Pediatric emergency medicine trisk 1018 1018
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either supernumerary or true deciduous teeth and are usually found in the lower
incisor region. Natal teeth may lead to ulcerations of the underside of the tongue,
called Riga–Fede disease.
Patients with ankyloglossia may be referred to as “tongue tied” because of
congenital shortening of the lingual frenum, limiting their ability to fully extend
the tongue. Surgical correction is considered when speech or feeding is affected.
Epulis is a congenital, fibrous, sarcomatous tumor that arises from the
periosteum of the mandible or maxilla. The mass is firm and pedunculated and
may regress spontaneously. Excision is required if it interferes with feeding or
breathing, or for cosmetic reasons.
Lymphatic malformations (LMs), also called lymphangioma or macrocystic
LM (formerly cystic hygroma), are benign congenital tumors of lymphatic vessels
that can appear on the tongue, lips, or buccal mucosa at birth or in early infancy.
They generally grow with the child, and can expand rapidly with intralesional
hemorrhage or infection. Hemangiomas are benign vascular tumors that become
more apparent as the patient grows. Oral hemangiomas may be accompanied by
additional internal or external vascular lesions. They generally involute
spontaneously, but if bothersome they may be treated medically, often with
propranolol, or surgically. In contrast, vascular malformations are congenital
structural anomalies of blood vessels which neither proliferate nor involute. They
appear as compressible blue or purple mucosal lesions, and may expand with
infection, injury, crying, or dependent position. They do not respond to
propranolol, requiring instead embolization, sclerotherapy, or surgical excision.
Dermoid or epidermoid cysts can be found on the floor of the mouth, soft
palate, or uvula, sometimes leading to submental swelling. They may contain hair
follicles, sebaceous glands, or sweat glands. Symptoms are minimal, and
treatment is surgical removal. Foregut duplication cysts may be present in the
floor of the mouth, containing ectopic or abnormally migrated stomach or
duodenal tissue, requiring surgical removal.
White sponge nevus is an autosomal-dominant condition presenting with white,
raised, folded-appearing lesions, often on buccal mucosa. It may be mistaken for
candidiasis.
Infectious Oral Lesions
Infectious oral lesions are most often viral in origin but may also be caused by
bacterial or fungal infections (see Chapter 94 Infectious Disease Emergencies ).
Candidiasis, or thrush, is common in neonates and infants. Caused by Candida
albicans , it presents as white plaque on the buccal mucosa, gingivae, and palate
that cannot be removed with gentle scraping. Thrush outside of infancy should
