Soft tissue lesions of Oral mucosa

Soft tissue lesions of Oral mucosa

1. Hyperplasia

   • Fibroepithelial polyp
     • = fibrous tissue lump
     • Normal epithelium
     • Keratosis
     • Cause = chronic trauma
     • Fibrous epulis
   • Epulis
     • Vascular epulis
     • Giant cell epulis
       • Peripheral giant cell granuloma
         • = lesion of giant cells + RBCs/blood products outside vessels
         • Purple/red due to blood products outside vessels
       • Most common = anterior to 6s
     • = swelling on gingiva
     • Peduncle attachment
       • Easy surgical removal
   • Pyogenic granuloma
     • = lobular capillary haemangioma
     • Thin epithelium with overgrowth of blood vessels
     • Red appearance due to blood vessels
     • Yellow appearance due to ulcer slough
     • Peduncle attachment
       • Easy surgical removal
     • Vascular epulis
       • Can be pregnancy-related with poor OH
   • Denture granuloma
     • Basically = fibroepithelial polp caused by chronic trauma from denture
     • Leaf fibroma
     • Paillary hyperplasia of palate
   • Mucocele
     • = swelling filled with saliva
     • Most common = lower lip
       • If seen on upper lip -> more likely adenoma
     • Types
       • Mucus extravagation cyst
         • Redder lesion as saliva burst out tissues
       • Mucus retention cyst
         • Red border, centrally blue as saliva retained within ducts
     • Cause = trauma to minor salivary glands/ducts
     • Management
       • Leave to burst if small
       • Surgical removal if large
         • May re-occur
   • Lingual tonsil hyperplasia
     • Hyperplastic lymphoid tissue
     • Sore throat

2. Neoplasia

   • Benign
     • Squamous cell papilloma
       • Most common = lip & soft palate
       • Cause = HPV (some cases), idiopathic
       • White due to keratosis
       • Easy to surgically remove
     • Haemangioma
       • = neoplasm of blood vessels
       • Blanches on pressure then refills
       • Purple
       • Less common than hamartoma
     • Lymphangioma
       • = neoplasm of lymph vessels
       • Covered with normal mucosa
       • Less common than hamartoma
       • Bubbles on tongue surface
     • Lipoma
       • = neoplasm of fat
       • Soft & squidgy
     • Salivary gland tumour
       • Pleomorphic adenoma = most common
     • Neurofibroma
       • = neoplasm of peripheral nerves/Schwann cells
     • Granular cell tumour
       • Most common = dorsum of tongue
       • Flesh-coloured, under epithelium
       • Single lump/lesion
   • Malignant
     • Carcinoma
       • Squamous cell
         • Most common (9/10)
       • Presentation
         • Ulcerated
         • Rock hard
         • Granular surface
         • Rolled edge
         • Fixed to underlying tissue
       • Adenocarcinoma
     • Melanoma
       • Most common = palate
       • Brown/black lesion
     • Lymphoma
       • Rubbery
       • = malignancy of lymphocytes
     • Sarcoma
       • = connective tissue malignancy
       • Fibrosarcoma, lipsarcoma, osteosarcoma
       • Karposi's sarcoma = angiosarcoma
     • Metastases
       • Most common = breast, prostate, lung

3. Traumatic neuroma

   • Cause = damage to peripheral nerves
   • seen in skin post-parotid gland surgery or with lingual nerve damage
   • = non-neoplastic overgrowth of nerve fibres