Rapidly growing, nonpainful, ulcerated swelling in the posterolateral palate.
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Biomedical subjects
Publications and source records attributed to R W Correll.
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A firm mass of tissue in a 52-year-old male was diagnosed as peripheral fibroma with metaplastic bone formation. Several terms have been used to describe this type of lesion, which is similar in appearance to the peripheral odontogenic fibroma. The lesions should be excised and removed tissue submitted for microscopic examination. Special care should be taken to remove the attachment because the lesions may recur. The prognosis is excellent.
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The focal osteoporotic bone marrow defect is seldom considered preoperatively when a differential diagnosis is considered for focal, ill-defined radiolucent areas of the jaws. Clinicians should be aware of the existence of this abnormality and understand that it appears radiographically similar to other lesions, some of which are malignant; therefore a biopsy is necessary to establish a diagnosis.
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Small, localized aggregations of lymphoid tissue can occur commonly in the oral cavity, especially in the soft palate, the floor of the mouth, and the ventral surface of the tongue. They normally appear clinically as asymptomatic, small, soft, pink, and discrete swellings situated immediately beneath the surface epithelium. Chronic irritation may cause the tissue to enlarge and become symptomatic. Clinicians should be aware of the existence of these rather common oral lesions and include them in a differential consideration of small, freely movable, nonulcerated subepithelial swellings in the oral cavity. Microscopic examination is indicated to rule out a more serious disease, especially a developing neoplastic process.
The intraoral lipoma is a slow-growing, usually asymptomatic, neoplasm of adipose tissue origin. The superficially located lipoma is fairly characteristic in its clinical appearance, a smooth-surfaced, yellowish-pink mass covered by a readily visible vascular network. The deep-seated tumors do not have this characteristic clinical appearance, and consequently are more difficult to detect and remove. Patients tend to overlook these lesions because they are so innocuous. Clinicians, however, should be aware of this uncommon neoplasm and consider it when diagnosing nonulcerated, soft tissue masses in the oral cavity. Surgical excision and microscopic examination are recommended for these lesions.
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All clinicians responsible for diagnosing and treating diseases of the head and neck should be familiar with the possible clinical manifestations of a mineralized stylohyoid or stylomandibular ligament. Many patients with Eagle's syndrome have been misdiagnosed as having neuralgias, TMJ problems, psychosomatic disorders, or other vague, ill-defined diseases of the head and neck. Unfortunately , patients have been treated for these conditions with negative results. Extraction of teeth, especially third molars, has been performed unnecessarily in an attempt to alleviate the symptoms caused by a mineralized stylohyoid or stylomandibular ligament. Patients complaining of vague facial pain (especially when swallowing, turning the head or opening the mouth), dysphagia, otalgia, and headache with dizziness and with radiographic evidence of mineralization in the stylohyoid-stylomandibular ligament complex may have Eagle's syndrome. If digital palpation of the tonsillar fossa on the affected side causes the typical pain that the patient has been experiencing and if the mineralized abnormality can be felt in the fossa, the patient is considered to have the syndrome, and surgical resection of the abnormality should be considered.
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It is very important for clinicians to understand that nonulcerated, firm, dome-shaped, nonpainful palatal swellings, if not inflammatory in nature, are probably arising in the palatal accessory salivary glands. The differential diagnosis must include benign mixed tumors; adenoid cystic carcinoma, and necrotizing sialometaplasia, which is usually ulcerated. Statistically, the possibility that the lesion is malignant is slightly greater than the possibility that it is benign. Incisional biopsy must be performed on these lesions to determine the proper treatment and management regimen.
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We have presented a case illustrating that an asymptomatic, red lesion in the oral mucosa should be considered a malignant neoplasm, until proved otherwise. A biopsy and microscopic examination of such lesions are necessary to establish a definitive diagnosis. An appropriate method of obtaining a tissue specimen from the floor of the mouth has been described, and the importance of taking a comprehensive clinical history has been reviewed. The value of transmitting this information to the pathologist, who examines the removed tissue, has been stressed. Small, asymptomatic erythroplastic lesions of the oral mucosa that have not resolved or responded to treatment with two weeks should have a biopsy examination.
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