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J Can Dent Assoc 2013;79:d88
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ESSENTIAL DENTAL KNOWLEDGE
Published by
The Canadian Dental Association
Figure 3: Higher magnification of the
connective tissue showing the numerous
lymphatic vessels (hematoxylin and eosin,
magnification 40×).
common site of oral lymphatic malformations. 2,4-9
Other less commonly
affected intraoral sites are
the buccal mucosa, lips,
soft and hard palates, floor
of the mouth, retromolar
pad, tonsils and gingiva.4,6-8
Few cases of lymphatic
malformations on gingival
tissue have been reported
in the literature.
Review of the Literature
Until the 1900s, lymphatic malformations
were considered neoplastic.10 Nowadays, they are
viewed as rare benign congenital anomalies 6,7,10
and are typically diagnosed during childhood. 5,7,9,10
Acquired lymphangiectasia refers to a specific
type of lymphatic malformation that develops as
a result of an infection or surgery that interferes
with regional lymphatic drainage.1,3,4
The first case of lymphatic malformation was described by Redenbacher in 1828.10
Nearly 15 years later, Wernher proposed the term
"hygroma" to identify this type of lesion. He then
developed a histologic classification of lymphangiomas based on 3 categories: capillary (simplex),
cavernous and cystic (cystic hygroma).10 Although
arbitrary, this classification is still used by some
authors, 2 while others suggest using the term lymphatic malformation.10
Another classification divides lymphatic malformations into 2 categories: microcystic lymphatic malformations and macrocystic lymphatic
malformations. The microcystic form includes
lymphangioma simplex and circumscriptum,
while the macrocystic form includes cavernous
lymphangiomas and cystic hygromas.7,11 However,
some authors suggest that histologic differences in
the various types of lymphatic malformations may
be attributed to anatomic location, making such
classification of little interest.1,4
Lymphangiomas have a marked predilection for
the head and neck, with 50–75% of all cases occurring in these regions.2,7 Although lymphatic malformations are always present at birth, they may
• 40 •
not be clinically identifiable until they develop or
a complication makes them more apparent.11 The
first symptoms may occur following an infection,
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DENTAIRES INDISPENSABLES
bleeding or lymphatic leakage.11 Approximately
l’Association dentaire
50% of lymphangiomas are visible at birth canadienne
and
up to 90% are visible by age 2 years2; 95% of oral
lymphangiomas are present before age 10 years.5
Lymphatic malformations are less common in
late childhood and rare in adults.7 Men and women
are affected equally.7,9 The malformations may vary
in dimension from capillary size to several centimetres.7 Cavernous lymphangiomas, unlike cystic
hygromas, are more commonly found in the oral
cavity.2 Connective tissue and skeletal muscles in
the oral cavity limit vessel expansion.2
In general, the lesion is superficial and its surface is characterized by a cluster of translucent
vesicles resembling tapioca pudding or frog eggs.2
A secondary hemorrhage in the lymphatic spaces
may account for the vesicles’ purple colour.2,3 The
clinical appearance of the surface of the lesion is
due to numerous thin-walled cavities and dilated
vessels directly beneath the mucous membrane.7
Deeper lesions present as poorly defined masses.2
Intraoral lymphatic malformations on gingival tissues are extremely rare. 5-7 Kalpidis and
colleagues7 reported a case of a solitary superficial microcystic lymphatic malformation confined to the gingiva. According to these authors,
this is the first case reported in the literature.
Three other cases of lymphangiomas confined to
the gingiva have been described,1,4,8 but the lesions
were bilateral.
Small lymphangiomas measuring less than
1 cm can be observed on the alveolar ridge in
approximately 4% of black newborns. 2 These
lesions are often bilateral on the mandibular
ridge. They occur in twice as many male infants
as female. Most resolve spontaneously, as they are
not seen in adults. Some authors believe that congenital lymphangioma of the alveolar ridge seen in
African-American newborns is a distinct lesion.4
The standard treatment for lymphatic malformations is surgical excision. 2,10 Ablation of
these lesions requires a reasonably wide resection
margin, as superficial ablation frequently results in
recurrence.7 However, other therapeutic modalities
include conservative surgical excision followed by
periodic examination to monitor for recurrence,1
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