Lumps and

swellings
Prepared by :Jamal Q Ahmed
Supervised by: Prof. Ali Al.Zubaidi
Lumps and swellings
 Swelling and lumps in the mouth are common,
and the tongue often detects even very small
swellings or patients may notice a lump because
it is sore. Some individuals discover worry about
normal anatomical features such as parotid
papilla, foliate papillae on the tongue, or the
pterygoid hamulus. Many oral cancers may be
diagnosed far too late, often after being present
several months , because the patient ignores
swelling. Some lumps become ulcerated as in
various bullous lesions or malignant neoplasms.
Causes
 The mouth’s normal anatomy
 Pterygoid hamulus
 Parotid papillae
 Foliate papillae
 Developmental
 Maxillary and mandibular tori
 Unerupted teeth
 Heamangioma
 Lymphangioma
 Hereditary gingival fibromatosis
 Von Recklinghausen’s neurofibromatosis
CONTD
 Inflammatory
 Abscess
 Pyogenic granuloma
 Crohn’s disease
 Sarcoidosis
 Wegener’s granulomatosis
 Infections
 Insect bites
 Traumatic
 Heamatoma / epulis / epithelial polyp / denture granuloma
CONTD
 Cystic
 Eruption cyst
 Developmental cysts
 Cyst of infective origin
 Hormonal
 Pregnancy epulis
 Oral contraceptive ( pill gingivitis )
 Drugs
 Phenytoin
 Ciclosporin
 Calcium channel blockers
CONTD
 Blood dyscriasis
 Leukemia and lymphoma
 Benign neoplasms
 Viral lesions like papillomas, common warts, genital warts
( condyloma acuminatum ), heck’s disease
 Fibro-osseous lesions like fibrous dysplasia, paget’s disease
 Malignant neoplasms
 Others
 Angioedema / Amyloidosis
Diagnosis
 Position: the anatomic position should be defined
as accurately as possible. The proximity of the
lumps other structures ( e.g. teeth, dentures)
should be noted. Does the swelling has an orifice,
or sinus? If fluid is draining from the opening, is it
clear, cloudy or purulent? Other similar or relevant
changes elsewhere in the oral cavity should be
noted.
 Midline lesions tend to be developmental e.g. Torus
palatinus
 Determine whether the lump is bilateral, Since most
neoplastic lumps are unilateral
CONTD
 Number of swellings, particularly with regard to whether the
lesion is bilaterally symmetrical and thus possibly anatomical.
Multiple lesions suggest an infective or occasionally
developmental origin
 Size: The size should always be measured and recorded.
Thus, significant changes which may occur later can be
recognized.
 Shape: many swellings have characteristic shapes which
point towards the diagnosis. Thus swelling of the parotid
gland often fills in the space, between the posterior border of
the mandible and the mastoid process.
CONTD
 Color and temperature: brown or black pigmentation
may be due to a variety causes such as melanoma.
Purple or red lesions may be due to an angioma or
Kaposi sarcoma. Is the lump pale in color suggesting
underlying fibrosis, or soft tissues stretched over bony
enlargement :red ( suggesting inflammation ) : or deep
red ( suggesting heamangioma or giant cell epulis )?
Any variation in color with in the lump e.g. a pointing
abcess should be observed. The skin and mucosa
overlying acute inflammatory lesion, such an abscess,
is frequently red and warm
CONTD
 Tenderness: inflammatory swellings such as an
abscess are characteristically tender, although
clearly palpation must be gentle to avoid
excessive discomfort to the patient
 Discharge: note any discharge from the lesion
( clear fluid, pus, blood)
 Movement: the mobility of any swelling should be
tested to determine if it is fixed to adjacent
structures or the overlying skin/ mucosa such as a
neoplasm
CONTD
 Consistency: this may vary from soft and
fluctuant to hard. Fluctuation refers to the
presence of fluid within a swelling such as a
cyst. This sign is elicited by directing movement
of fluid when the swelling is compressed.
Palpation may then help assessment of it’s
contents and these can be put into such
categories as fluid ( fluctuant because of cyst
fluid, mucus, pus or blood), soft, firm, or hard
like a carcinoma ( indurant).
CONTD
 Palpation may cause release of fluid ( e.g. pus from an
abscess) or cause the lesion to blanch ( vascular) or
occasionally cause a blister to appear or expand ( Nikolsky
sign). some times palpation cause the patient pain
( suggesting an inflammatory lesion). The swelling overlying
a bony cyst may crackle ( like an egg-shell) when palpated.
Palpation may disclose an underlying structure (e.g. the
crown of a tooth under an eruption cyst) or show that the
actual swelling is in deeper structures ( e.g. submandibular
calculus). Bimanual manual palpation should be used when
investigating lesions in the floor of the mouth, cheek, and
occasionally the tongue
CONTD
 Surface texture; the surface texture may
vary from uniform smooth texture of many
fibrous lumps to the grossly irregular.
 Papillomas have an anemone-like appearance.
 Carcinomas tend to have a nodular surface and
may ulcerate.
 Ulceration: the character of edge of ulcer,
ulcer base appearance should be noted.
Also induration of ulcer should be noted.
CONTD
 Margin: the margins of the swelling may be well
defined or poorly defined. This may give some
indication of the underlying pathology. Ill defined
margin are frequently associated with malignancy,
where as clearly defined margins are suggestive
of benign growth.
 Associated swelling: some conditions are
associated with multiple swellings of a similar
nature ( e.g. neurofibromatosis).
Investigation
 Any teeth adjacent to a lump involving the jaw should be
tested for vitality, and any caries or suspect restorations
investigated
 The periodontal status of any involved teeth should also be
determined.
 Imaging is required whenever lumps involve the jaws, and
should show the full extent of the lesion and possibly other
areas. Special radiograph ( e.g. the skull, sinuses, salivary
gland function), CT, MRI or Ultrasonography may be
indicated.
 The medical history should be fully reviewed as systemic
disorders may be associated with intraoral or facial swellins.
Blood tests or endocrine function test may be needed.