Oral Pathology in the Pediatric Patient: A Clinical Guide to the Diagnosis and Treatment of Mucosal Lesions

149 Pages·2016·8.84 MB·English

by  Elizabeth Philipone

Elizabeth Philipone
Angela J. Yoon
Oral Pathology in
the Pediatric Patient
A Clinical Guide to the
Diagnosis and Treatment
of Mucosal Lesions
123
Oral Pathology in the Pediatric Patient
Elizabeth Philipone (cid:129) Angela J. Yoon
Oral Pathology in the
Pediatric Patient
A Clinical Guide to the Diagnosis and
Treatment of Mucosal Lesions
Elizabeth Philipone , DMD Angela J. Yoon , DDS, MPH, MAMSc
Associate Professor John W. Richter Associate Professor
Columbia University College of Dental of Oral Pathology
Medicine and Department of Pathology and Columbia University College of Dental
Cell Biology Medicine and Department of Pathology
Columbia University Medical Center and Cell Biology
New York , NY Columbia University Medical Center
USA New York , NY
USA
ISBN 978-3-319-44638-7 ISBN 978-3-319-44640-0 (eBook)
DOI 10.1007/978-3-319-44640-0
Library of Congress Control Number: 2016957759
© Springer International Publishing Switzerland 2017
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Pref ace
The authors of O ral Pathology in the Pediatric Patient : A Clinical Guide to the
Diagnosis and Treatment of Mucosal Lesions both practice clinical oral pathology
in New York City and are certifi ed by the American Board of Oral and Maxillofacial
Pathology. Based on their experience seeing patients and supervising an active
biopsy service, they have compiled a sampling of the oral mucosal lesions most
likely to be encountered in children in everyday practice. The authors’ goal was to
create an easy to use reference guide for clinicians to turn to for guidance in identi-
fying and managing oral mucosal lesions in pediatric patients.
O ral mucosal lesions are not uncommon in the pediatric population. Fortunately,
the vast majority of these mucosal lesions are benign and many are transient – being
of either a traumatic or infectious etiology. Often times a diagnosis can be rendered
by coupling a careful clinical history with the clinical presentation.
For each entity covered in this manual, characteristic clinical photographs are
provided, the clinical appearance is concisely described, and guidance is offered on
formulating a differential diagnosis and selecting appropriate treatment.
Oral mucosal indications of systemic diseases, clinical indicators of drug use,
sexual abuse, and eating disorders are addressed in section two.
F or those lesions in which the clinical diagnosis and subsequent patient manage-
ment is unclear, it is best to seek a second opinion from a specialist. In addition, it
is also often prudent to communicate your fi ndings to the child’s pediatrician.
Having a complete and accurate medical history is crucial for proper patient
management.
New York , NY , USA Elizabeth Philipone , DMD
v
Acknowledgements
W e would like to express our sincere thanks to Dr. David Zegarelli and Dr. Michael Z.
Marder for providing many clinical photos from their own collections and for
sharing their vast clinical experience and knowledge with us.
vii
Contents
Part I Mucosal Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1 Mucosal Lumps and Bumps with Smooth Surfaces . . . . . . . . . . . . . . . . 3
1.1 Mucocele . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.2 Ranula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.3 A Note on Salivary Gland Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
1.4 Fibroma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
1.5 Pyogenic Granuloma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
1.6 Hemangioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
1.7 Vascular Malformation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
1.8 Lymphangioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
1.9 A Note on Soft Tissue Sarcomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2 Papillary Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
2.1 Verruca Vulgaris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
2.2 Squamous Papilloma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
2.3 Condyloma Accuminatum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2.4 Heck Disease (Focal Epithelial Hyperplasia) . . . . . . . . . . . . . . . . . . 30
3 Oral Ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
3.1 Acute Herpetic Gingivostomatitis (Primary Herpes) . . . . . . . . . . . . . 34
3.2 Herpes Labialis and Recurrent Intraoral Herpes . . . . . . . . . . . . . . . . 35
3.3 Herpangina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
3.4 Hand-Foot-and-Mouth Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
3.5 Traumatic Ulcer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
3.6 Aphthous Ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
3.7 Erythema Multiforme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
3.8 Summary of Multifocal Oral Ulcers in a Child. . . . . . . . . . . . . . . . . 59
3.9 Impetigo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
4 White and Red Macules and Patches . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
4.1 Morsicatio Buccarum, Linguarum, and Labiorum . . . . . . . . . . . . . . 62
4.2 Superfi cial Chemical Burn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
4.3 Oral Candidiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
4.4 Benign Migratory Glossitis/Geographic Tongue . . . . . . . . . . . . . . . . 67
ix
x Contents
4.5 Leukoplakia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
4.6 Erythroplakia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
5 Gingival Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
5.1 Pyogenic Granuloma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
5.2 Peripheral Ossifying Fibroma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
5.3 Peripheral Giant Cell Granuloma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
5.4 Eruption Cyst . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
5.5 Parulis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
5.6 Summary of Focal Gingival Nodules . . . . . . . . . . . . . . . . . . . . . . . . . 91
5.7 Gingival/Alveolar Cysts of the Newborn . . . . . . . . . . . . . . . . . . . . . . 92
5.8 Localized Juvenile Spongiotic Gingival Hyperplasia . . . . . . . . . . . . 93
5.9 Mouth-Breathing Gingivitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
6 Pigmented Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
6.1 Amalgam Tattoo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
6.2 Melanotic Macule (Focal Melanosis) . . . . . . . . . . . . . . . . . . . . . . . 103
6.3 Physiologic (Racial) Pigmentation . . . . . . . . . . . . . . . . . . . . . . . . . 106
6.4 Mucosal Nevi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
6.5 Coated Tongue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Part II Mucosal Manifestations of Systemic Disease,
Habits, and Abuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
7 Mucosal Manifestations of Gastrointestinal Disease . . . . . . . . . . . . . . 115
7.1 Recurrent Aphthous-like Ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
7.2 Pyostomatitis Vegetans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
7.3 Mucosal Tags or Folds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
7.4 Cobblestoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
7.5 Mucogingivitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
7.6 Persistent Orofacial Swelling (Orofacial Granulomatosis) . . . . . . . 117
8 Mucosal Manifestations of Nutritional Deficiencies . . . . . . . . . . . . . . 121
9 Mucosal Manifestations of Immunosuppression . . . . . . . . . . . . . . . . . 125
9.1 HIV/AIDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
10 Oral Soft Tissue Manifestations of Hematologic
Abnormalities and Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
10.1 White Blood Cell Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
10.2 Red Blood Cell Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
10.3 Platelet Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
11 Oral Manifestations of Habits and Abuses . . . . . . . . . . . . . . . . . . . . . . 135
11.1 Physical Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
11.2 Eating Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Part I
Mucosal Lesions
1
Mucosal Lumps and Bumps with Smooth
Surfaces
M ucosal lumps and bumps are more accurately referred to as submucosal nod-
ules. In general, submucosal nodules do not spontaneously resolve and often
require surgical excision for treatment. A retrospective analysis of 3,129 oral
pathology biopsy specimens from pediatric patients (0–18 years of age) submitted
for diagnosis to Columbia University Medical Center, Department of Oral and
Maxillofacial Pathology found mucocele and fi broma to comprise the two most
frequently diagnosed soft tissue lesions. In this chapter, we review the clinical
appearance, etiology, differential diagnosis, and recommended treatment for sub-
mucosal nodules.
Gingival nodules are covered in Chap. 5 .
Mucosal lumps and bumps with smooth surfaces
Mucocele
Fibroma
Pyogenic granuloma
Hemangioma, vascular malformations, lymphangioma
© Springer International Publishing Switzerland 2017 3
E. Philipone, A.J. Yoon, Oral Pathology in the Pediatric Patient,
DOI 10.1007/978-3-319-44640-0_1