Lumps and swellings of the mouth

Types of lumps and swelling

It is not uncommon for an individual to experience a lump/swelling in the
oral environment. The overall presentation is highly variable and the
progression of these lesions can also differ, for example: development of a
lesion into a bulla or a malignant neoplasm. Lumps and swellings can occur
due to a variety of conditions, both benign and malignant such as:
• Normal variation lesions
◦ Pterygoid hamulus: This is a hook-shaped structure protruding
postero-laterally from the inferior boundary of the medial plate
of the pterygoid process
◦ Parotid papillae: This is the exiting duct from the parotid gland
which is commonly found adjacent to the upper second molar
on the buccal mucosa
◦ Lingual papillae: Seen covering the dorsum of the tongue
• Inflammatory
◦ Abscess: An abscess is a painful collection of pus, usually caused
by a bacterial infection
◦ Cellulitis: Commonly due to a bacterial infection spreading to the
deeper layers of the skin leading to a multitude of complications
◦ Cysts: A cyst is an epithelial lined sac of tissue that has either fluid
or semi-fluid content inside
◦ Sialadenitis: Infection of the salivary glands
◦ Pyogenic granuloma: Is a relatively common, tumor-like, exuberant
tissue response to localized irritation or trauma
• Chornic granulomatous disorders
◦ Orofacial granulomatosis: This is an uncommon condition but is
seen to be increasing in prevalence. This condition presents
with facial/labial swellings commonly accompanied with angular
stomatitis or cracked lips, ulcers, mucosal tags, cobblestone
mucosea or gingival swellings
◦ Crohn's disease: This is a disease affecting the bowel but
commonly has oral lesions associated. Examples of some oral
presentations are: raised gingival lesions, hyperplastic
folds/cobble-stone mucosa, ulcers, facial swelling and/or
angular cheilitis
◦ Sarcoidosis: Sarcoidosis is a multi-system condition which may lead
to gingival enlargement or salivary gland swelling which may
result in xerostomia
• Developmental
◦ Unerupted teeth
◦ Odontogenic cysts
◦ Eruption cysts
◦ Haemangioma
◦ Lymphangioma
◦ Palatal tori and mandibular tori: formation of new bone upon the
surface of a present bone
◦ Lingual thyroid: this is an abnormal mass of ectopic thyroid tissue
seen at the base of tongue
• Traumatic
◦ Denture-induced hyperplasia
◦ Epulis
◦ Fibroepithelial polyp
◦ Haematoma
◦ Mucocele
◦ Surgical emphysema
• Hormonal
◦ Pregenancy epulis
◦ Oral contraceptive pill gingivitis
• Metabolic
◦ Amyloidosis
• Drugs
◦ Phenytoin
◦ Calcium channel blockers
◦ Ciclosporin
• Allergy
◦ Angioedema
• Infective
◦ HPV
• Fibro-osseous
◦ Cherubism
◦ Fibrous dysplasia
◦ Paget's disease
• Neoplasms
◦ Carcinoma
◦ Leukeamia
◦ Lymphoma
◦ Myeloma
◦ Odontogenic tumours
◦ Minor salivary gland tumours

So as seen above the list is extensive and by no means is this a complete

and comprehensive representation of all the possible lumps/swellings that
can occur in the mouth as to the means of acquiring a swelling in the
mouth. When considering what a lump might be caused by the site of which
it has appeared can be of significance. Below are some examples of
swellings/lumps which usually are present as specific locations in the oral
cavity:[8]
• Gingiva
◦ Congenital hyperplasia
◦ Abscesses
◦ Pyogenic granuloma
◦ Neoplastic
◦ Pregnancy epulis
◦ Drug-induced hyperplasia
◦ Angioedema
◦ Papilloma/warts
• Palate
◦ Torus palatinus
◦ Abscesses
◦ Unerupted teeth
◦ Pleomorphic adenomas/salivary neoplasms
◦ Invasive carcinoma from maxillary sinus
◦ Kaposi’s sarcoma
◦ Developmental swellings associated with Paget’s disease
• FOM
◦ Most commonly salivary calculi and denture-induced hyperplasia
◦ Mucocele
◦ Ranula
◦ Mandibular tori
• Tongue and buccal mucosa
◦ Congenital haemangioma
◦ Congenital macroglossia
◦ Mucocele
◦ Vesiculobullous lesions
◦ Ulcers
◦ Hyperplasia
Diagnosis of the cause of a lump or swelling
If there is any suspect or unknown reason as to why a lump has arisen In
an individuals mouth it is important to establish when this first was noticed
and the accompanied symptoms if any. On examination ensure that there
is not an obvious cause to the swelling/lump via a thorough: medical,
social, dental and family history, followed by an oral examination. Whilst
examining the suspected lesion there are some diagnostic aids to note
which can be used to formulate a provisional diagnosis. There are many
factors taken into consideration in this diagnosis, such as:
• The anatomical position & symmetry
◦ Midline associated lesions tend to be of a developmental origin (e.g.
torus palatinus)
◦ Bilateral lesions tend to be benign (e.g. sialosis, diabetes etc)
◦ Consider associations with surrounding anatomical structures
◦ Malignant lesions are usually unilateral
• Size and shape
◦ Diagrams or photographs are usually recorded alongside the actual
measurement of the lesion
• Colour
◦ Brown and black pigmentation may occur from a variety of
aetiologies s such as: tattoo, naeuvus, melanoma
◦ Purple or red pigmentation may occur due to conditions such as:
haemangioma, kaposi’s sarcoma or a giant cell lesion
• Temperature
◦ If the lesion is warm it is thought an inflammatory cause is most
likely (e.g. abscess or haemangioma)
• Tenderness
◦ If a lesion is significantly tender on palpation the origin is usually
thought to be inflammatory
• Discharge
◦ Are there any secretions associated with the lesion upon palpation
or spontaneously occurring
• Movement
◦ The lesion should be tested to determine whether it is attached to
adjacent structures or the overlying mucosa
• Consistency
◦ Carcinoma is usually suggested by a hard/indurated consistency
◦ If a lesion is palpated and a crackling, ‘egg shell’ sound occurs this
tends to be a swelling overlying a bony cyst
• Surface texture
◦ Abnormal vascular changes suggests neoplasm
◦ Maliganant lesions tend to be nodular and may ulcerate
◦ Papillomas are usually comparative to a wart-like appearance
• Ulceration
◦ Squamous cell carcinoma is an example of a malignancy which can
present with superficial ulceration
• Margin
◦ Malignant lesions tend to have an ill defined margin
◦ Benign lesions tend to have a clearly defined margin
• Number of lesions
◦ Multiple lesions might suggest an infective or developmental
aetiology

Investigations
Once the surrounding tissues and the immediate management of any
lumps/swellings are taken care of, an Image of the full extent of the lesion
is needed. This is done to establish what the lump/swelling is associated
with and to ensure that any damaging probablitiy is kept to a minimum.
There are a variety of imaging technique options which are chosen based
on the lesion: size, location, growth pattern etc. Some examples of images
used are: DPT, Scintigraphy, Sialography, Computed Tomography,
Magnetic Resonance Imaging and Ultrasound.

As described some lumps or swellings can be in close relation to

anatomical structures. Commonly, Teeth are associated in a lesion which
brings about the question – “are they still vital?” In order to clarify, any tooth
that is associated with a lump or swelling is vitality tested, examined for any
pathology or restorative deficiencies in order to determine the long term
prognosis of this tooth and how this might affect treatment of the lump /
swelling at hand.
Alongside any radiographs wchih may be justified, Blood tests may be
needed in order to obtain a definitive diagnosis if there is a suspicion of
potential blood dyscrasias or any endocrinopathy involvement.
Finally, a particularly vital means of diagnosis is a biopsy. These tend to be
regularly done in the cases of singular, chronic lesions and are carried out
in an urgent manner as lesions of this category have a significant malignant
potential. The indications to carry out a biopsy include:
• Lesions that have neoplastic or premalignant features or are enlarging
• Persistent lesions that are of uncertain aetiology
• Persistent lesions that are failing to respond to treatment
Once a small piece of tissue is removed for the biopsy, it is then
microscopically histopathologically examined.