Theme Section Differential diagnosis of oral enlargements in children

The purpose of this article is to review soft tissue and bony enlargements that typically occur in the oral and perioral region of children. In order to organize these lesions into a thorough but comprehensible format, the principles of differential diagnosis must be used. All oral enlargements are broadly classified as soft tissue or bony abnormalities. Determination of the specific lesion category is based primarily on a prominent feature that demonstrates the nature of the lesion, followed by the secondary clinical features and any contributory patient information. Classification of exophytic soft tissue entities includes: papillary surface enlargements, acute inflammatory enlargements, reactive hyperplasias, benign submucosal cysts and neoplasms, and aggressive and malignant neoplasms. Bony enlargements of the maxilla and mandible are divided into three categories: inflammatory lesions, benign cystic and neoplastic lesions, and aggressive and malignant lesions. This extensive topic is summarized on flow charts for easy reference with emphasis on grouping together lesions with common characteristics. ( P ediatr Dent 17:294-300,1995) A n enlargement of the oral cavity may represent a wide range of entities such as anatomic variations, developmental anomalies, inflammatory and reactive diseases, cysts, and neoplasms. The goal of differential diagnosis is to determine the nature of the enlargement as a basis for formulating a rational treatment approach. The symptoms, growth rate, palpation characteristics, surface morphology, and lesion site allow for categorization of the soft tissue lesions into one of the five lesion groups as outlined in Fig 1". These descriptive categories consist of: 1. Papillary surface enlargements (Fig 2) 2. Acute inflammatory enlargements (Fig 3) 3. Reactive hyperplasias (Fig 4) 4. Benign submucosal cysts and neoplasms (Fig 5) 5. Aggressive and malignant neoplasms (Fig 6). Once a specific category has been selected, the characteristics of the lesion can be compared with other diseases that share common clinical features and behavioral patterns.