Journal: SunText Review of Dental Sciences
DOI: 10.51737/2766-4996.2020.S1.003
Download PDFBenign neoplasms of head and neck region in
pediatrics are very rare. Therefore it is important for general as well as the
dentists to have proper knowledge, so that with early diagnosis, timely
treatment and careful follow up, the risk of potential malignancy can be
reduced and more lesions can be treated before it progresses into malignant.
Fibromas
are hyperplasia of oral mucosa in response to trauma or local irrigation [1].
Fibroma is the most common benign neoplasm of the oral cavity. It is also known
as irrigational fibroma, traumatic fibroma, or fibro epithelial polyp [2].
Fibromas are usually less than one cm in diameter. Its presumed etiology
is trauma to affected mucosa mainly due to parafunctional habit or trauma from
sharp object. It is seen most on buccal mucosa along the occlusal line, labial
mucosa tongue and gingiva. These lesions are often encapsulated with nodular,
hard, smooth surface and do not metastasize. Microscopically it
shows keratinized stratified squamous epithelium with short rete pegs and
nodular deposition of dense collagen and spindle shaped fibroblasts. Lymph
nodes maybe palpable, non-tender and enlarged. These lesions are generally
asymptomatic. Complete surgical excision with scalpel is the
treatment of choice. Ablation with carbon dioxide and (Er:YAG) lasers can be
used [2,3].
Lymphangiomas
are rare, congenital benign lesions occurring in head, neck and oral cavity.
Its incidence is 1.2-2.8 per 1000 newborns [4]. 50% - 70% of these lesions are
located in head and neck region; and rarely occurs in oral cavity, of which 50%
are noted at birth and 90% develop by age of 2 years (5,6).Anterior triangle of
neck is the most common site for lymphangiomas. Intra oral lymphangiomas are
seen on dorsum of the tongue (6% cases), followed by palate, buccal mucosa,
gingiva, and lips. Most prominent sign is the presence of mass, usually
characterized by presence of a soft, compressible, lobulated, and ill-defined
mass which is not attached to the skin or movable across deeper tissues.
Increased size of lesion leads to difficulty in swallowing, airway obstruction,
speech disturbances and maxillofacial deformities. Lymphangioma of tongue is
the most common cause of macroglossia in children [4,5]. Lymphangiomas most
likely present as development malformations arising from sequestration of
lymphatic tissue that do not communicate with rest of the lymphatic channels.
They are known to be associated with turner’syndrome, noonan's syndrome,
trisomies, cardiac anomalies, fetal hydrops, fetal alcohol syndrome and familial
pterygium coli [6]. Pretreatment with OK-432 and followed by
surgical removal is the treatment of choice. Total removal of mass is necessary
to reduce the risk of recurrence [4].
It
is a rare benign mesenchymal tumor of infancy and early childhood. It rarely
occurs in head and neck region; and accounts for 30% of adipocytes tumors in
children. It is common in boys than girls (3:1). It occurs exclusively in
infants and children below 3 years. Site of origin for these lesions is limbs,
followed by trunk, retroperitoneum and the head and neck. Other locations
include parotid gland, cheeks, skin, and orbit. It can be either circumscribed
(70%) or diffused (30%) and usually presents as painless and progressive
growing soft tissue mass which is lobulated. Lobules are composed of mature and
immature fat cells in varying degree separated by fibrous septa. Depending on
the location, nerve compression and related symptoms may be present. Treatment
of choice is total excision with preservation of vital structures. Prognosis is
excellent but the recurrence rate is high in incompletely resected tumors
[7,8].
Hemangioma
is the most common benign vascular tumors of childhood occurring in head and
neck region [9,10]. It is characterized by proliferative growth followed by
very slow involutive phase between 1-10 years of age and 60%-70% of these
lesions are found in head and neck region .It is common in Caucasian females
with female to male ratio 2.4:4.1 [11-13]. These lesions have
unknown etiology and manifest as a pale patch which is easily neglected, later
it grows rapidly and finally appears as port wine stain like lesion. Most of
them appear as bright red exophytic lesions of skin, though deep-seated lesions
can cause no discolorations. These lesions are primarily composed of highly
proliferative hyperplastic endothelial cells. If the growth rate of
proliferative tumors is faster than that of infant’s development, then
functional and cosmetic problems such as ulcerations, nasal obstruction, vision
problems and airway obstruction would appear [14]. Treatment should
be conservative except when there is mechanical obstruction of airway,
haemorrhage, infection, tissue loss or threatened cardiovascular decompensation
[10]. Embolization, surgery, laser, cryotherapy with steroids and
antifibrinolytics may be used in selected cases. Prognosis is excellent with
90% resolution by 9 years of age [13].
They
are common benign lesions of the oral mucosa, common in children. They
represent as single, multiple, or diffuse lesions involving broad areas of oral
mucosa. They are commonly seen in children less than 10 years of age and
accounts for 8% of all oral tumors in children. Average size of the lesion is
less than 1.0 cm and there is no sex predilection. Common site of occurrence is
tongue and soft palate [15-17]. Etiology is unknown, but it has been
associated with HPV 6, 11 and trauma. Mode of transmission in children has been
reported as ingestion of viral particles of infected cells from birth canal. It
may also result from haematogenous spread from a recent infection or
reactivation of a latent infection in mother. They are often painless, slow
growing lesions with cauliflower appearance and present as a papillary or
verrucous exophytic mass [15]. Surgical removal is the treatment of
choice and can be performed with electrocautery, laser ablation, and
cryosurgery or intra lesional injections of interferon [16].
It
is a rare, benign, highly vascular lesion of the base of the skull. It usually
affects males between 9 - 19 years of age and accounts for 0.05% of head and
neck tumor. It is common in Indian subcontinent than in the west. It originates
in the lateral wall of nasal cavity, close to the superior border of
sphenopalatine foramen and is usually rounded, circumscribed, non-capsulated
mucosa covered mass. Frequent symptoms are nasal obstruction and epistaxis
(brisk or intermittent) with or without rhinorrhea. It invades adjacent
structures causing further symptoms such as impaired eustachian tube function,
facial deformation, proptosis, and changes in visual acuity. Angiofibroma
originating outside the nasopharynx may appear as an intraoral mass in
retromolar or buccal space area. Surgery is the treatment of choice and
pre-operative embolization can be used to control the bleeding. Radiotherapy is
also effective as it shows 80-85% control rates. It is locally invasive, and
rate of recurrence is high [18-20].
Although
rare, it is the most common benign tumor of salivary gland in children. It
accounts for 60% of all salivary gland neoplasms and is frequently found in
major salivary glands (85%) and rarely in minor salivary glands (10-15%). Hard palate
and soft palate are the most common site of occurrence [21]. Etiology
remains unclear although exposure to radiation and virus infection (SV40) has
been reported as a causative role in its development. Painless intra oral
swelling is the most common symptom. It is usually mobile, slow growing, firm,
nodular, well circumscribed, painless mass and may grow rapidly at times. It
causes difficulty in eating and talking [21,22]. Treatment of choice
is complete wide excision with good safety margins to prevent recurrence. Most head and neck masses in children are
inflammatory in nature and most of these growths in children are benign. These
benign growths can be related to infection, inflammation, or swellings. Low
rate of benign neoplasms in children indicates that more attention should be
paid to the diagnosis for proper management of the condition [22].