This is a fairly common lesion that presents as a firm pink lump. It normally affects
the buccal mucosa at the occlusal level. They are caused by trauma. They are usually
symptomless unless further traumatized and are easily removed.
FIBROUS EPULIS
This presents as a mass on the gingiva. Colour varies from pink to red depending
upon the degree of vascularity of the lesion. (1018HFig. 15.11). It consists of an
inflammatory cell infiltrate and mature fibrous tissue, occasionally a calcified variant
is found. Surgical excision is curative.
PYOGENIC GRANULOMA
These commonly occur on the gingiva usually in the anterior maxilla. They are
probably a reaction to chronic trauma, especially from a sub-gingival calculus. Due to
their aetiology they have a tendency to recur after removal.
PERIPHERAL GIANT-CELL GRANULOMA
This dark-red swelling of the gingiva can occur in children. It often arises
interdentally. Radiographs may reveal some loss of the interdental crest. The central
giant-cell granuloma (see below) shows much greater bone destruction. This
condition is thought to be a reactive hyperplasia. Unless excision is complete it will
recur.
HAEMANGIOMAS
Haemangiomas are relatively common in children. They are malformations of blood
vessels. They are divided into cavernous and capillary variants, although some lesions
contain elements of both. Capillary haemangiomas may present as facial birthmarks.
The cavernous haemangioma is a hazard during surgery if involved within the
surgical site. It is a large blood-filled sinus that will bleed profusely if damaged (1019HFig.
15.12). The extent of a cavernous haemangioma can be established prior to surgery
using either angiography or magnetic resonance imaging (MRI) scanning. Small
haemangiomas are readily treated by excision or cryotherapy. Larger lesions are
amenable to laser therapy.
STURGE-WEBER SYNDROME
Sturge-Weber angiomatosis is a syndrome consisting of a haemangioma of the
leptomeninges with an epithelial facial haemangioma closely related to the
distribution of branches of the trigeminal nerve. Mental deficiency, hemiplegia, and
ocular defects can occur. Intraoral involvement may interfere with the timing of
eruption of the teeth (both early and delayed eruption have been reported).
LYMPHANGIOMAS
Lymphangiomas are benign tumours of the lymphatics. The vast majority are found in
children. The head and neck region is a common site (1020HFig. 15.13). The cystic hygroma
is a variant that appears as a large neck swelling, which may extend intraorally to
involve the floor of the mouth and tongue.
NEUROFIBROMAS
These may present as solitary or multiple lesions. They are considered hamartomas (a
haphazard arrangement of tissue). They present intraorally as mucosal swellings on
the tongue or gingivae. Multiple oral neuromas are a feature of the multiple endocrine