Salivary gland cysts
Cysts of the minor salivary glands manifest as thinning of the mucous membrane with a characteristic bluish tint. Treatment is exclusively surgical: the cyst is isolated and excised, with mandatory removal of adjacent gland lobules to prevent recurrence.
Special attention is deserved by the sublingual gland cyst (ranula), also known as a «frog belly» cyst.
- Morphology: In most cases, this is a pseudocyst without an epithelial lining.
- Clinical presentation: The lesion appears as a hemispherical protrusion in the sublingual region. The mucosa over it is stretched, translucent, and bluish in color.
- Diagnostics: The ranula aspirate is a transparent, viscous yellowish fluid. This distinguishes it from an epidermoid cyst (which contains cholesterol crystals) and a hemangioma (where the aspirate is blood).
Epithelial and connective tissue tumors
Maxillofacial neoplasms are identical to tumors in other locations, but have specific features due to their anatomical location.
Papilloma is a true benign epidermal tumor. On the skin of the face, it looks like a warty growth on a stem (cauliflower-like). On the oral mucosa, papillomas are often localized on the lips, cheeks, and palate. When traumatized by teeth, they can become dense, bleed, and ulcerate. Treatment includes electrocoagulation, cryosurgery, or laser surgery; however, if there are doubts about the diagnosis, classical excision with histological examination is indicated.
Fibroma consists of mature connective tissue.
- Hard fibromas (collagen-rich).
- Soft fibromas (fibrolipomas — containing adipose tissue).
- Angiofibromas (containing vascular tissue).
A special type is symmetrical fibromas on the alveolar processes. They are dense, painless, and can cover a significant part of the tooth crown, provoking secondary inflammation due to food retention.
Tumor-like lesions of the gingiva (Epulis)
An epulis (peripheral giant cell granuloma) is a tumor-like outgrowth on the gingiva arising in response to chronic inflammation or mechanical trauma (clasps, overhanging fillings), as well as against the background of hormonal changes (in pregnant women).
Two main forms are distinguished:
- Fibrous epulis: The surface is smooth, pale pink. Dense, does not bleed. X-rays may reveal resorption of the alveolar bone margin.
- Angiomatous epulis: Characterized by a soft consistency, bright red color, and pronounced bleeding. Consists of numerous blood vessels. In pregnant women, it often increases in size, but may partially regress after childbirth. Surgical treatment in pregnant women is indicated only in cases of functional impairment.
Lipomas, Hemangiomas, and Fibromatosis
Lipoma is a tumor originating from mature adipose tissue. In the maxillofacial region, it is often localized in the buccal, parotid-masseteric, and submandibular regions. It grows slowly, has a lobular structure, and a thin capsule. It is removed strictly along with the capsule.
Hemangiomas develop from blood vessels (often congenital). They can be capillary, arborizing, cavernous, and mixed. The main danger is the ability to acquire infiltrative growth, destroying surrounding tissues, including the bones of the facial skeleton.
Gingival fibromatosis (elephantiasis of the gums) is an extensive proliferation of connective tissue leading to deformation of the alveolar process. Teeth may be completely hidden under bumpy overgrowths of cartilage-like density. Treatment is surgical, with mandatory excision of the periosteum; however, the risk of slow recurrences is high. There is a tendency towards malignant transformation.
Tumor-like lesions: Scars
In the maxillofacial region, hypertrophic and keloid scars are distinguished:
- Hypertrophic scars: Begin to grow immediately after healing, do not extend beyond the borders of the primary wound, and whiten over time.
- Keloid scars: May occur 1–2 years later even after minor trauma (e.g., ear piercing). They spread along skin tension lines (Langer's lines), have a cartilage-like density and a bluish-red color. They often lead to cicatricial contractures.
Briefly: answers to topical questions
What are the clinical and morphological forms of epulis?
Clinically and morphologically, two main forms of epulis are distinguished: fibrous and angiomatous.
- Fibrous epulis is a dense formation covered by unchanged mucosa, consisting predominantly of mature fibrous tissue.
- Angiomatous epulis is a lesion of soft consistency, represented by a large number of blood vessels and prone to bleeding.
Peripheral giant cell granuloma is a tumor-like fibrous lesion of soft tissues developing from gingival tissues; an outdated term is giant cell epulis.
What are the clinical signs of malignant transformation of a benign maxillofacial tumor?
Clinical signs of malignant transformation of a benign tumor include a change in its growth pattern and involvement of surrounding structures.
- Change in growth pattern — a sharp acceleration of growth after a long period of slow and painless development.
- Decrease in tumor mobility — indicates invasion of the neoplasm into surrounding tissues.
- Facial nerve palsy — indicates damage to the facial nerve (typical for tumors of the parotid salivary gland).
What precancerous diseases of the oral mucosa exist?
Acquired precancerous pathologies of the oral mucosa include keratoses and leukoplakia.
- Keratoses and leukoplakia are clinical terms for white or yellowish-brown spots and plaques on the mucosa that are not classified under other diseases.
Historically, these conditions were classified as precancerous lesions. Risk factors for their development include cigarette smoking, smokeless tobacco use, alcohol abuse, vitamin A deficiency, and chronic mucosal trauma.
What histological types of malignant maxillofacial tumors are most common?
Among malignant tumors in the maxillofacial region, carcinomas overwhelmingly predominate, whereas sarcomas are significantly less common.
- Carcinomas — in decreasing order of frequency: keratinizing squamous cell carcinoma, non-keratinizing squamous cell carcinoma, as well as poorly differentiated and glandular carcinoma.
- Sarcomas — are characterized by great diversity; osteosarcomas are most common, while chondrosarcomas, fibrosarcomas, and myxosarcomas are diagnosed less frequently.
For the differential diagnosis of epulis, remember: Fibrous — «Porcelain» (light, dense, does not bleed). Angiomatous — «Scarlet» (red, soft, bleeds).
Class and exam questions
What is the difference between a ranula and an epidermoid cyst based on puncture results?
The puncture fluid of a ranula represents a translucent, viscous yellow fluid, whereas the aspirate of an epidermoid cyst reveals a transparent fluid with cholesterol crystals.
What triggers the growth of an angiomatous epulis and what is the management strategy in pregnant women?
Growth is provoked by chronic trauma or hormonal shifts. In pregnant women, an epulis is operated on only in the presence of functional disorders, as it may regress after childbirth.
How to differentiate a hypertrophic scar from a keloid?
A hypertrophic scar strictly corresponds to the wound area and grows immediately after healing. A keloid scar extends beyond the boundaries of the primary trauma, can appear in 1–2 years, and has a bluish-red color.
What is the main danger of hemangiomas in the maxillofacial region?
They are capable of acquiring an infiltrative growth pattern, leading to the destruction of surrounding soft tissues and even the bones of the facial skeleton.
What else to study on this topic
- Pathomorphology and histological structure of hemangiomas
- Surgical techniques for ranula removal (cystotomy, cystectomy)
- Principles of radiowave and laser surgery in fibromatosis
- Central giant cell granuloma (osteoblastoclastoma)
- Tumors of paraganglionic structures and peripheral nerves
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Other topics from the section "Chapter 14. Tumors and Tumor-like Lesions of the Maxillofacial Region (V.N. Bogatov, S.N. Lebedev)"
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