

painless
single/multiple
exophytic
cauliflower like appearance

Question 10

Papilloma - pathology

Answer 10

SSE
Supported vascular CT
Keratinised

Question 11

Papilloma - management

Answer 11

not considered to be pre malignant
excision
cryotherapy
if multiple consider potential for underlying immunodeficiency
management of skin lesion elsewhere

Question 12

Pyogenic granuloma CF

Answer 12

Painless
Pedunculated
Red and inflamed
Commonly on gingiva
assoc with pregnancy epulis

Question 13

Pyogenic granuloma aetiology

Answer 13

local low grade irritation
hormonal changes
trauma

Question 14

Pyogenic granuloma pathology

Answer 14

hyperplastic lesion
dilated capillaries in loss ct stroma
mature lesions more fibrous with variable inflammation

Question 15

Pyogenic granuloma management

Answer 15

excision
remove causative factors
pregnancy epulis : delay excision where possible until post partum
Improve oral hygiene

Question 16

Giant cell granuloma

Answer 16

uncommon lesion
20-40 yrs
tooth bearing areas – ant mandible
2f;1m

Question 17

GCG classification

Answer 17

central – reparative granuloma
peripheral – giant cell epulis

Question 18

GCG CF

Answer 18

Bony swelling
Erode through cortical plate
Loosening of teeth
Purple gingival swelling
Ulceration/inflammation of overlying mucosa

Question 19

CGCG Radiographic features

Answer 19

extent - large
quality – radiolucent, bubble appearance
margin – localised with ill defined edges
adjacent anatomy – perforate alveolar bone and extend into the mouth. may resorb/displace adjacent roots

Question 20

CGCG histopathology

Answer 20

Multiple multinucleated giant cells
stroma of plump spindle shaped cells
highly vascular
areas of old and new haemorrhage
large cystic blood filled spaces
new bone deposits at margins
similar in appearance to brown tumour of hyperparathyroidism and aneurysmal bone cyst

Question 21

CGCG management

Answer 21

excision of soft tissue lesion and curettage underlying bone
recurrence 15%
larger lesions – resection
corticosteroids/calcitonin/interferon alpha/bisphosphonates
may be linked to Noonan syndrome – ptpn11 gene mutation, cardiac abnormalities etc

Question 22

Central v Peripheral GCG

Answer 22

Peripheral has local irritants for its aetiology whereas central has no known.

Central and Peripheral are both non-neoplastic.

PGCG is located on gingiva and alveolar ridge. CGCG is intra-osseous.

PGCG is a little aggressive whereas CGCG is aggressive.

PGCG is slow growth whereas CGCG is rapid.

Bone resorption occurs CGCG.

Dental involvement involved CGCG.

Treatment is surgical in both conditions.

Question 23

Hyperparathyroidism

Answer 23

Brown’s tumour
Parathyroid hormone overproduction (mobilise calcium from skeleton/raises plasma calcium)
F>M
Elderly
Incidental finding
Xerostomia

Question 24

Hyperparathyroidism: RF

Answer 24

Minimal bony changes
Adv cases – reduced bone density/loss of trabecular bone/loss of lamina dura/brown tumour

Question 25

Brown’s tumour

Answer 25

Cyst like radiolucency
Uni or multilocular

Question 26

Hyperparathyroidism TX

Answer 26

Correction of underlying lesion

Question 27

Vascular malformation

Answer 27

seemingly disorganised vessels

Question 28

vascular malformation aetiology

Answer 28

defects in vasculogenesis/angiogenesis
structural defect in blood vessels
congenital
present at birth but may go unnoticed
M:F
usually grows at a rate proportional to body

Question 29

vascular malformation cf

Answer 29

raised or flat
soft - may become firm with time due to thrombus or calcification
deep red/bluish colour
size varies
blanch with pressure
affecting tongue may impact on movement

Question 30

management of vascular malformation

Answer 30

excision
laser surgery
cryotherapy
radiation therapy
corticosteroids - topical/intralesional

Question 31

vascular malformations - syndromes

Answer 31

Sturge Weber – Encephalotrigeminal Angiomatosis/haemangiomas of face affection trigeminal divisions

Osler rendu weber – hereditary haemorrhagic telangiectasia (HHT)

Question 32

Haemangioma

Answer 32

similar to vascular malformation
aetiology - benign vascular tumour/abnormal endothelial cell proliferation
classification - central/capillary/cavernous/arterial

Question 33

Purpura

Answer 33

bleeding into skin or mucous membranes
results in petechia or ecchymoses
spontaneous gingival bleeding
purpura can forma at any site of trauma
underlying platelet disorder