Pediatric cyst and tumors the most common types prevalence, management, clinical feature, radiographic finding

1. Pediatric Cysts &Tumors
Presented by : Rahaf Najjar & Shimaa Ibrahim
Supervised By: Dr. Medhat Abdallah & Dr. Omar El Meligy

2. Presentation outline
1. Odontogenic cysts.
2. Non odontogenic cysts.
3. Benign tumors of the oral soft tissues.
4. Malignant tumors.
5. Odontogenic tumors.
6. Non odontogenic tumors.
7. Tumors of the bone.
8. Infections.
9. Vesiculobullous lesions.
10. White lesions.

3. Odontogenic Cysts
1. Primordial Cyst.
2. Dentigerous Cyst.
3. Eruption Cyst or Eruption Hematoma.
4. Odontogenic Keratocyst.

4. 1) Primordial Cyst
Origin:
• Formed by cystic degeneration of the enamel organ
(primordium) before the formation of enamel or dentin.
Epidemiology:
• Uncommon.

5. 1) Primordial Cyst
Location:
• Third molar region OR any location where a permanent
tooth would have formed.
Clinical Findings:
• Asymptomatic

6. 1) Primordial Cyst
Radiographic
Findings:
• Found on routine
radiographic
examination.
• well circumscribed ,
unilocular- or
multilocular- radiolucent
lesion.

7. 1) Primordial Cyst
Treatment:
• Surgical removal.
• Extremely large bone-destructive lesion
Cystotomy & polyethylene drain
Cystectomy ( manageable size )

8. 1) Primordial Cyst
Prognosis:
• If the lesion is found histologically to be an Odontogenic
Keratocyst Recurrence is high.

9. 2) Dentigerous Cyst
• Found with crown of an impacted, embedded, or unerupted
tooth.
Epidemiology:
• Most common .
• 2nd to 3rd decades.
• More in Males.

10. 2) Dentigerous Cyst
Location:
• 3rd molar and maxillary
canine; mostly IMPACTED
• More in Mandible.
Clinical Findings:
• Asymptomatic.
• Large, destructive,
expansile lesions of bone.

11. 2) Dentigerous Cyst
Radiographic Findings:
• Found on routine radiographic.
• Well defined radiolucent lesion unilocular or multilocular
radiolucency.

12. Central type : Cyst surrounding
the crown & crown project in the
cyst.
Lateral type : Mesioangular 3rd
impacted molar & Cyst grow
laterally along the root and partially
the crown .
Circumferential type : Cyst
surrounding the crown ,root &root
lie in the cyst.

13. 2) Dentigerous Cyst
Treatment:
• Surgical removal.
Prognosis:
Changed to:
• Odontogenic keratocyst.
• Ameloblastoma.
• Mucoepidermoid carcinoma.
•

14. 3) Eruption Cyst or Eruption Hematoma
Epidemiology:
• Children >10 years.
Location:
• Most commonly with 1st molar & maxillary incisors .

15. 3) Eruption Cyst
Clinical Findings:
• Translucent, smooth ,
painless swelling over
the erupting tooth.

16. Eruption Hematoma
•If bleeding in cystic space
Blue to blue-black
Eruption hematoma

17. 3) Eruption Cyst or Eruption Hematoma
Treatment:
• NO treatment Cyst raptures spontaneously.

18. 4) Odontogenic Keratocyst
Epidemiology:
• 2nd & 3rd decades.
• 17% >20 years.
Location:
• Mandible < Maxilla

19. 4) Odontogenic Keratocyst
Clinical Findings:
• Half of the patients symptomatic.
• Swelling and drainage the most common clinical findings.
• May exhibit aggressive clinical behavior.
• Associated with nevoid basal cell carcinoma (Gorlin
syndrome).

20. 3) Odontogenic Keratocyst
Radiographic Findings:
• Unilocular or multilocular
radiolucency with well-defined
sclerotic border.
• displacement of tooth .
• Resorption of the root.
• Associated with missing or
unerupted tooth.

21. 4) Odontogenic Keratocyst
Treatment:
• Surgical excision with peripheral osseous curettage
• Osteoectomy is the preferred method of management.
• In large cyst; Marsupilization, followed by Enucleation.

22. 4) Odontogenic Keratocyst
Prognosis:
• High rate of recurrence.
• Potential to become an aggressive (bone-destructive
lesion).

23. Nevoid Basal Carcinoma (Gorlin Syndrome )
 Oral – multiple odontogenic keratocysts, cleft lip or
palate.
 Skin – multiple nevoid basal cell carcinoma.
 Skeletal – rib anomalies, vertebral deformities,
polydactyly (Birth defect characterized by the presence
of more than the normal number of fingers or toes)
 Central nervous system – calcified falx cerebri, brain
tumors.

25. Multiple keratocysts in a child
with Gorlin’s syndrome.
Basal cell tumors of
the skin in the child

26. Non Odontogenic Cysts
1. Palatal and gingival cysts of newborns.
2. Dermoid cyst.
3. Thyroglossal duct (tract) cyst.
4. Trumatic bone cyst
5. Nasolabiale cyst.
6. Nasoplatine duct cyst.
7. Median platine cyst.

27. 1) Palatal and gingival cysts of newborns
Epidemiology:
• Common (more than half of neonates).
Location:
• Midline of the palate or laterally in the hard and soft plat.
• Mucosa overlying alveolar process in the new born.
• Max. < Mand.
.

28. N.B . Similar to:
Epstein pearls
Small keratin-filled cysts
along the median palatal
raphe.
Bohn’s nodules
• Scattered over the hard
palate ,often near the soft
palate junction .

29. 1) Palatal and gingival cysts of newborns
Clinical Findings:
• Small, multiple whitish
papules.
• Occasionally in clusters.
• Cysts is 2-3mm in diameter.
Treatment:
• No treatment, spontaneous
rupture.

30. 2) Dermoid cyst
Epidemiology:
• Uncommon.
 Location:
• Mostly occur in the midline of the floor of the mouth above or
below the geniohyoid muscle.
.

31. 2) Dermoid cyst
Clinical Findings:
• Generally classified as Teratoma.
• Simple in structure than complex Teratomas(DON’T
contain tissue from all 3 germ layer).
• Slow growing &painless.
• Rubbery texture.

32. 2) Dermoid cyst
• Above the Geniohyoid
Muscle
Tongue displaced
toward the roof of the
mouth (difficulty
swollowing )

33. 2) Dermoid cyst
• Below Geniohyoid
Muscle
Creat a submental or
double chin apperance

34. 2) Dermoid cyst
Treatment:
• Complete surgical removal.
Prognosis:
• Recurance is uncomon.

35. 3) Thyroglossal duct (tract) cyst
Epidemiology:
• 1st & 2nd decayed of
life but can develop at
any age .
Location:
• Develop in the midline
any way from the
foramen cecum to the
suprasternal notch.

36. 3) Thyroglossal duct (tract) cyst
Clinical Findings:
• Painless fluctuant ,
movable swelling unless
secondary infected.
• will move vertically
during swallowing or
protrusion of the tongue.

37. Treatment:
• Best treated by Sistrunk Procedure ( removes cyst and midline
segment of the hyoid bone).
Prognosis:
• Recourence rat > 10%
3) Thyroglossal duct (tract) cyst

38. Epidemiology:
• 2nd decayed of life.
• More in Male.
Location:
• Maxilla.
Clinical findings:
• Accident finding.
4) Traumatic bone cyst

39. Radiographic findings:
• Well defined radiolucent w/ smooth thin,
Scalloped border.
• Extends between the roots of teeth.
• Intact lamina dura.
Treatment:
• Curettage and initiate bleeding.
4) Traumatic bone cyst

40. 5) Nasolabial cyst
Epidemiology:
• Rare.
• Most commnly in adult .
Location:
• Upper lip.

41. 5) Nasolabial cyst
Clinical findings:
• Swelling of the upper lip
latral to the midline.
• Elevation of the ala of
the nose.

42. 5) Nasolabial cyst
Treatment:
• Surgical excision.
Prognosis:
• Recurrence are rare.

43. 6) Nasoplatine duct cyst.
Epidemiology:
• 4th 6th decayed of life .
Location:
• Palate.

44. 6) Nasoplatine duct cyst.
Clinical findings:
• Swelling of anterior palate (
dranige , pain ).
• Asymptomatic.
Radiographic findings:
• Discovered in a routine
radiograph.
• Range from > 6mm to 6 mm (
the most 1 to 2.5cm).

45. 6) Nasoplatine duct cyst.
Treatment:
• Surgical inculcation
Prognosis:
• Recurrence is rare

46. 7-Median platine cyst.
Epidemiology:
• Adult.
Location:
• Midline of the hard palate.

47. 7-Median platine cyst.
Clinical findings:
• Swailing 2cm in the
midline of the hard palat

48. 7-Median platine cyst.
Radiographic findings:
• Well circumscribed radiolucency
Treatment:
• Surgical inculcation
 Prognosis:
• Recurrence is rare

49. Benign Tumors Of The Oral Soft Tissue
1. Fibroma.
2. Pyogenic Granuloma & Peripheral Giant Cell
Granuloma.
3. Peripheral Ossifying Fibroma & Peripheral
Odontogenic Fibroma (WHO type).
4. Hemangioma.
5. Lymphangioma.
6. Mucocele.
7. Ranula.

50. 1) Fibroma ( focal fibrous hyperplasia)
Epidemiology:
• Most common benign soft tissue.
• Any age.
Location:
• Sites predisposed to irritation or trauma.
• Buccal mucosa, lip, tongue, gingiva, and hard palate.

51. 1) Fibroma ( focal fibrous hyperplasia)
Clinical Findings:
• Dome-shaped lesion with
a sessile base and a
smooth surface.
• Color of the surrounding
mucosa.
• Firm .

52. 1) Fibroma ( focal fibrous hyperplasia)
Treatment:
• Simple surgical excision.
Prognosis:
• There is little chance to recurrence.

53. 2) Pyogenic Granuloma, Peripheral Ossifying Fibroma,
Peripheral Odontogenic Fibroma (WHO type), and Peripheral
Giant Cell Granuloma
a) Pyogenic Granuloma
Epidemiology:
• Common.
Location:
• 70% gingiva, maxillary anterior labial gingiva.
• lips, tongue, buccal mucosa, palate, mucolabial or mucobuccal
fold, and alveolar mucosa of edentulous Areas.

54. 2) Pyogenic Granuloma, Peripheral Ossifying Fibroma,
Peripheral Odontogenic Fibroma (WHO type), and Peripheral
Giant Cell Granuloma
a) Pyogenic Granuloma
Clinical Findings:
• Sessile or a pedunculated
base.
• Smooth, lobulated, or,
occasionally, warty
appearance.
• Erythematous and often
ulcerated.
• Firm.
• Bleed easily.

55. 2) Pyogenic Granuloma, Peripheral Ossifying Fibroma,
Peripheral Odontogenic Fibroma (WHO type), and Peripheral
Giant Cell Granuloma
a) Pyogenic Granuloma
Treatment:
• Surgical excision.
• Remove any local irritant.

56. 3) Peripheral Ossifying Fibroma and Peripheral
Odontogenic Fibroma (WHO type)
Epidemiology:
• Between 5 - 25 years of age
• Peak incidence at 13 years.
• Women < Men.
Location:
• Gingiva.
• Maxilla= Mandible.
• Incisor- cuspid area .

57. 3) Peripheral Ossifying Fibroma and Peripheral
Odontogenic Fibroma (WHO type)
Clinical Findings:
• Nodular mass either
pedunculated or sesile.
• Emanates from interdental
papilla.
• Red to pink .
• Ulcerated.
• >2cm.

58. 3) Peripheral Ossifying Fibroma and
Peripheral Odontogenic Fibroma (WHO type)
Treatment:
• Surgical excision.
Prognosis :
• Recurrences are common.

59. 4)Hemangioma
Epidemiology:
• 1st -8th week of life.
Location:
• Tongue, lips, and buccal mucosa.

60. 4)Hemangioma
Clinical Findings:
• Characterized by rapid
growth phase followed by
gradual involution.
• Flat or raised.
• Deep red to blue in color.

61. 4)Hemangioma
Treatment:
• Many lesions spontaneously involute with age.
• Others require no treatment because of their small size
and innocuous nature.

62. 5) Lymphangioma
Epidemiology:
• Rare.
• 2/3 of cases present at birth .
• 90% being present by the second year of life.
Location:
• Head & Neck.
• Tongue, lips, and buccal mucosa.

63. 5) Lymphangioma
Clinical Findings:
• Elevated and nodular .
• Same color as the
surrounding mucosa.

64. 5) Lymphangioma
Treatment:
• Not indicated for small oral
mucosal lymphangiomas partial
or complete spontaneous
involution.

65. 6) Mucocele
Epidemiology:
• Any age ( present at birth & 2nd and 3rd).
Location:
• Lower lip, floor of the mouth and buccal mucosa.

66. 6) Mucocele
Clinical Findings:
• Superficial to mucosa :
fluid-filled vesicle or
blister.
• Deep within the
connective tissue : as a
fluctuant nodule with the
overlying mucosa normal
in the color.

67. 6) Mucocele
Treatment:
• Surgical excision with removal of the involved accessory
salivary gland.

68. 7) Ranula
Epidemiology:
• Any age.
Location:
• Occurring to one side of the midline of the floor of the
mouth.

69. 7) Ranula
• Clinical Findings:
• Slowly enlarging,
fluctuant masses.
• Bluish swelling of the
floor of the mouth.

70. 7) Ranula
Treatment:
• Marsupialization.
Prognosis:
• Occasional recurrence.
• Chronic recurrence may require excision of the entire
involved gland.

71. NON ODONTOGENIC TUMORS
1. Melanotic neuroectodermal tumor of infancy
2. Cherubism

72. 1) Melanotic Neuroectodermal Tumor of
Infancy
Epidemiology:
Under 1 Year Old No Sex Predilection
Location: Anterior Maxilla
Clinical Findings:
• Localized non ulcerated expansile bony
enlargement
• Blue / black areas of pigmentation
• Variable growth rate
• Displacement of upper lip

73. 1) Melanotic Neuroectodermal Tumor of
Infancy
Radiographic Findings:
• Diffuse radiolucencies
• Displacement of Tooth buds
• Floating appearance of teeth
Treatment: Excision w/ vigorous bone
curettage.
Prognosis:
15% recurrence rate

74. 2) Cherubism
Epidemiology:
• 1st decayed of life
• Male predilection
Location: Bilateral involvement of the angle of the mandible.
Clinical Findings:
• Bilateral, symmetrical, painless enlargement
• Teeth malposition
• Premature loss of primary teeth
• Failure of eruption of permanent teeth

75. 2) Cherubism
Radiographic Findings:
• Bilateral multilocular radiolucencies
• Teeth displacement & appear to be floating
Treatment: No treatment , regress during puberty.
Cosmetics treatment : bone contouring

76. ODONTOGENIC TUMORS
1. Ameloblastoma
2. Adenomatoid Odontogenic Tumor
3. Ameloblastic Fibroma
4. Ameloblastic Fibro-Odontoma
5. Odontoma
6. Myxoma

77. 1) Ameloblastoma
Epidemiology:
• The most common odontogenic neoplasm
• 4th decayed of life.
• Unicystic type below 20 Y.
Location: mandible in the molar-ramus area
Clinical Findings:
• Asymptomatic lesion
• Initial presentation may be facial swelling.
• It may present with pain and occasionally with lip/facial numbness.
• May be discovered on routine radiographic evaluation
• May show features such as bony expansion, mobility, or divergence
of teeth.

78. Radiographic Findings:
• Either unilocular or multilocular radiolucent
lesions.
• In association with the crowns of impacted
teeth.
Treatment: surgical removal w/ safety
margins.
Prognosis:
• Recurrence rate of 55% to 90%
1)Ameloblastoma

79. 2)Adenomatoid Odontogenic Tumor (AOT)
Epidemiology:
• More in females
• In the 2nd decade of life.
Location: In the maxilla, in canine -
incisor regions.
Clinical Findings:
• The (dentigerous) type in which the tumor is found in
association with the crown of an impacted tooth.
• Extrafollicular type in which here is no association with the
crown of an impacted tooth.
• The peripheral or extraosseous variant.

80. Radiographic Findings:
• Unilocular radiolucent lesion.
• Radiopacities of varying size and density are
often present.
• Divergence of roots
• displacement of teeth may be noted.
Treatment: conservative surgical enucleation
and curettage
Prognosis:
• No propensity for recurrence.
2)Adenomatoid Odontogenic Tumor (AOT)

81. 3) Ameloblastic Fibroma
Epidemiology:
• average age of occurrence is 14 years.
• No sex predilection.
Location: In the mandible, the molar
region.
Clinical Findings:
• Most often swelling; however it is may
be symptomatic.

82. Radiographic Findings:
• Unilocular or multilocular radiolucent lesion
• with well-defined, sclerotic borders
• May be found in association with unerupted or displaced teeth.
Treatment: conservative surgical
removal.
Prognosis:
• Recurrence rate of 33%
3)Ameloblastic Fibroma

83. 4) Ameloblastic Fibro-Odontoma
Epidemiology:
• 5-12 years old.
• No sex predilection.
Location: In posterior mandible.
Clinical Findings:
• painless, slow-growing, and expanding tumor.
• the lesion is associated with unerupted teeth .

84. Radiographic Findings:
• Well defined radiolucent lesion w/
variable amount of calcified material.
Treatment: conservative surgical
removal.
Prognosis:
• No recurrence
4) Ameloblastic Fibro-Odontoma

85. 5) Odontoma
Epidemiology:
• Compound odontomas ,having a mean age of 14years
• Complex odontoma in 20 years .
Location:
• compound odontomas in the canine
and incisor region, in the maxilla
• complex odontomas in the posterior jaws
Clinical Findings:
• most frequent presenting symptom: lack of eruption of
a permanent tooth or bony expansion or swelling.

86. Radiographic Findings:
• Mixed radiolucent and radiopaque lesion. ( tooth
like structures)
Treatment: conservative surgical removal.
Prognosis:
• No recurrence
5) Odontoma

87. 6) Odontogenic Myxoma
Epidemiology:
• 2nd – 4th decayed of life .
• Location: more in the mandible . molar
and premolar region
Clinical Findings:
• usually painless,
• slow-growing lesions .
• noticeable signs and symptoms such as swelling or mobility and
divergence of teeth
• Several cases occurring in association with impacted or missing
teeth

88. 6) Odontogenic Myxoma
Radiographic Findings:
• unilocular or multilocular lesions
• may cause expansion,thinning and destruction of the cortical
plates of bone
• displacement of teeth.
• Multilocular lesions often exhibit a
mottled,soap bubble or honeycombed
appearance.
Treatment:
• dependent on its size and location.
• The preferred treatment is complete surgical excision, which is
difficult because of infiltration and expansion of the tumor into
bone and the absence of a true capsule

89. TUMORS OF BONE
1. Fibrous Dysplasia
2. Juvenile Ossifying Fibroma
3. Central Giant Cell Granuloma

90. 1) Fibrous dysplasia
Epidemiology:
• 2nd decayed of life
• No sex predilection
Location: maxilla
Clinical Findings:
• smooth, uniform,fusiform expansion of the involved alveolar
ridge.
• Obliteration of the mucobuccal or mucolabial fold
• Non-tender facial asymmetry
• Displaced teeth

91. 1) Fibrous dysplasia
Radiographic Findings:
• Mixed radiolucent and radiopaque lesion w/ ground glass
apperance
• Blends into adjacent normal structure
• Displacement of roots of adjacent teeth
Treatment: Cosmetics surgical reduction

92. McCune-Albright syndrome
• Associated with cafe-au-lait macules on the skin
• Polycystic fibrous dysplasia
• Variety of endocrine disorders

93. 2) Juvenile Ossifying Fibroma
Epidemiology:
• Age from 8 to 12 years
Location: both the maxilla and the mandible
Clinical Findings:
• Most patients are asymptomatic.
• may present with non-specific symptoms.

94. 2) Juvenile Ossifying Fibroma
Radiographic Findings:
• well demarcated, expansile mass with an ossified rim at the
periphery
Treatment:
surgical excision

95. 3) Central Giant Cell Granuloma
Epidemiology:
• more than 60% of lesions noted before 20 years
• more in females.
Location: in the mandible .
Clinical Findings:
• Usually asymptomatic
• May present with aggressive growth, pain, and swelling.

96. 3) Central Giant Cell Granuloma
Radiographic Findings:
• vary from a unilocular radiolucency to a multilocular
• expansile bone-destructive lesion
• displacement and noneruption of teeth
• root resorption
• cortical perforation
Treatment:
Surgical curettage

97. MALIGNANT TUMORS
1. Fibromatosis
2. Malignant Lymphoma
3. Rhabdomyosarcoma
4. Osteosarcoma
5. Ewing’s Sarcoma
6. Langerhans Cell Histiocytosis (Histiocytosis X )

98. 1) Fibromatosis
Soft tissue :
• juvenile or aggressive fibromatosis
• locally aggressive in behavior with a tendency for recurrence.
not metastasize.
• they can kill by local infiltration and extension into vital
structures.
In bone:
• Desmoplastic fibromas
• the mandible is the most common site of involvement
Epidemiology: 1st decade of life.

99. 1) Fibromatosis
Clinical Findings:
• most commonly present as a painless mass
• involving the cheek, tongue, or submandibular region
• with erosion of bone
• arising in soft tissue adjacent to the jaws
Radiographic Findings:
• unilocular to multilocular with borders that may vary from ill-
defined to well demarcated.
Treatment:
complete surgical excision with a safety margin

100. 2) Malignant Lymphoma (Burkitt
Lymphomas.)
Epidemiology:
• 4 to 7 years and common in boys.
• young children who have Epstein-Barr, the virus that
causes infectious mononucleosis.
• People with HIV
Location:
• tumor of the jaw or other facial bones.

101. 2) Malignant Lymphoma (Burkitt
Lymphomas.)
Clinical Findings:
• firm, nontender swelling.
• Weight loss
• Fatigue
• Night sweats
• Unexplained fever
Treatment:
Chemotherapy.
Prognosis: long-term survival rates of 60% to 90%

102. 3) Rhabdomyosarcoma
Epidemiology:
• 2 to 6 years.
• a malignant neoplasm of skeletal muscle origin.
• is the most common soft tissue sarcoma in children.
Location: Head and neck is most common location.
• in children: the eyelid and orbit, parameningeal.
• In oral cavity: the soft palate and tonsillar region, tongue.
Clinical Findings:
• rapidly growing, nonulcerated soft tissue mass.
• Hearing loss & Neurologic symptoms
• Extensive destruction of the bone at base of skull.
• Metastasis to lung

103. 3) Rhabdomyosarcoma
Treatment:
• based primarily on the extent of disease using multiagent
chemotherapy, surgery, and external-beam radiation therapy .
• Prognosis: Good prognosis (~70% 5-year survival)
• dependent on age, stage and site
• orbital lesions having the highest survival rates
• parameningeal tumors having a worse prognosis.

104. 4) Osteosarcoma
Epidemiology:
• the modal age of incidence being 16 years for girls and 18 for
boys.
Location: The mandible.
Clinical Findings:
• Swelling with or without pain is the most frequently described
early symptom.
• Paresthesia, anesthesia and loosening of the teeth .

105. 4) Osteosarcoma
Radiographic Findings:
• A frequently described radiographic feature is a “sun-ray”
appearance
Treatment:
• be radical surgery with safety margins.
• Prognosis:
• 50% recurrence in 1st year
• 5-year survival: 40% (< 5 cm) .

106. 5) Ewing’s Sarcoma
Epidemiology:
• the second most common primary
malignancy of bone.
• the average age to be 15 years
• More in male.
Location: bones of the head and neck, with the
skull being the most frequent site, then the posterior mandible.
Clinical Findings:
• Localized swelling and pain are the most frequent complaints.
• paresthesia
• tooth mobility
• The soft tissue overlying the lesion may be erythematous and warm
to the touch,

107. 5) Ewing’s Sarcoma
Radiographic Findings:
• Diffuse bone-destructive lesion,
appearing as an irregular, mottled,
radiolucent lesion.
• reduplication or lamination
of the periosteum
Treatment:
• systemic multiagent chemotherapy along with local control,
surgery, radiation therapy, or a combination of the two.
• Prognosis:
• 3-year survival: 80% .

108. 6) Langerhans Cell Histiocytosis
Letterer-Siwe disease.
Location: skin, thymus, and mucosal epithelium.
 Clinical Findings:
• development of a scaly erythematous skin rash
on the trunk.
• Oral lesions with swelling, painful ulcers,
gingival inflammation and necrosis and
destruction of alveolar bone
• premature exfoliation of the teeth.
Treatment:
• chemotherapy
Prognosis: poor prognosis

109. 6) Langerhans Cell Histiocytosis
Hand-Schuller-Christian disease
Epidemiology: 1st decayed of life
 Clinical Findings:
• occurrence of punched-out–appearing
radiolucent defects in membranous bones
• exophthalmos.
• diabetes insipidus.
• Chronic otitis media
Treatment:
• with surgical curettage or radiation therapy being used to treat focal
disease
• Multiagent chemotherapy in long-term control of disseminated
disease.

110. 6) Langerhans Cell Histiocytosis
Eosinophilic granuloma
Epidemiology: most common and also least
severe form.
• Older children and young adults
Location: the mandible and skull.
 Clinical Findings: pain and swelling.
Radiographic Findings: single or multiple well-defined radiolucent
bony lesions.
Treatment:
• the lesion may be left alone for observation
• it may be surgically curetted or excised,
• intralesional injections of corticosteroids

111. Infections
A. Viral infections :
1. Herpetic infections primary herpes simplex infection.
2. Secondary herpes simplex infection.
3. Herpes varicella-zoster.
4. Mumps.
5. Measles.
6. Rubella.
7. Herpangina.
8. Hand, foot & mouth disease.
9. Infectious mononucleosis.
10. Human papiloma virus.

112. Infections
B. Bacterial infection:
1. Staphylococcal infections.
2. Streptococcal infection.
3. Congenital syphilis.
4. Tuberculosis.
5. Cat-scratch disease.

113. Infections
C. Fungal infections:
1. Candida.
2. Actinomycosis.
3. Protozoal infections.

114. Vesiculobullous lesions
1. Epidermolysis bullosa .
2. Erythema multiforme.
3. Pemphigus.
4. Pemphigoid.

115. White lesions
1. White spongy naevus .
2. Leucoedema.
3. Candidiasis.
4. Geographic tongue.

116. References
• McDonald and Avery Dentistry for the Child and Adolescent,
Jeffrey A. Dean, David R. Avery, Ralph E. McDonald; 9th
edition, chapter 8.
• Pediatric Dentistry: Infancy through Adolescence, Paul S.
Casamassimo , Henry W., Jr. Fields , Dennis J.
McTigue , Arthur Nowak ; 5th edition.