Papillary lesions Soft tissue enlargement MUDr. Hana Poskerová 1/ Papillary lesions •oral mucous has papillary / verrucous (wart-like) cofiguration •they are epithelial origin - white in color (excess of keratin and limited vascularity) •human papillomavirus HPV •proliferative verrucous leukoplakia •verrucous carcinoma •inflammatory papillary hyperplasia Sublingual fimbriae Papilloma virus infection HPV HPV – skin and oral mucous lessions - exophytic - well circumscribed - pedunculated or sessile growth - usually solitary – multiple lesions - white or grayish colour Proliferative verrucous leukoplakia •often associated with tobacco exposure •painless, persistent •can develope into verrucous carcinoma Inflammatory papillary hyperplasia •chronic mechanical irritation from ill-fitting maxilary denture (continuously wearing) •often infected with C. albicans •multiple, erythematous, broad - based nodules •persistent, painless 2/ Soft tissue enlargement •soft tissue swellings can be caused by - infection - reactive proliferations - neoplasia •soft tissue swellings arise in the submucosa and usually have broad bases •the surface can be smooth, hyperkeratotic, ulcerated •Pyogenic granuloma •Fibroma •Lipoma •Fibrolipoma •Neuroma •Neurofibroma •Hemangioma •Lymphangioma •Benign salivary gland neoplasms •Malignant lesions Pyogenic granuloma •reactive hyperplasia of vascularized granulation tissue that develops in response to local irritating factors •on gingiva epulis granulomatosa Pyogenic granuloma •hormonal changes associated with pregnancy are a contributing factor for gingival lesions •on gingiva - epulis gravidarum Granuloma (epulis) fissuratum •reactive hyperplasia of fibrous connective tissue caused by chronic irritation from a denture margin •circumscribed, pin nodule with a broad base •usually painless, persistent Fibroma •reactive hyperplasia of fibrous connective tissue in response to trauma or local irritation •pyogenic granuloma may precede fibroma Fibroma •solitary, circumscribed, pin nodule with a broad base, covered with smooth mucous •firm to palpation •painless, persistent Lipoma •benign neoplasm of fat •may also represent a reaction of fat to local trauma •superficial lesions are are typically yellow in color, deeper lesions are pink Hemangioma •benign neoplasm of the endothelial cells that form blood vessels •can be present at birt (congenital lesion may regress with time) or acqired later in life (persistent) Hemangioma •circumscribed, red to blue nodule •soft to palpation, painless •digital pressure may cause the lesion to blanch Lymphangioma •benign neoplasm of the endothelial cells that form lymphatic vessels •can be present at birt or acquired later in life Lymphangioma •tongue is the most common site •occasionally lesions are diffuse and exhibit a multinodular surface Lymphoid hyperplasia •lymphoid tissue located in oropharynx, soft palate, lateral tongue Oral lymphoepitelial cyst •developes from epithelium in oral lymphoid tissue •solitary, circumscribed, yellow, sessile nodule covered with intact mucosa •common sites - floor of the mouth, ventral tongue, soft palate Mucocele •local trauma damages the excretory duct of a minor salivary gland •saliva escapes into the adjacent connective tissue causing a chronic inflammatory reaction •solitary, circumscribed nodule with a braod base •occures most often on the lower lip Ranula •usually caused by a sialolith or local trauma to the duct of the submandibular salivary gland •saliva escapes into the connective tissue of the floor of the mouth causing a chronic inflammatory reaction Differencial diagnosis - abscess !!! - gingival, - periodontal, - periapical - acute pain associated with a tooth? - pocket, fistula? Detailed examination+X ray Drug induced gingival hyperplasia •phenytoin, calcium channel blockers, cyclosporine •plaque induced gingivitis modified by drugs •affects the anterior facial gingiva most often •firm to palpation, usually painless, persistent Leukemic gingival infiltrate •proliferation of malignant white blood cells, infiltration of gingival tissue •acute monocytic leukemia •diffuse gingival swelling •spontaneous bleeding