Pediatric emergency medicine trisk 1028 1028
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Peripheral ossifying fibroma is a benign gingival neoplasm, likely arising from
cells in the periodontal ligament and the periosteum. They appear as soft or firm
sessile nodules. Recurrence after resection is common. Peripheral giant cell
granuloma is a similar lesion that may be found on the lingual or buccal aspect of
the interdental papillae. Typical size is approximately 2 cm, and surgical excision
and curettage is required. Desmoids are another type of benign tumor that may be
found intraorally, deriving from the musculoaponeuroses. They are histologically
benign, but require wide excision and close follow-up as they are locally
aggressive with a high recurrence rate.
Mucoceles are soft, well-demarcated masses arising from obstruction of
salivary glands. Symptoms are minimal, but excision or marsupialization is
typically required. A ranula is a retention cyst or mucocele of the submaxillary or
sublingual duct ( Fig. 52.3 ). Ranulas are typically found on the underside of the
tongue or the floor of the mouth. Many will resolve spontaneously, but resection
is appropriate for persistence or repeated recurrence.
Lingual thyroid tissue may be present in the posterior midline of the tongue
due to complications in embryologic migration. Radionuclide scanning should be
used to determine if it represents the patient’s only functioning thyroid tissue.
Excision is generally avoided unless there is concern for airway obstruction.
Administration of thyroid hormone may reduce the size of the mass.
A fibroma is a benign, smooth mass with a sessile base that frequently
develops due to soft tissue injury from minor trauma on the tongue, lips, buccal
mucosa, or palate.
Pyogenic granuloma represents granulation tissue that develops in response to
an irritant such as trauma or foreign body. Most commonly found on the gingiva,
pyogenic granulomas also occur on the tongue, lips, and buccal mucosa.
Treatment involves incision and drainage. Recurrence is common, especially
when a foreign body is present.
