Lesions of the Palate,Tongue, Floor of the Mouth Shafa Amirsoltani D.D.S.

Lesions of the Palate l Torus Palatinus l Incisiva Canal Cyst l Palatal Abscess l Benign Lymphoid Hyperplasia l Necrotizing Sialometaplasia l Pleomorphic Adenoma l Monomorphic Adenoma l Mucoepidermoid Carcinoma l Adenoid Cystic Carcinoma l Lymphoma Of the Palate l Torus Palatinus l Incisiva Canal Cyst l Palatal Abscess l Benign Lymphoid Hyperplasia l Necrotizing Sialometaplasia l Pleomorphic Adenoma l Monomorphic Adenoma l Mucoepidermoid Carcinoma l Adenoid Cystic Carcinoma l Lymphoma Of the Palate

Torus Palatinus l bony exostosis l 20% of adult l slowly increases in size l single,smooth,dome-shape bony hard swelling l midline of the hard palate l asymptomatic l unless traumatized l bony exostosis l 20% of adult l slowly increases in size l single,smooth,dome-shape bony hard swelling l midline of the hard palate l asymptomatic l unless traumatized

Incisive Canal Cyst l developmental l anywhere along the course of incisive canal l generally confined to the palatal bone between #8 & #9 l asymptomatic l a well developed incisive canal cyst may swell the entire anterior third of the hard palate l radiographically : –delineated, symmetrically oval or heart shape radiolucency located between roots of vital central incisors l if located more posterorly in palate has been raffered to as the Median Palatal Cyst l Treatment is surgical enucleation l developmental l anywhere along the course of incisive canal l generally confined to the palatal bone between #8 & #9 l asymptomatic l a well developed incisive canal cyst may swell the entire anterior third of the hard palate l radiographically : –delineated, symmetrically oval or heart shape radiolucency located between roots of vital central incisors l if located more posterorly in palate has been raffered to as the Median Palatal Cyst l Treatment is surgical enucleation

Periapical Abscess l fluctuant soft- tissue swelling l bacterial infection of the pulp l tender to percussion l you should know everything about this by now l fluctuant soft- tissue swelling l bacterial infection of the pulp l tender to percussion l you should know everything about this by now

Benign Lymphoid Hyperplasia l reactive process l proliferation of the lymphoid tissue of the palate l age over 50 more affected l unknown etiology l usually soft, nonulcerated, dome-shape or lumpy l surgical exsicision l reactive process l proliferation of the lymphoid tissue of the palate l age over 50 more affected l unknown etiology l usually soft, nonulcerated, dome-shape or lumpy l surgical exsicision

Necrotizing sialometaplasia l reactive lesion,chiefly of accessory salivary glands l begins after trauma as a rapidly growing nodular swelling on the lateral aspect of the hard palate l usually after dental traeatment l tissue infarction due to vasoconstriction and ischemia l initially small painlesss nodule l eventually enlarges and ulcerates and becomes painfull l heals in 4-8 weeks l biopsy is recommended to rule out malignancy l reactive lesion,chiefly of accessory salivary glands l begins after trauma as a rapidly growing nodular swelling on the lateral aspect of the hard palate l usually after dental traeatment l tissue infarction due to vasoconstriction and ischemia l initially small painlesss nodule l eventually enlarges and ulcerates and becomes painfull l heals in 4-8 weeks l biopsy is recommended to rule out malignancy

Pleomorphic Adenoma l most common benign neoplasm of accessory salivary gland l major and minor salivary glands l 55% on the palate l occcours to the lateral to the midline l firm painless,nonulcerated, irregulary dome- shaped swelling l slow persistent enlargement over period of years l through excisional biopsy l most common benign neoplasm of accessory salivary gland l major and minor salivary glands l 55% on the palate l occcours to the lateral to the midline l firm painless,nonulcerated, irregulary dome- shaped swelling l slow persistent enlargement over period of years l through excisional biopsy

Mucoepidermoid Carcinoma and Adenoid Cysytic Carcinoma l two most common introral malignant accessory salivary gland neoplasms l ages 20 to 50 affected by mucoepidermoid carcinoma l ages over 50 affected by adenoid carcinoma l asymptomatic, firm, dome- shaped, swelling on lateral to midline of the palate l in duration and spontaneous ulceration indicating rapid malignant growth l bluish appearance and/or mucous exudate emanating from the ulcerated surface of the swelling are distinctive for mucoeperdimiod carcinoma l Treatment is radical excision l two most common introral malignant accessory salivary gland neoplasms l ages 20 to 50 affected by mucoepidermoid carcinoma l ages over 50 affected by adenoid carcinoma l asymptomatic, firm, dome- shaped, swelling on lateral to midline of the palate l in duration and spontaneous ulceration indicating rapid malignant growth l bluish appearance and/or mucous exudate emanating from the ulcerated surface of the swelling are distinctive for mucoeperdimiod carcinoma l Treatment is radical excision

TongueTongue l lateral border of the tongue is the site of 25% of all oral squamous cell carcinoma and 50% of intraoral lesions l normal tongue anantomy; circumvallate papillae, folliate papilla, lingual tonsil, fissured tongue l ankyloglossia l vercosity l scalloped tongue l macroglossia l hairy tongue l lateral border of the tongue is the site of 25% of all oral squamous cell carcinoma and 50% of intraoral lesions l normal tongue anantomy; circumvallate papillae, folliate papilla, lingual tonsil, fissured tongue l ankyloglossia l vercosity l scalloped tongue l macroglossia l hairy tongue

Tongue contiued l hairy leukoplakia l geographic tongue l anemia l xerostomia l median rhomboid glossitis l atophic csnadidtis l granular cell tumor l lingual thyroid l hairy leukoplakia l geographic tongue l anemia l xerostomia l median rhomboid glossitis l atophic csnadidtis l granular cell tumor l lingual thyroid

AnkyloglossiaAnkyloglossia l lingual frenum attached to ventral tongue and genial tubercles of mandible l speech may disturbed l Treatment surgical correction l lingual frenum attached to ventral tongue and genial tubercles of mandible l speech may disturbed l Treatment surgical correction

MacroglossiaMacroglossia l abnormally enlarged tongue l congential muscular hypotherapy, muscular hemihypotherapy l acquired passive enlargemenet of the tongue after losing mandibular teeth l abnormally enlarged tongue l congential muscular hypotherapy, muscular hemihypotherapy l acquired passive enlargemenet of the tongue after losing mandibular teeth

Hairy Tongue l abnormal elongation of the filiform papillae l poor oral hygeine l cancer therapy l infection with candida albicans l smoking l white, yellow, brown, or black l Treatment, vigourous brusshing, topical antifungal agents l abnormal elongation of the filiform papillae l poor oral hygeine l cancer therapy l infection with candida albicans l smoking l white, yellow, brown, or black l Treatment, vigourous brusshing, topical antifungal agents

Hairy Leukoplakia l HIV patient l lateral border of tingue l Epstein-Barr virus l do not rub off l bilatereral occurrence is common l antiviral agent reduces the size l HIV patient l lateral border of tingue l Epstein-Barr virus l do not rub off l bilatereral occurrence is common l antiviral agent reduces the size

Geographic Tongue l benign inflammatory condition l unknown etiology, stress, and nutritional deficiency, and heredity l single or multiple pink to red denuded patches l 1% ot 2% of population l topical anesthetic or topical steroid for symptomatic patient l benign inflammatory condition l unknown etiology, stress, and nutritional deficiency, and heredity l single or multiple pink to red denuded patches l 1% ot 2% of population l topical anesthetic or topical steroid for symptomatic patient

Median Romboid Glossitis l permanent end result of a candidad albicans infection in conjuction with other factors: –smoking –oral PH change l smooth denoted beefy red patch l with time becomes granular,lobular, and indurated l midline of the dorsum of the tongue is the most common site l asymptomatic l permanent end result of a candidad albicans infection in conjuction with other factors: –smoking –oral PH change l smooth denoted beefy red patch l with time becomes granular,lobular, and indurated l midline of the dorsum of the tongue is the most common site l asymptomatic

Lingual Thyroid l when embryonic tissue from the thyroid gland fails to migrate to antrolateral surface of the trachia l raised asymptomatic mass about 2 cm in diameter l hemorraghe dysphogia, dysphonia, sympotoms of hypothyroidism can be associated with this condition l when embryonic tissue from the thyroid gland fails to migrate to antrolateral surface of the trachia l raised asymptomatic mass about 2 cm in diameter l hemorraghe dysphogia, dysphonia, sympotoms of hypothyroidism can be associated with this condition

Granular Cell Tumor l submucosal mass l most dorsal or lateral aspects of the tongue l firm submucosal nodule or plaque l the surface of the mucosa is usually intact l growth is very slow and painless l Treatment is excision l submucosal mass l most dorsal or lateral aspects of the tongue l firm submucosal nodule or plaque l the surface of the mucosa is usually intact l growth is very slow and painless l Treatment is excision

Lesion of The Floor of The Mouth l 20% of oral carcinoma l 3rd most common site of al intraoral l Ranula l Salivary Calculi l Mucous Retention Phenomenon l 20% of oral carcinoma l 3rd most common site of al intraoral l Ranula l Salivary Calculi l Mucous Retention Phenomenon

Dermoid Cyst l soft tissue swelling l developmental anywhere on skin l floor of the mouth is more common l painless midline, domeshaped mass l tongue is slightly elevated l dough-like consistency l patient might complain of pain during eating and speaking l slow growth l Treatment is surgical ennuculation l soft tissue swelling l developmental anywhere on skin l floor of the mouth is more common l painless midline, domeshaped mass l tongue is slightly elevated l dough-like consistency l patient might complain of pain during eating and speaking l slow growth l Treatment is surgical ennuculation

RanulaRanula l same as mucus retention phenomenon but in greater size l large mucine containing cyst in the floor of the mouth l as a result of inhibition of normal salivary flow l unilateral domeshaped fluculant and asymptomatic l same as mucus retention phenomenon but in greater size l large mucine containing cyst in the floor of the mouth l as a result of inhibition of normal salivary flow l unilateral domeshaped fluculant and asymptomatic

SialolithsSialoliths l salivary calculi or stones may obstruct salivary flow l causes the floor of the mouth to swell, which creates pain and is firm l twice as often in male than female l usually in submandibular gland l acute symptoms often occur during mealtime l secondary infrection result in pus emanating from the ductal opening or in redness of the swollen floor of the mouth l Treatment is surgical removal l salivary calculi or stones may obstruct salivary flow l causes the floor of the mouth to swell, which creates pain and is firm l twice as often in male than female l usually in submandibular gland l acute symptoms often occur during mealtime l secondary infrection result in pus emanating from the ductal opening or in redness of the swollen floor of the mouth l Treatment is surgical removal

Pigmented Lesion Shafa Amirsoltani, DDS

MaculeMacule l circumscribed area l less than 1 cm or smaller l not elevated or depressed l circumscribed area l less than 1 cm or smaller l not elevated or depressed

PapulePapule l elevated solid lesion l less than 1 cm l may be attached by a stalk l elevated solid lesion l less than 1 cm l may be attached by a stalk

NoduleNodule l like papules but extends to deeper tissue

Benign Pigmented Lesion l Production and extra cellular deposition of melanin l lesions with melanin in basal cells appear brown l lesions with melanin in keratinand spinous cells appear black l lesions with melanin in connective tissue appear blue l Production and extra cellular deposition of melanin l lesions with melanin in basal cells appear brown l lesions with melanin in keratinand spinous cells appear black l lesions with melanin in connective tissue appear blue

Melanitic Macules l physiologic or reactive l small, flat, brown areas l two kinds : l labial melanotic macule / lip lesion l oral melanotic macule / oral mucosa lesion l physiologic or reactive l small, flat, brown areas l two kinds : l labial melanotic macule / lip lesion l oral melanotic macule / oral mucosa lesion

Labial Melanotic Macule l asymptomatic l primarily found on vermilion border of the lower lip l usually solitary l less than 5 mm in diameter l flat l brown to brownish- black l asymptomatic l primarily found on vermilion border of the lower lip l usually solitary l less than 5 mm in diameter l flat l brown to brownish- black

Oral Melanotic Macule l asymptomatic less than 1 cm in diameter l occurrs on the gingiva,buccal mucosa, and palate l asymptomatic less than 1 cm in diameter l occurrs on the gingiva,buccal mucosa, and palate

Oral Melanoacanthomas l years old African American l develp within a few month resolves without Treatment l solitary, multiple l dark brown to black l 5 mm to 2 cm l years old African American l develp within a few month resolves without Treatment l solitary, multiple l dark brown to black l 5 mm to 2 cm

TreatmentTreatment l accurate diagnosis may not be attainable through clinical examination alone l if lesion arise within a short period of time excisional biopsy is indicated l accurate diagnosis may not be attainable through clinical examination alone l if lesion arise within a short period of time excisional biopsy is indicated

Smoker’s melanosis l associated w/ prolonged smoking l increase in melnin production l most in max. /man./anterior labial region l soft palatal melanosis might indicate bronchogenic carcinoma and emphysema, so accurate diagnosis is important l associated w/ prolonged smoking l increase in melnin production l most in max. /man./anterior labial region l soft palatal melanosis might indicate bronchogenic carcinoma and emphysema, so accurate diagnosis is important

TreatmentTreatment l stop smoking l biopsy l stop smoking l biopsy

Melanoma l malignant neoplasm l skin/ mucosa l rare in oral mucosa l dark brown, bluish- black l papule l nodule l malignant neoplasm l skin/ mucosa l rare in oral mucosa l dark brown, bluish- black l papule l nodule

Phases of oral cavity melanoma’s growth l radial – confined to the surface epithelium l vertical –neoplastic cells invade and papulate the connective tissue l growth phase duration differs in different types of melanoma l radial – confined to the surface epithelium l vertical –neoplastic cells invade and papulate the connective tissue l growth phase duration differs in different types of melanoma

Types of Melanoma l superficial -spreading of melanoma –skin and oral mucosa l nodular –skin and oral mucosa l lentigo maligna melanoma –skin l acral lentigo melanoma –skin l superficial -spreading of melanoma –skin and oral mucosa l nodular –skin and oral mucosa l lentigo maligna melanoma –skin l acral lentigo melanoma –skin

Superficial Spreading Melanoma l most common 80% of all lesions l irregular shape l brown-black macule with jagged border l multiple satellite lesions l radial phase –may take days to months – lesion becomes l larger l more intense l nodular / ulcerated frank invasion of connective tissue by tumor cells l most common 80% of all lesions l irregular shape l brown-black macule with jagged border l multiple satellite lesions l radial phase –may take days to months – lesion becomes l larger l more intense l nodular / ulcerated frank invasion of connective tissue by tumor cells

TreatmentTreatment l early diagnosis when lesion still is in radial stage is the key –less than 0.76 mm thick rarely metastasize l chemotherapy/immunotherapy in experimental stage l poor prognosis for nodular melanoma with vertical growth l early diagnosis when lesion still is in radial stage is the key –less than 0.76 mm thick rarely metastasize l chemotherapy/immunotherapy in experimental stage l poor prognosis for nodular melanoma with vertical growth

NeviNevi l benign l exophytic l pigmented l mole l benign l exophytic l pigmented l mole

Classification of Ne`vi l intramucosal (intradermal) l junctional l compound l intramucosal (intradermal) l junctional l compound

Intramucosal (Intradermal) Nevos l benign l young pts. l mole l asymptomatic l pigmented brown to black l slightly elevated papule / flat macule l grows slowly l less than 1 cm in diameter l do not recur l histopathology –nests of nevos cells confind to the connective tisue l benign l young pts. l mole l asymptomatic l pigmented brown to black l slightly elevated papule / flat macule l grows slowly l less than 1 cm in diameter l do not recur l histopathology –nests of nevos cells confind to the connective tisue

TreatmentTreatment l excisional biopsy

Junctional Nevos l benign l less common l pigmented macule l histopathology –nests of nevos cells in the basilar region of the epithelium / epithelial rete pegs –carefull examination / simmilar to early phase of melanoma –might transform to melanoma l benign l less common l pigmented macule l histopathology –nests of nevos cells in the basilar region of the epithelium / epithelial rete pegs –carefull examination / simmilar to early phase of melanoma –might transform to melanoma

TreatmentTreatment l excisional biopsy l do not recur l excisional biopsy l do not recur

Compound Nevos l more common in skin l pigmented papule or macule l histopathology –nevos cells in the basal region and adjuacent connective tissue l more common in skin l pigmented papule or macule l histopathology –nevos cells in the basal region and adjuacent connective tissue

Blue Nevus l benign l pigmented /dark blue l dome shape / or flat macule l histopathology –spindled l benign l pigmented /dark blue l dome shape / or flat macule l histopathology –spindled

TreatmentTreatment l excional biopsy

Ephelides( Freckles) l lip l skin l dark brown macule l lip l skin l dark brown macule

Peutz- Jeghers Syndrome l autosomal dominant l multiple melanotic mucocataneous macules l gastrointestinal polyposis l autosomal dominant l multiple melanotic mucocataneous macules l gastrointestinal polyposis

Addison’s disease l failure of the feedback loop from the adrenal gland l results in increases (ACTH ) adrenocorticotrophic hormones which l results in Increase of MSH which l results in increase the deposition of melanin l replacement therapy with corticosteroids –results gradual decrease of the hyperpigmentation l failure of the feedback loop from the adrenal gland l results in increases (ACTH ) adrenocorticotrophic hormones which l results in Increase of MSH which l results in increase the deposition of melanin l replacement therapy with corticosteroids –results gradual decrease of the hyperpigmentation

TattooTattoo l implantation of exogenous pigments in the mucosa l accidentally –amalgam tattoo l intentionally l implantation of exogenous pigments in the mucosa l accidentally –amalgam tattoo l intentionally

Amalgam Tattoo l entrapment of amalgam in wounded soft tissue l blue black l non elevated l radiographic evidence l entrapment of amalgam in wounded soft tissue l blue black l non elevated l radiographic evidence

Heavy Metal Pigmentation l lead l silver l lead l silver

VarixVarix l reactive proliferation l vascular lesions of the lip and oral mucosa l may arise in adulthood l focal venous dilatation l may become hyperplastic l reactive proliferation l vascular lesions of the lip and oral mucosa l may arise in adulthood l focal venous dilatation l may become hyperplastic

TreatmentTreatment l most untreated l may be excised for cosmetic reason l most untreated l may be excised for cosmetic reason