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Oral Pathology:  Soft Tissue Case #34

 

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Patient: Neonate, either sex.

Chief Complaint:
The parents are concerned about a soft tissue enlargement noticed at birth. The parents believe it has not changed since first noticed and is nonpainful.

Medical History:
No abnormalities are identified.

Dental History:
No abnormalities, other than the chief complaint, are identified.

Clinical Findings:
The lesion consists of a circumscribed, exophytic, soft tissue nodule, 4 x 5 mm in diameter, located at the midline of the mandibular alveolar ridge. The lesion is nontender, moderately compressible and fixed to surface mucosa and underlying periosteum.

Clinical Image
mandibular alveolar ridge with lesion
Mandibular Alveolar Ridge with Lesion

 

There are no radiographs available for this case.

There are no lab reports available for this case.

There are no charts available for this case.

Summary:
Parents are concerned with a soft tissue enlargement noticed at birth of their newborn.  The lesion consists of a circumscribed, exophytic, soft tissue nodule, 4x5 mm in diameter, located on the mandibular alveolar ridge.  The lesion is nontender, moderately compressible, and fixed to surface mucosa and underlying periosteum.  The parents believe it has not changed since first noticed.

Lesions to Exclude from the Differential Diagnosis:
This lesion is described as a soft tissue enlargement.  Reactive soft tissue enlargements can be excluded from differential diagnosis because these lesions are not localized and are rare at birth.

Within the category of tumors, malignant tumors can be excluded because these almost always occur later in life, are more rapidly enlarging and poorly circumscribed.  

Congenital soft tissue cysts of the alveolar ridge (dental lamina cyst of the newborn) may be eliminated because these usually appear as white or tan surface lesions. 

Within the category of benign tumors, salivary gland and epithelial tumors can be eliminated.  Benign salivary gland tumors can be excluded because these occur only where salivary glands are located.  Benign epithelial tumors can be excluded because they are pale, firm, and have a white, rough surface.

From the category of benign mesenchymal tumors, only hemangioma, lymphangioma and congenital epulis are present at birth.  Hemangioma can be excluded because they are red or blue in color and blanch upon pressure.  Lymphangioma can be excluded because these are typically poorly circumscribed lesions. 

Lesions to Include in the Differential Diagnosis:
Congenital epulis is the diagnosis based on the location and presence at birth.  Note that occasionally a newborn will have a soft tissue enlargment arising from the vestibule adjacent to the alveolar ridge.  If this latter enlargement fluctuates in size, it is typically a mucocele (salivary extravasation phenomenon).

Management:
Excisional biopsy with microscopic diagnosis is the recommended management.  Prognosis is good.

Final Diagnosis:
Congenital epulis
.