BENIGN AND PREMALIGNANT

LESIONS OF ORAL CAVITY,

GEOGRAPHICAL TONGUE, FUNGAL
INFECTIONS
 CLASSIFICATION

• BENIGN TUMOURS
• PREMALIGNANT
1. Solid LESIONS • MALIGNANT LESIONS
2. Cystic
1. Carcinoma
2. Nonsquamous
malignant lesions
BENIGN TUMOURS
SOLID TUMOURS CYSTIC LESIONS
1. Papilloma
2. fibroma (fibroepithelial polyp) 1. Mucocele
3. Haemangioma 2. Ranula
4. Lymphangioma
3. Dermoid
5. Torus
6. Pyogenic granuloma
7. Pregnancy granuloma
8. Granular cell myoblastoma
9. Minor salivary gland neoplasms
10. Solitary fibrous tumour
SOLID TUMOURS
PAPILLOMA
• Benign epithelial neoplasms producing
microscopically or macroscopically visible finger like
or warty projections from epithelial ssurfaces
• Common in the oral cavity
• Peak incidence: 3rd to 5th decade
• Common site:
1. Soft and hard palate
2. Uvula
3. Tongue lips
• Less than 1 cm, pedunculated, white
• Irregular surface, sometimes smooth
• TREATMENT: excisional biopsy
• Recurrence is rare
EXCISION BIOPSY
Indications:
1. With small lesions, should
be less than 1 cm
2. The lesion on clinical
examination appears
benign
3. When complete excision
with a margin of normal
tissue is possible without
mutilation
FIBROMA (FIBROEPITHELIAL POLYP)
• Benign tumor arising in fibrous tissue
• Smooth, mucosa covered
pedunculated tumour
• about 1 cm, soft to firm in
consistency
• Site: anywhere in the oral or
oropharyngeal mucosa
• Cause: chronic irritation
• Treatment: conservative surgical
excision
HEMANGIOMA
• Tumours characterized by increased numbers
of normal or abnormal vessels filled with blood
• oral cavity or oropharynx
• Types:
1. Capillary
2. Cavernous
3. mixed
• present at birth or young age – observe -
spontaneous regression
• In 40-50 year old patients phlebostastis
(hemangioma like dilated veins) may occur
• If large and persistent, and continues to grow -
problematic
• TREATMENT
• Microembolisation alone, or as an preoperative adjunct to surgery
• By Polyvinyl alcohol (Ivalon),
• Cryosurgery and laser: not possible in large and diffuse lesions
• Sclerotherapy: not been found effective
LYMHANGIOMA
• Benign lymphatic anologues of blood vessel
hemangiomas
• Mostly involves anterior 2/3rd of tongue
• May involve tongue diffusely and cause macroglossia
• May present as a localized soft, compressible swelling
• May involute spontaneously
• TREATMENT:
1. Small lesions- surgical excision
2. Symptomatic large lesions- partial excision
(total excision is not possible)
TORUS
• Submucosal body outgrowth
• May involve hard palate or
mandible
• Palatine torus : more common
• Presents as a narrow ridge,
solitary nodule, or a lobulated
mass in the midline of the hard
palate
• Mandibular torus: projects
from lingual aspect of gingiva,
near bicuspid area and are
bilateral
• TREATMENT:
• Are innocuous
• Indication of resection of tori
1. Interferes with speech
2. Interferes with mastication
3. Fitting of dentures
PYOGENIC GRANULOMA
• Form of capillary hemangioma
• Reactive granuloma
• in response to trauma or chronic
irritation
• Site: mostly anterior gingiva.
• Soft, smooth, reddish to purple mass
• Bleeds on touch
• TREATMENT: surgical excision
• Recurrence: unlikely
PREGNANCY GRANULOMA/
GRANULOMA GRAVIDARUM
• Similar to pyogenic granuloma
• starts in 1st trimester of pregnancy
• Regresses after pregnancy has ended
• Likely to recur if operated during pregnany
 GRANULAR CELL MYOBLASTOMA/
GRANULAR CELL TUMOUR
• Site of predilection: tongue
• Thought to arise from muscle, hence “myoblastoma”
• Now considered to be derived from schwann cells
• Firm submucosal nodule
• TREATMENT : conservative surgical excision
• CONGENITAL EPILUS
• Granular cell tumour
• Involves the gums of future incisors in female infants
MINOR SALIVARY GLANDS
NEOPLASMS
• PLEOMORPHIC ADENOMA – most common
• Site: soft or hard palate
• “mixed tumours” : both epithelial and
mesenchymal elements
• Sends pseudopods into surrounding gland
• TREATMENT: wide surgical excision
• Recurrence rate is high
SOLITARY FIBROUS TUMOUR
• Most common in the pleura
• Site: tongue, buccal mucosa
• Rarely sen in nasopharynx, sinonasal tract, soft palate, retromolar
trigone, salivary glands and thyroid
• Painless, slow growing, submucosal tumour
• Well demarcated, mobile
• Mean age: 49 years
• Females
• Arises from mesenchyme
• Histology:
• spindle cells arranged
haphazardly with thick collagen
bundles in between
• May show capillary proliferation
and pericystic pattern
• Must be differentiated from
haemangiopercytoma
• TREATMENT: complete surgical
excision
CYSTIC LESIONS
MUCOCELE
• Site: most common in lower lip
• Retention cust of minor salivary glands of the lip
• Soft and cystic mass of bluish color
• TRATMENT: surgical excision
 RANULA
• Cystic translucent lesion
• On the floor of mouth on one side of frenulum , pushes
tongue up
• Obstruction of ducts of sublingual salivary gland
• Some extend to neck- plunging type
• TREATMENT:
• small: complete surgical excision
• Large: marsupialization
• Its thin wall and ramification in various tissue planes-
not possible to excise
DERMOID
• SUBLINGUAL DERMOID
• Situated above mylohyoid, median or
lateral
• Shines through mucosa as a white mass
(ranula –transluscent)

• SUBMENTAL DERMOID
• Below the mylohyoid
• Presents as a submental swelling behind
the chin
• http://misc.medscape.com/pi/android/medscapeapp/html/A1080571
-business.html
• https://www.harbourpointeoralsurgery.net/oral-biopsy-types-purpose
-and-procedure/