ORAL PATHOLOGY : Benign tumors in pediatric dentistry

Hemangiomas are benign, enlarged, vascular hamartomas that may occur in any soft-tissue location, most commonly on the lip, dorsum of the tongue, gingiva, and buccal mucosa.

Clinically, hemangiomas typically present as red or bluish red, slightly raised lesions and are moderately firm to palpation.

They occur early in life and are more common in girls than in boys. Hemangiomas may enlarge rapidly or progressively as the patient grows. They are usually painless but may ulcerate and possibly hemorrhage if traumatized.

The hemangioma is a tumor of mesenchymal origin, which is characterized by the formation of vascular tubes of endothelial cells.

Treatment consists of laser therapy or surgical resection of the lesion. The potential for severe hemorrhage caused by the vascular nature of the lesion must be considered.

Lymphangiomas are benign tumors of lymphatic vessels that are present at birth or develop early in life. The tongue is the most common intraoral site, followed by the lips and buccal mucosa.

Superficial tumors are soft and compressible and may be pink to reddish-blue. Deeper lesions may show no surface changes. Cystic hygroma is a large lymphangioma involving the floor of the mouth and neck.

Any lymphangiomas creating a functional or aesthetic concern usually are surgically removed. Recurrences are common and caused by their lack of encapsulation.

Read also: ORAL PATHOLOGY: Guideline on Dental Management of Heritable Dental Developmental Anomalies

The mucous extravasation phenomenon is commonly known as mucocele. This retention of mucus in subepithelial tissues most commonly occurs in children and adolescents, on the lower lip midway between the midline and commissure.

The cause is mechanical trauma to a minor salivary gland, with pooling of mucus in an obstructed and dilated excretory duct.

The lesions are usually painless and smooth surfaced and are bluish or translucent. Most mucoceles are less than 1 cm in diameter. The treatment of choice is surgical excision, with removal of associated minor salivary glands to prevent recurrence.

One of the most common benign lesions of the oral cavity, the fibroma results from reactive connective tissue hyperplasia caused by a chronic irritant. Fibromas may be found on any area of the oral mucosa, but primarily on the palate, tongue, cheek, and lip.

Most fibromas are less than 1 cm in diameter, pale pink, smooth, and firm and have a sessile or pedunculated base. Treatment involves surgical excision and removal of the source of the irritation. Recurrence is rare.

°Jayne E. Delaney, DDS, MSD, and Martha Ann Keels, DDS, PhD

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