Lesions of the mouth and throat are common in children and can range from benign conditions that require no intervention to significant systemic illness requiring extensive treatment and support (Table 124-1). Making the distinction between these conditions can be difficult. Mouth pain secondary to viral infections of the oropharynx is one of the most common presenting complaints of pediatric patients; however, most patients require no treatment beyond supportive care and pain control. Bacterial infections of the mouth and throat, such as pharyngitis and uvulitis, cause local and systemic illness and rarely can lead to life-threatening complications. The management of dental injuries, whether from neglect or trauma, differs for primary and permanent teeth.
TABLE 124-1Common Causes of Oral Lesions in Children ||Download (.pdf) TABLE 124-1 Common Causes of Oral Lesions in Children
|Anterior ||Posterior ||Diffuse |
|Aphthous ulcers ||Adenovirus pharyngitis ||Autoimmune disease |
|Contact stomatitis ||Coxsackievirus ||Candidiasis (thrush) |
|Herpes simplex gingivostomatitis || |
|Chemotherapy-related mucositis |
|Trauma ||Streptococcal pharyngitis ||Medication-related (phenytoin [Dilantin®]) |
|Vincent’s angina || || |
| || || |
Epstein pearls are remnants of embryonic development that present as white, slightly raised nodules seen most commonly midline at the junction of the soft and hard palates of neonates. They are often seen incidentally during feeding and do not cause the child any pain or discomfort. Most resolve spontaneously.
Geographic tongue or migratory glossitis (Figure 124-1) can be a source of great parental concern. It is a benign, asymptomatic condition and is often incidentally noticed by parents during another illness. Findings include an area of erythema and atrophy of the papillae of the tongue surrounded by a serpiginous, elevated white or yellow border usually located in the anterior two thirds. The lesions will improve and disappear gradually over time but tend to recur in other areas of the tongue. There is no known cause, although it has been associated with childhood allergies and atopy. No treatment other than reassurance is necessary.
Geographic tongue. [Reproduced with permission from Wolff K, Johnson RA, Saavedra AO: Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 7th ed. © 2013 by McGraw-Hill, Inc., New York, Figure 33-4.]
Mucoceles (Figure 124-2) and ranulas are lesions of the oral mucosa that present as small, bluish, discrete, mucosal swellings on the lower lip or sublingual areas. These are most often caused by minor trauma such as biting the lip. Referral to otolaryngology for intervention is needed only with disruption of feeding or development of speech. Adjacent salivary glands are usually removed in addition to the lesion to prevent recurrence.
Mucocele. [Reproduced with permission from Wolff KL, Johnson R, Suurmond R: Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology...