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–  BENIGN TUMORS AND TUMOR-LIKE LESIONS OF THE ORAL CAVITY

Chapter 69Timothy S. Lian

Presented in otorhino-laryngology Department of Isfahan Medical School

• Congential

• inflammatory/traumatic

• neoplastic

CONGENITAL CONDITIONS

• Torus palatin

• Torus manndibular

• Lingual Thyroid

• *Developmental Cysts

Torus

• Torus palatinus and torus mandibularis • present in the second decade of life continue to grow

slowly• Tori present as mucosally covered bony outgrowths of the

palate and mandible.• in 3% to 56% of adults /f>m• The tori of the palate : only in the midline of the hard

palate,• mandibular tori : only the lingual surface of the anterior

mandible, primarily in the premolar region• usually asymptomatic, unless the torus interferes with

denture placement or is repeatedly traumatized when the patient eats.

• In symptomatic treated by removing them from the underlying cortex with osteotomes or cutting burrs.

• * Recurrence is occasionally seen; however, malignant transformation has not been reported.

Lingual Thyroid

• 90% of all ectopic thyroid dorsum of the tongue• Because: the lack of descent • in the midline: in the area of foramen cecum.• approximately 1/18,000 to 1/100,000 live births were associated with

ectopic thyroid tissue involving the tongue• usually asymptomatic, can be associated with hypothyroidism.(70%

of patients )• Other symptoms : mass effect cause airway obstruction and/or

difficulties with swallowing. dysphagia or the sensation of a lump in their throat.

• Symptoms may occur at times of increased metabolic • Malignant transformation is rare• Treatment: for hypothyroid thyroid replacement therapy, reduce

the size reduce any obstructive symptoms.• Treatment for symptomatic euthyroid patients typically involves

surgical excision. • *1(transcervical routes pharyngotomy or transhyoid pharyngotomy,

2) transoral excision with use of the CO2 laser administer postoperative exogenous thyroid hormone, because 70% of patients : lingual thyroid as the only functioning thyroid tissue

Developmental Cysts

• Dermoid cyst,

• Duplication cysts,

• *Nasoalveolar cysts.

Dermoid cyst• cystic mass found along embryonic fusion lines

and form from epithelial rests• are lined by squamous epithelium contain

elements of epidermal appendages, including hair follicles, sweat glands, and connective tissue.

• 7% of dermoid cysts in the head and neck,

( 6.5% to 23% : in the floor of the mouth)• functional problems difficulties with

deglutition, speech, and respiration • * Treatment : complete excision

Duplication cysts• Enteric duplication cysts contain

elements of gastrointestinal mucosa

• . found anywhere along the digestive tract, tongue and floor of the mouth.

• at birth as an asymptomatic swelling involving the tongue and/or the floor of mouth

• functional problems difficulties with deglutition, speech, and respiration

• Treatment : complete excision

Nasoalveolar cysts• from trapped nasal epithelium between the

developing lateral and medial maxillary nasal processes.

• usually occur in adulthood as the cyst increases in size with swelling in the nasolabial area, which unilateral elevation of the nasal ala.

• Intraorally, a smooth, mucosal covered mass in the gingival labial sulcus is seen.

• Remodeling of the anterior maxilla is also seen • Treatment: complete excision (usually : sublabial

approach Care : repair any disrupted nasal mucosa ( risk of oronasal fistula )

INFLAMMATORY CONDITIONS

• Fibroma

• Mucosal Ulcerations

• Pyogenic Granuloma

• *Necrotizing Sialometaplasia

Irritation Fibroma

• common tumorlike of the oral cavity and oropharynx.

• inflammatory :fibrous hyperplastic response to chronic irritation.(not be confused with true fibromatous )

• in 1.2% of adults ( 66% =female • usually after the fourth decade• Usually: solitary& < 1.5 cm.• an asymptomatic, sessile or pedunculated, firm

mass IN the buccal, labial, or tongue mucosa.• Treatment is with conservative excision• recurrence is unlikely.)

Mucosal Ulcerations

• Can similar to malignant lesions. such as recurrent aphthous stomatitis, Crohn's disease, Behçet's syndrome, hematinic deficiency, or immunoincompetence.

• the most common cause : recurrent aphthous stomatitis.• Aphthae : inflammatory mucosal ulcerations : in 20% to

60% • Stress, local trauma, and/or allergy develope• a painful ulceration surrounded by an erythematous halo

+ thin line of coagulation necrosis separating the halo from the saucerized ulcer bed of fibrinoid necrotic debris

• (Immunoincompetent conditions do not produce the surrounding erythematous ring.

• Most : resolve without therapy within 10 days. • persist beyond 10 to 14d :workup : tissue analysis.\

Pyogenic Granuloma

• occur on any mucosa surface subject to acute or chronic trauma or infection

• association with pregnancy= epulis gravidarum • association with recent tooth extraction, =

epulis granulomatosa, • Most : involve the gingiva; other common =

the labial mucosa, the buccal mucosa, and the tongue

• typically : raised or pedunculated (<2.5 cm ):bleed with minor trauma.

• Treatment is by excision and removal of potential traumatic or infective factors

Necrotizing Sialometaplasia

• a self-healing, ulcerative, inflammatory reaction of unknown etiology

• may be precipitated by local trauma • typically arises from minor salivary glands ( in 77%

involves the palate)• painful ulceration and surrounding area of swelling • that clinically stimulates a malignancy such as squamous

cell carcinoma or mucoepidermoid carcinoma.• <2 cm. • Dx:biopsy = lobar necrosis and sialadenitis mixed with

squamous metaplasia of excretory ducts and acini.. Treatment : supportive care lesions are self-limited. ( within 3 to 6 weeks)

• . Close follow-up during the healing : can be found in conjuction with a malignancy

BENIGN NEOPLASMS

• Papilloma

• Granular Cell Tumor

• Neurofibroma

• Lipoma

• Hemangioma

• Ameloblastoma

• Pleomorphic Adenoma

Papilloma

• most frequently : squamous papilloma• Approximately 4 out of 1000 adults in US • most commonly associated with HPV-6 &HPV11• in adults have a lower recurrence rate, • Development of precancerous : rare.• Sites : lingual, buccal, or labial mucosa. • present as a single, asymptomatic soft,

pedunculated mass with numerous fingerlike projections at the surface

• Treatment =surgical excision or ablation with use of a CO2 laser.

• Recurrence in the oral cavity or oropharynx is unlikely.

Granular Cell Tumor

• neural in origin. • after the third decade of life.• more than half of all cases occur in the oral

cavity.• >1/3: the dorsum of the tongue.• Other sites : soft palate, uvula, and labial

mucosa• present as firm, painless, relatively immobile

sessile nodular-appearing lesions <1.5 cm • malignant variety of : 1% of all cases. • Surgical excision is the treatment of choice. • *Recurrence is <10%, even with a

microscopically positive margin.

Neurofibroma

• most common of the peripheral nerve neoplasms.• The lesion is derived from a mixture of Schwann cells and

perineural fibroblasts.• in adolescents and young adults.• multiple neurofibromas : with von Recklinghausen's

neurofibromatosis.• 70% of all cases of von Recklinghausen's :involve the oral cavity,

primarily the tongue.• Solitary neurofibromas of the oral cavity usually involve the tongue,

buccal, or labial mucosa• as soft, painless, slow-growing masses.• Treatment : complete surgical excision. • Solitary neurofibroma can be excised with relatively little risk of

recurrence. • Solitary neurofibromas very rarely undergo malignant transformation

into sarcoma;• however, up to 12% of those with von Recklinghausen's

neurofibromatosis have a malignancy develop.

Lipoma

• uncommon neoplasm of the oral cavity

• usually occur after the third decade of life

• as a soft, slowly enlarging, mucosal covered, smooth, painless mass.

• typically : in the buccal, lingual, or floor of mouth areas.

• Histologically, lipomas consist of mature adipocytes

• Treatment = surgical excision

Hemangioma

• relatively common.• In OC: 14% of all hemangiomas.• present at birth with a rapid proliferative phase,• they may become clinically evident later in life.• associated with a : Sturge-Weber-Dimitri syndrome& von Hippel-

Lindau syndrome. • most frequent site :LIP• as a soft, painless mass that is red or blue. <2 cm (can become

quite extensive to involve significant portions of the oral cavity and oropharynx to include the tongue.)

• spontaneously regress; however may be incomplete involution or associated fibrosis

limit the form and function : treated with conservative surgical excision.

• Recurrence or persistence is not unusual.• Intralesional sclerosing agents, interferons, laser treatment, local

and systemic steroids, and radiation have been reported as primary or adjunctive treatment with varying success

Ameloblastoma

• the most common neoplasms of odontogenic origin.• to arise from rests of primitive dental lamina related to

the enamel organ in alveolar bone.• seen in the third decade of life• a painless mass involving the maxilla or mandible (85% :

the mandible is involved, usually at the molar/ramus area)

• x-ray imaging : unilocular or multilocular radiolucency. Cortical bone expansion can be seen

• Treatment : en bloc resection with at least 1-cm margins of normal-appearing tissue.

• recurrence rate is 22%, > recurrences: within 5YLifelong follow-up is recommended.

• Malignant transformation can occur but is rare.

Pleomorphic Adenoma

• < 10% of salivary gland tumors arise from minor salivary glands.

• 40% : arising from minor salivary glands are benign

• is the most frequently encountered benign tumor of minor salivary glands

• Most common site :the hard palate

• . smooth and are slow growing.

• Treatment = surgical excision.

• Torus palatinus

• Duplication cyst involving the tongue

• Aphthous ulcer

• Pyogenic granuloma of the lateral tongue

•   Granular cell tumor of the lingual dorsum

• Ameloblastoma of the molar and ramus of the mandible

• Minor salivary gland pleomorphic adenoma of the retromolar trigone.

• Necrotizing Sialometaplasia

• Torus palatinius

• Pyogenic Granuloma

• epulis gravidarum

• Thanks for your attention