September 2019 HSC Section 1 Congenital and Pediatric Problems

Benign and Malignant Pediatric Oral Lesions

examination of all oral cavity subsites and palpation of the floor of mouth are critical in recognizing a potential infection and the subsequent need for aggressive treatment and airway intervention. Any stable patients in whom spread of an odontogenic infec- tion is suspected should also undergo CT imaging to identify whether there is any abscesses in the submandibular, sublingual, retropharyngeal, buccal, and masticator spaces. 57 Salivary Gland Pathology Although the major salivary glands, which are located in the face and neck, specifically the parotid and submandibular glands, harbor the majority of salivary pathologies and tumors, minor salivary glands are found throughout the oral cavity, in particular the hard palate and mucosal surfaces of the lips, and can present with numerous pathologies. Sialolithiasis Pediatric sialolithiasis is rare and occurs in less than 5% of all cases of sialadenitis. 58 Ultrasonography is a useful diagnostic tool that limits the need for radiation and ex- cludes the presence of stones but has low sensitivity for stones less than 2 mm. 59 For the pediatric patient, stimulation of salivary secretion and sialolithotripsy with or without sialendoscopy are appropriate treatments. 59–61 Obstruction or loss of glan- dular functionality may indicate need for sialadenectomy. 58 Pleomorphic adenoma Pleomorphic adenomas account for more than 90% of all benign epithelial salivary gland tumors. 62 Reported in the submandibular gland as well as the hard and soft pal- ate, 63 they present as persistent, slow-growing, painless masses with an average symptom duration for 12 months. 64 Appropriate work-up involves exclusion of any in- fectious or inflammatory process followed by a fine-needle aspiration biopsy for cytology. 65 Radiographic imaging is a valuable tool used to evaluate the anatomic extent of the tumor. Small calcifications may be seen on CT, with T2-weighted enhancement on MRI. 66 Necrotizing sialometaplasia Necrotizing sialometaplasia (NS) is a rare, benign inflammatory disorder of the minor salivary glands that may be confused for a malignant process. There are at most a few documented cases of pediatric NS. 67,68 Seen in glands of the hard palate, NS may present in all other areas where salivary glands exist. 67 It is associated with the chronic self-induced vomiting seen in bulimic patients as well as local trauma, alcohol use, tobacco use, and application of local dental anesthesia. 67–69 Visually, NS appears as a deep ulceration with induration and well-defined edges. 67 Incisional biopsy and analysis by an experienced pathologist is essential to rule out malignancy. NS is self-limiting within 4 weeks to 10 weeks and should be closely followed until complete resolution. 68 Oral Manifestation of Systemic Disease Aphthous stomatitis, otherwise known as a canker sore, is the most common inflam- matory ulcer diagnosed in North America. 25 Found on the labial or buccal mucosa, it first occurs in childhood and appears with a tan-yellow base and erythematous halo. 30 Although self-limited and spontaneously resolving within a month, it may be extremely painful. Treatment involves topical corticosteroids and analgesics. A thorough history is important due to its association with various nutritional deficiencies (iron, folate, vitamin B 1 , vitamin B 2 , vitamin B 6 , vitamin B 12 , and zinc) and Behc¸ et syndrome. 25

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