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PART II
Soft Tissue Lesions
A
Fig. 1J-8. Major RAU of the soft palate. This painful lesion had been present for 3 months.
constituents; (2) maintenance of cellular membrane integrity with prevention of cellular swelling; (3) inhibition of lysozyme release from granulocytes and inhibition of phagocytosis; (4) stabilization of the membranes of the intracellular lysozomes containing hydrolytic enzymes; (5) decreased scar formation by inhibiting proliferation of fibroblasts; and (6) possible effect on antibody formation when administered in large doses. Corticosteroids have also been shown to suppress T-cell formation. 3 I
Herpetiform Aphtha HA account for approximately 10% of all cases of aphthous ulceration? I This condition is more common in female patients, and the cause is unknown. Many small, painful punctate ulcers occur over the mucosal surfaces, sometimes in clusters (Fig. 11-9). The duration is similar to minor RAU. The widespread distribution calls for management by mouthrinse instead of treatment of individual ulcers. Beh~et's Syndrome Beh~et's syndrome involves the following types of ulcers: (I) oral ulcers (aphthouslike); (2) recurrent ulcers of the genital region; and (3) ocular lesions, including conjunctivitis, retinitis, and uveitis. 31
ULCERS FROM ODONTOGENIC INFECTIONS Ulcers resulting from the drainage of pus from odontogenic infections are easily recognized. Two similar clinical situations can cause them: The ulcer may serve as the cloacal opening of a sinus draining a chronic alveolar abscess, or the ulcer may be the site of a superficial space abscess that has spontaneously ruptured.
Features In most cases of chronic alveolar abscess, the ulcer is on the al veolar ridge on the buccal or the lingual surface, usually near the mucobuccal fold but occasionally on the palate (Figs. 11-10 and 13-6). The majority of chronic
B
Fig. 11-9. Herpetiform aphthous ulceration. Small vesiculoulcerative lesions of the buccal mucosa (A) and posterior palate (B). (Courtesy J. Guggenheimer. Pittsburgh.)
alveolar abscesses are seen in children younger than 14 years of age. Such draining sinuses and similar patho es are discussed in detail in Chapter 13. Other ulcers may represent the ruptured surface of an odontogenic space abscess situated on the palate or in the sublingual or vestibular areas (see Fig. 11-10). Pressure on the adjacent soft tissue, which causes pus to exude from the ulcer, identifies the condition. If odontogenic infection is suspected, a thorough clinicoradiologic examination of the teeth and supporting structures is indicated. A gutta-percha point may be placed in the ulcer and passed into the tract as far as it will go without undue force. A radiograph is taken, and if the point is seen to reach the apex of an infected tooth. the diagnosi. is ensured.
Differential Diagnosis The odontogenic ulcer can be misdiagnosed only as the result of a cursory or careless examination. When a small ulcer (0.2 to I em in diameter) is present on the mucosa of the palate, alveolus, or vestibule, an odontogenic ulcer must always be considered. Other. less likely conditions are sinus openings from osteomyelitis and infected malignant tumors. A thorough discussion may be