Common Palatal Masses and Their Treatment

Two weeks ago a general dentist referred a healthy 20 year old female patient to my office for evaluation and removal of a growth located in the retromolar pad area. The patient had no medical problems, did not smoke nor drink, and was asymptomatic. The lesion was about 4 mm in length and was on a stalk and a preliminary diagnosis of fibroma was made. The lesion was excised and submitted to Tufts-New England Medical Center department of oral pathology for routine microscopic exam. The pathology report diagnosis: mucoepidermoid carcinoma (low grade). Just as it is difficult to clinically diagnose a benign or malignant lesion located on the retromolar pad area, it is as difficult to diagnose a palatal mass. Palatal lesions are the second most common lesion for which patients are referred to my office for evaluation and possible biopsy. The most common palatal lesions include palatal abscesses, salivary gland neoplasms, benign neural tumors, and irritation fibromas. Because the clinical appearance may not distinguish these entities biopsy may be necessary. A brief review of the clinical appearance and standard treatment of these common palatal masses are reviewed.

The palatal abscess most often develops in the premolar-molar region. It presents as a compressible swelling and yields a purulent exudate on aspiration. After the source of the infection has been identified and appropriate antibiotics initiated, the abscess must be drained. Treatment may include extraction, periodontal therapy, or endondontic therapy.

The most common salivary gland neoplasm is the pleomorphic adenoma (benign mixed tumor). This non invasive tumor usually is located lateral to the midline on the posterior hard palate. It is frequently asymptomatic and occurs more often in women and middle-aged patients. Surgical excision is the recommend treatment.

Adenoid cystic carcinoma is another malignant tumor of the salivary gland. Occurring most often in middle aged patients, it presents as an indurated mass lateral to the midline, usually on the hard palate, and may be ulcerated. Treatment includes complete excision and radiation therapy. The long term prognosis for this carcinoma is poor.

Benign neural tumors may also affect the hard palate. The neurofibroma and neurilemmoma (schwannoma) are clinically similar to one another. They are slowly enlarging lesions with smooth surface. Again, excision is the treatment of choice.

Irritation fibroma is a focal well circumscribed proliferation of fibrous connective tissue. It has normal color and may appear anywhere in the oral cavity. It can be treated with conservative excision.

The 5 year survival rate for patients with intraoral carcinoma has remained a low 30% to 40% for the past 20 years. Patients who present with suspicious lesions should be referred promptly for evaluation by an oral pathologist or oral and maxillofacial surgeon.