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PART II
Soft Tissue Lesions
A
A
B B
Fig. 10-12. Palatal growths posterior to denture flanges. A, Epulis fissuratum. B, Malignant SGT. ote the progressive fissuring.
in patients from childhood to old age but are seen more often in patients over 40 years of age. Differential diagnosis The frequency of occurrence of the epulis fissuratum far exceeds that of any other exophytic lesion at the periphery of dentures. However the possibility of malignancy must be considered in each case: squamous and verrucous carcinomas, minor salivary gland tumors (SGTs), metastatic tumors, osteosarcoma, and down-reaching maxillary sinus malignancies (Figs. 10-12 and 10-25). Management Small, red lesions composed mostly of inflamed tissue and some hyperplasia may subside in 2 or 3 weeks if the denture flange is reduced without further treatment. Larger, more fibrosed lesions will require excision, perhaps combined with a sulcus-deepening procedurc. In either case a new, well-adapted denture should be fabricated, or at least the current appliance should be adjustcd and rebased. Microscopic examination of excised tissue is always mandatory.
Parulis A parulis is a small, IH type of lesion that develops on the alveolar mucosa at the oral terminus of a draining sinus (Fig. 10-13 and Plate A). This lesion usually accompanies a draining chronic alveolar abscess in children. The maxillolabial and buccoalveolar mucosae are the most
Fig. 10-13. A, Parulis. IH lesion at the mucosal draining site of a chronic alveolar abscess. B, The lesion contains pus and is reall) a soft tissue abscess.
Frequent sites (see Fig. 10-13), but the mandibuloal\'eolar mucosa and palate may also be involved (see Fig. 13-6). Slight digital pressure on the periphery of a parulis may force a drop of pus from the sinus opening. and this is almost pathognomonic. The lesion usually regresses spontaneously after the chronic odontogenic infection has been eliminated. If size is considerable and there is a substantial amount of fibrosis, however, the lesion regresses somewhat and then persists as FH. Rarely. a draining osteomyelitis or infected malignant tumor may produce a similar appearance.
Papillary Hyperplasia of the Palate The IH lesion known as papillary Inpelplasia qf The palate (PHP) (palatine papillomatosis) occurs almost e>.elusively on the palate beneath a complete or partial removable denture. It is more commonly associated with a flipper-type partial denture or a full denture. Approximately 10% of the people who wear maxillary dentures have this eondition,lJ and mosl wear their dentures cominuously. Although its cause is nOI well understood. PHP appears to be related to the Frictional irritation produced