Inflammatory pappilary hyperplasia & ranula

INFLAMMATORY PAPILLARY HYPERPLASIA &

RANULA

Presented By :-

Irfan Zunzani III rd Year

INFLAMMATORY PAPILLARY HYPERPLASIA /PALATAL OR DENTURE

PAPILLOMATOSIS

Introduction

• Papillary hyperplasia is a unusual condition involving the mucosa of the palate.

• It is of unknown etiology.

• It may be considered a from of inflammatory hyperplasia associated in instances with ill fitting denture.

ETIOLOGY

• Exact pathogenesis is not known.

• An ill-fitting denture.

• Poor denture hygiene.

• Wearing the denture 24 hours a day. (20% OF PATIENTS).

• Candida also has been suggested as a cause.

CLINICAL FEATURES

• SITE – Hard palate beneath a denture base.

Edentulous mandibular alveolar ridge.

• The lesion presents itself as numerous, closely arranged, red, edematous papillary projections.

• The individual papillae are seldom over a millimeter or two in diameter.

• The tissue exhibit varying degrees of infllamation, but sometimes there is ulceration.

HISTOLOGICAL FEATURES

• Microscopic section shows numerous, small vertical projections each composed of parakeratotic or sometimes orthokeratotic stratified squamous epithelium and a central core of connective tissue.

• Pseudoepitheliomatous hyperplasia, in varying degrees, is seen in most of the cases.

• Severe inflammatory cell infiltration is nearly always present in the connective tissue.

• Chronic inflammatory cell consist of lymphocytes and plasma cells.

Treatment

• Discontinuing the use of ill fitting denture or construction of new denture without surgical removal of the excess tissue will generally result in regression of edema and inflammation, but papillary hyperplasia persists.

• Surgical excision of the lesion prior to new denture construction will return the mouth to a normal state.

• Use of conditioner to rebase an old denture often results in some improvement of the lesion .

RANULA

Frog belly

Definition

• Name derived from Latin word rana, which means frog, because the swelling may resemble a frog’s translucent underbelly.

• It is a form of mucocele that specifically occurs in the floor of the mouth in association with ducts of the submaxillary or sublingual gland.

• It may arise through duct blockage or through development of ductal aneurysm.

CLINICAL FEATURES

• Appears as blue, dome-shaped, fluctuant swelling in the floor of mouth.

• Deeper ranulas are normal in color.• Lesion develops as a slowly enlarging painless

mass located lateral to the midline of the floor of the mouth.

• Ranulas can develop into large masses that are many centimeters in diameter, fill the floor of mouth and elevate the tongue.

• An unusual clinical variant.

• The PLUNGING or CERVICAL RANULA.

• Occurs due to herniation of spilled mucin through the mylohyoid muscle, producing swelling within the neck.

Differential diagnosis

• Dermoid cyst, • Abscess, • Hemangioma, • Lymphangioma,• Lymphoepithelial cyst.

HISTOPATHOLOGIC FEATURES

• Variable epithelial lining of cuboidal, columnar, or atrophic squamous cells, surrounding the thin or mucoid secretions in the lumen.

• Some cysts (more commonly those arising due to ductal obstruction) demonstrate oncocytic metaplasia of the epithelium.

EPITHELIAL LINING SHOWS CUBOIDAL TO COLUMNAR EPITHELIUM WITH SCATTERED MUCIN – PRODUCING CELLS

TREATMENT AND PROGNOSIS

• Removal of the feeding sublingual gland & marsupialization (i.e. to unroof the lesion rather than to excise it totally).

• Occasionally the lesion recur if the entire

sublingual gland or other gland causing them is not excised with the lesion