Floor of the mouth lesions

1. Torus mandibularis
It is a bony growth in the mandible in the surface nearest to the tongue and
appear in the floor in the mouth. Mandibular tori are usually near the canine and
premolars and above the site of the mylohyoid muscle's attachment to the
mandible.[1], there is a torus on both sides the left and right (fig.3), making this
finding a predominantly bilateral condition in 90% of cases.
It's unknown the etiology of tori. Possible causes include hyperfunction of
mastication, continued growth of the bone, genetic factors and environmental
factors such as diet. {2} Tori prevalence was measured at 12.3 percent to 26.9
percent with an average starting age usually in the fourth decade of life, and an
increased prevalence in males. {3}
Torus mandibularis is still thought caused mainly by environmental factors such
as bruxism, vitamin deficiencies and supplements rich in calcium, though
genetic history also plays a key role. [4] Medical diagnosis is normally simple,
so study is typically needless. Peripheral ossifying fibroma, osteoma,
osteochondroma, osteoid osteoma, osteoblastoma, and osteosarcoma should
also be included in the unilateral, rising lesion differential diagnosis. [5]
Etiology:
Neither was the cause of mandibular torus clearly established but all hereditary
factors and environmental factors including diet, teeth presence, and an occlusal
pressure is suspected [6]. Some studies indicated genetic engineering
Predisposition may be inherited to mandibular torus in dominant form [7]

Figure 3: mandibular tori

2. Mucous retention cyst (ranula)
It is a benign pathologic lesion. The lesion is the product of saliva extravasation
from a small salivary gland which has been damaged. The collection of
extravasated fluid develops a pseudocyst forming a fibrous wall around itself.
Depending on its fluid-filled state the lesion may vary in size. A reduction in
lesion size is frequently related to a history of drainage of a dense viscous fluid.
It is nonpainful, soft, doughy, and fluctuant to palpation. [8]
Clinical features:
The overlying mucosa may clinically have the same coloration as the lower lip,
or may have a bluish hue. Long-term lesions can appear firmer and fibrotic, and
are hard to differentiate from a fibroma. Most likely a mucocele results
secondary to a traumatic event which goes unrecognized in most situations. The
most prevalent location is the lower lip. [8]
Ranula:
A ranula is a mucous retention cyst that develops in the mouth floor and is
connected to the sublingual gland. (figure.2) A ranula needs to be differentiated
from the lymphatic malformation in a young pediatric patient. A ranula may be
managed by the sublingual gland being excised. [8]

Figure 1: Ranula

3. Salivary gland stones

 A salivary gland stone is a calcified structure that can develop within a salivary
gland or duct. It can block saliva flow into the mouth.
Etiology
The expect etiology of the salivary stones is not well known, and different
theories have been proposed. These hypotheses include sialomicrolith
agglomeration, salivary duct anatomical variations and an altered biochemical
composition of the saliva. Salivary stasis or a reduced salivary flow is thought
to lead to calcium precipitation. [11]
Signs and symptoms:
They are variable and subjective and largely depend on whether the duct
obstruction is complete or partial, and how much resulting pressure is produced
within the gland.[9] Signs and symptoms are also influenced by the
development of gland infection. [10]
 Pain, which is intermittent and may suddenly worsen before meals, and
then improve slowly (partial obstruction).
 Swelling of the gland, often usually intermittent, sometimes arising or
growing abruptly before meals, and then gradually descending (partial
obstruction).
 Tenderness of gland involved.
 If the stone is placed at the end of the duct, palpable hard lump.
 When the stone is at the orifice of the submandibular duct, the lump may
be felt under the tongue.
 Lack of secretion (total obstruction) coming from the duct.
 Mouth floor erythema (redness) (infection).

Diagnosis
Diagnosis is usually made through historical characteristics and physical
examination. Diagnosis can be confirmed by x-ray (80 percent of measured
salivary gland is visible on x-ray), sialogram, or ultrasound.
Figure 2: salivary stone