144
PART II
Soft Tissue Lesions
glands, respectively. They are discussed Chapter 12 as bluish lesions.
In
detail
In
Differential Diagnosis
A
When the mucosal covering is thicker than usual or the lesion is not superficial, the appearance is pink. not bluish. It is soft to rubbery in consistency and is fluctuant but not emptiable. In such instances it must be differentiated from a superficial cyst. lipoma, plexifornl neurofibroma. relatiYely deep cavernous hemangioma, lymphangioma. and mucusproducing salivary gland tumor. If aspiration of the lesion produces a sticky. viscous. clear, mucuslike fluid, all the preceding lesions can be eliminated except the mucus-producing salivary gland tumors (SGTs). These lesions are uncommon. Mucoceles occur almost 80% of the time on the lower li p40 and rarely on the palate. Mucus-producing malignant SGTs (e.g., mucoepidermoid tumor, mucous adenocarcinoma) occur most often on the posterior hard palate. retromolar area, and posterolateral aspect of the floor of the mouth. An induration at the base of a retention phenomenon may be just fibrous tissue. but it should alert the clinician to the possibility of a malignant tumor.
Management If the conservative approach of marsupialization is followed, the base of the lesion must be examined carefully for pathosis, and cautious periodic follow-up must be maintained. Clinicians may choose complete excision. Specimens must be examined microscopically.
Fig. 10-18. Peripheral fibroma with calcification. A, The lesion (arrow) has caused a separation of the lateral incisor and canine.
B, Radiograph. The arrow indicates calcification within the mass.
Chondrosarcoma and osteogenic sarcoma, considered together, are less frequent gingival lesions than PFe. Although a slight bony resorption may occur beneath the PFC, more worrisome bony changes typically are seen with malignant lesions. A bandlike asymmetric widening of the periodontal ligaments of involved teeth is another finding suggestive of chondrosarcoma and osteogenic sarcoma but is not a feature of PFC (see Fig. 21-12). Management PFC should be excised and special care taken to remove the lesion's attachment in the periodontal ligament and alveolar bone. As a rule, the adjacent teeth do not have to be extracted. Although the recurrence rate is 13% to 16%,33.34.39 management is not a problem. All excised tissue should be examined microscopically.
MUCOCELE AND RANULA The mucocele and ranula are retention phenomena of the minor salivary glands and the sublingual (major) salivary
HEMANGIOMA, LYMPHA GIOMA, AND VARICOSITY Hemangiomas, lymphangiomas, and varicosities are discussed as bluish lesions in Chapter 12. If a hemangioma, lymphangioma, or varicosity is deep in the tissue, its bluish color is masked. and it is seen as a pink, smooth, nodular or dome-shaped lesion. The differential diagnosis of such lesions is similar to that of the mucocele and ranula in that significant information can be obtained by sampling the material within the lesion by aspiration, whether the aspirate be mucus: pus; red blood; blue blood; or foamy, colorless lymph fluid.
CENTRAL EXOPHYTIC LESIONS Central lesions of the jawbones frequently produce exophytic masses as the result of expansion, erosion. or inYasion. Consequently, for the differential diagnosis of oral lesions, the possibility that an exophytic mass could be central in origin must always be considered. sually a complete examination, including a history and clinical and radiographic surveys, indicates whether the lesion is central in origin. Since lesions of bone are discussed in