September 2019 HSC Section 1 Congenital and Pediatric Problems

Benign and Malignant Pediatric Oral Lesions

Fig. 5. Dermoid cyst. Coronal ( A ) and sagittal ( B ) contrast-enhanced CT showing a midline cystic lesion.

Radicular (periapical) cysts comprise 62.1% of all odontogenic cysts and 49.6% of all odontogenic lesions. 38 These cysts develop from epithelium of the apical peri- odontal ligament spaces that undergo inflammatory-mediated proliferation. 39 Consid- ered a direct complication of endodontic infection and subsequent granulation, the chronic inflammatory nature of development results in a lesion that is asymptomatic. 40 Proper oral hygiene and health care habits are essential for prevention. 38 Surgical curettage is usually necessary for successful resolution of true cysts. 40,41 Dentigerous cysts are the second most frequent odontogenic cysts at 21.5% with a male predilection. 38 Although more well known as a developmental cyst, the inflammatory type presents with pain and swelling within the first and early second decade. 40 Tooth extraction and complete surgical excision of the cyst is the mainstay of treatment and in most cases is curative with an extremely low rate of recurrence. 40 Nonodontogenic benign masses Craniofacial presentation of multiple osteomas should raise suspicion for Gardner syndrome, an autosomal dominant disorder with associated familial adenomatous polyposis, epidermoid cysts, desmoid tumors, and supernumerary teeth. 42 Because extraintestinal symptoms occur prior to the development of colon cancer, early iden- tification is of utmost importance. These mandibular osteomas may present as a pedunculated unilateral mass in the lingual molar-premolar area. 42 Surgical excision is appropriate for any symptomatic mass. 43 Peripheral giant cell granulomas are gingival reactive nodules that are believed to develop secondary to local irritation or trauma. These benign hyperplastic lesions often affect girls and women and are smaller than 2 cm in diameter. 25 Typically asymp- tomatic, some large lesions may displace adjacent teeth. 29 Treatment involves full- thickness surgical excision. Squamous papilloma presents as a single whitish pedunculated papule measuring up to 0.5 cm. 29 They appear most often on the larynx; however, they also may be found on the soft palate, tongue, or uvula. Induced by HPV types 6, 11, 14, and 22, squamous papilloma represents approximately 8% of all soft tissue masses in the pediatric population. 44 Treatment involves surgical excision or laser ablation to avoid risk of distal seeding. 8 Importantly, development of the quadrivalent HPV vaccine may lead to reduced rate of infection and decrease in the incidence of squamous papilloma. 45

191