White Soft Tissue Lesions (Non-Malignant)

Question 1

What are Fordyce granules?

Answer 1

• ectopic sebaceous glands on oral mucosa
• normal anatomic variation (>80% of population)
• more commonly in adult than children (puberty appears to stimulate dev)

Question 2

Clinical presentation of Fordyce Granules..

Answer 2

• multiple
• small (1-2mm)
• white or yellow-white papules
• asymptomatic

Question 3

Location of Fordyce granules?

Answer 3

• buccal mucosa
• lateral portion of vermillion border of lips
• retromolar areas, anterior tonsillar pillar (less common)

Question 4

Histopathologic findings of fordyce granules..

Answer 4

• resemble sebaceous glands found in skin BUT lacks hair follicles
• acinar lobules seen beneath epithelial surface, communicating w surface via central duct
• sebaceous cells in lobules
  
  • polygonal shape
  • centrally located nuclei
  • abundant foamy cytoplasm

Question 5

Management of fordyce granules?

Answer 5

• NO treatment needed
• can laser off if aesthetics is a concern

Question 6

What is leukoedema?

Answer 6

• common oral mucosa condition of unknown cause
• more common in blacks than whites (more noticeable in blacks due to background mucosal pigmentation)

Question 7

Clinical presentation of Leukoedema..

Answer 7

• folded surface => wrinkles & streaks
• diffuse, greyish-white, opalescent
• does not rub off, but disappears on stretching of mucosa

Question 8

Locations where Leukoedema occurs..

Answer 8

• bilateral buccal mucosa
• floor of mouth (rare)

Question 9

Histopathology of leukoedema..

Answer 9

• acanthosis: increased thickness of epithelium & elongation of rete ridges
• intracellular oedema (keratinocyte oedema) of spinous layer
• large vacuolated cells w pyknotic nuclei

Question 10

Management of Leukoedema..

Answer 10

NO treatment needed, benign condition

Question 11

Leukoedema can be confused w..

Answer 11

Leukoplakia, OLP, oral candidiasis, submucous fibrosis

Question 12

What is Benign Alveolar Ridge Keratosis (BARK)?

Answer 12

• Chronic mechanical irritation
• Due to:
  
  • opposing dentition
  • reaction to trauma of impacted food on mucosa

Question 13

Clinical presentation of Benign Alveolar Ridge Keratosis (BARK)?

Answer 13

Poorly demarcated white plaque, commonly found on the keratinised mucosa of alveolar ridge, retromolar pad

Question 14

Histopathologic findings of Benign Alveolar Ridge Keratosis (BARK)?

Answer 14

• Hyperkeratosis & acanthosis
• Keratinocyte oedema
• No/mild inflammatory infiltrate
• No dysplasia

Question 15

Management of Benign Alveolar Ridge Keratosis (BARK)?

Answer 15

NO treatment needed, no malignant potential

Question 16

What are the 2 types of frictional hyperkeratosis?

Answer 16

1. Linea Alba
2. Morsicato Buccarum (Chronic mucosal chewing)

Question 17

What is Linea Alba?

Answer 17

• Female predominance
• Due to frictional irritation from repetitive interdigitation of teeth (cheek biting)

Question 18

Clinical presentation of Linea Alba..

Answer 18

• Usually bilateral
• uniform, adherent horizontal white line
• rough & frayed surface
• may be scalloped
• more prominent adjacent to posterior teeth

Question 19

Location of Linea alba..

Answer 19

Buccal mucosa, along occlusal plane

Question 20

Management of Linea Alba

Answer 20

• NO treatment needed, no malignant potential
• Spontaneous regression may occur

Question 21

What is Morsicato Buccarum (Chronic mucosal chewing)?

Answer 21

• common, unintentional habit of cheek biting
• across all ages

Question 22

Clinical presentation of Morsicato Buccarum..

Answer 22

• Usually bilateral
• shredded, white area
• irregular ragged surface w tags of epithelium that peel off
• may have erythema, erosion or ulceration
• more prominent at anterior buccal mucosa

Question 23

Morsicato Buccarum is commonly found on..

Answer 23

Buccal mucosa, lateral border of tongue, labial mucosa (rare on upper lip mucosa)

Question 24

Management of Morsicato Buccarum..

Answer 24

NO treatment needed, no malignant potential
- preventive therapy: use acrylic shield to separate teeth form adjacent mucosa => quick resolution