Differential Diagnosis of Oral Lesions and Developmental Anomalies
Awide variety of oral lesions and soft tissue anomalies are detected in children, but the low frequency at which many of these entities occur makes them challenging to clinically diagnose. The purpose of this chapter is to highlight selected oral lesions that are most commonly found in children and pathologic entities that primarily develop in this age group. In addition, oral lesions associated with several genetic disorders and specific malignancies, which may mimic benign or inflammatory conditions, are included to broaden the disease scope. The material is outlined in tables to make this comprehensive subject more succinct and easier to review. The brief description for each entity summarizes the most important clinical information that is relevant to the child patient. Representative examples of these conditions are included to illustrate the characteristic clinical or radiographic features.
Each oral lesion is described according to key points: (1) the most common pediatric age group affected and the gender predilection, (2) the characteristic clinical and radiographic findings of the lesion, (3) the most frequent location for the lesion, (4) the pediatric significance of the lesion, (5) the treatment and prognosis for the lesion, and (6) the differential diagnosis that is pertinent to this age group.
Except for the first table on selected developmental anomalies, the other tables are arranged to capture the primary clinical or radiographic characteristics for the purpose of comparison. The sequential headings for each of the tables include the following disease categories:
FIGURE 2-1 Developmental anomalies.
A, Fissured tongue. B and C, Partial ankyloglossia with lingual frenum attachment at the tip of the tongue (B). Note the restricted mobility of the tongue with extension (C). D, Lingual thyroid of the midline base of the tongue. E, Thyroglossal duct cyst with sinus tract, midline neck. F and G, Commissural lip pit (F) with depth illustrated by periodontal probe (G). H, Paramedian lip pits. I, Retrocuspid papilla of the lingual mandibular gingiva. J, Bifid uvula. K, Hyperplastic maxillary labial frenum. L, Torus palatinus of the midline hard palate. M, Small exostosis of the anterior mandibular alveolus, facial aspect. (D courtesy Dr. G. E. Lilly, University of Iowa College of Dentistry.)
FIGURE 2-2 White soft tissue lesions.
A and B, Frictional keratosis of the lateral tongue (A) and buccal mucosa (B) from chronic biting of the tissues. C, Smokeless tobacco keratosis of the posterior mandibular vestibule. D and E, Leukoedema of the buccal mucosa, bilaterally. F to I, White sponge nevus of the buccal mucosa (F and G) and lateral tongue (H and I). J, Ulcerated linea alba from aggressive sucking habit. K, Pseudomembranous candidiasis of the buccal mucosa. L, Chemical burn from overuse of a topical anesthetic. M, Coated tongue in a child who is mouth breathing. N, Fan-shaped scar at the corners of the mouth due to an electrical burn. O, Cluster of Fordyce granules of the anterior buccal mucosa. P, Oral lymphoepithelial cyst of the posterior lateral tongue. Q, Single palatal cyst of the newborn on the midline hard palate. R, Cluster of gingival cysts of the newborn on the mandibular alveolar mucosa.