benign soft tissue tumors

2.  Structural variations of the jaw bones and
overlying oral soft tissues are sometimes
mistakenly identified as tumours
 Examples of such structural variants are
tori,localised nodualr thickening of the
attached gingiva,papilla associated with the
opening of stensen’s duct,circumvallate
papillae of the dorsum of tongue and
sublingual varicosties in older individuals

3.  Localised nodular enlargements (exostosis) of
the cortical bone of the midline of the palate
(torus palatinus),the lingual aspect of
mandible(torus mandibularis) are also
considered normal

4.  Reactive hyperplasia of fibrous connective
tissue in response to local irritation or trauma
 Also called Traumatic fibroma/Irritation
fibroma
 CLINICAL FEATURES
 Common in 4th to 6th decades of life
 Small lesions ,lesions >1cm are rare
 Most common in buccal mucosa
 Also occur in labial mucosa,tongue,gingiva
 Appears as a smooth surfaced pink nodule

5.  Lesions are generally less than 1.5cm
 Fibromas occur either pedunculated or sessile
growth on any surface of the oral mucosa
membrane
 Firm on palpation
 Associated with:-
 Multiple fibromas indicate cowden syndrome
(autosominal dominant trait characteerised by
multiple papillomatosis,pebbly or fissured
tongue,-cobblestone effect on mucous
membrane)or tuberous sclerosis(seizures & mental
retardation)

6.  Differential Diagnosis
 Lipofibroma and myxofibroma- but these are
soft on palpation
 Giant cell fibroma-younger age,on histological
examination stellate shaped and
multinucleated cells in connective tissue
 TREATMENT
Conservative surgical
excision

7.  Epulis is any tumour of the gingiva or alveolar
mucosa
 Examples of epulides are:-
 Giant cell epulis (peripheral giant cell
granuloma)
 Ossifying fibroid epulis(peripheral ossifying
fibroma)
 Congenital epulis

8.  It is a tumour like hyperplasia of fibrous
connective tissue that develops in association with
ill fitting complete or partial denture
 Also called inflammatory fibrous
dysplasia/denture irritation hyperplasia
 CLINICAL FEATURES
 Common in middle aged and older adults
 Occur mostly in maxilla
 Mostly seen under the buccal and labial flanges
 Anterior portion of the jaws are most affected than
posterior region
 Female predilection

9.  The exophytic often elongated epulis usually
has atleast one cleft into which the denture
flange fits with a proliferation of tissue on each
side
 Size vary from localised hyperplasia measuring
less than 1cm size to massive lesions involve
most length of the vestibule
 Appears as single or multiple fold or folds of
hyperplastic tissues in the alveolar vestibule

10.  DIFFERENTIAL DIAGNOSIS
 On rare occasions squamous cell
carcinomas,verrucous carcinomas and
malignant salivary gland tumours have arisen
around denture flanges thus microscopic
examination of excised tissue is imperative
 TREATMENT
 Surgical removal

11.  It is a reactive tissue growth that develops beneath
the denture
 Condition mostly associated with ill fitting denture
 Also called pallatal papillomatosis
 CLINICAL FEATURES
 Usually occurs on the hard plate beneath the
denture base
 Usually associated with denture stomatitis due to
candidal infection ,poor oral hygiene,AIDS are also
its etiologic factors

12.  Asymptomatic
 The lesion may be red to scarlet with swollen and
tightly packed projections resembling overripe
berry
 Lesions are friable and often bleed with minimal
trauma,may be covered with a thin whitish
exudate
 DIFFERENTAL DIAGNOSIS
 1.Nicotine stomatitis:-
> exclusive in pipe smokers
> More nodular and broader
lesions
> Nodules in NS has a red dot
(inflammed minor salivary duct openings) in their
approximate centre

13.  TREATMENT
 Removal of the denture may allow the
erythema and edema to subside
 Topical or systemic antifungal therapy
 Surgical methods include:-
 Curettage
 Electrosurgery
 Cryosurgery
 Laser surgery

14.  It is rare spindle cell neoplasm that consists of
myofibroblasts
 Mostly solitary lesions but some patients
develops multicentric tumour process known
as myofibromatosis
 CLINICAL FEATURES
 predilection for head and neck region
 first 4 decade of life,mean age:22 years
 Painless mass that sometimes rapidly exhibits
rapid enlargement

15.  Mostly,solitary lesions,multicentric tumour
also develop known as myofibromatosis
 Multicentric myofibromatosis primarily affects
neonates and infants who may have tumours of
skin,subcutaneous tissues,muscle,bone,viscera
 Number of tumours can vary from several to
more than 100

16.  RADIOGRAPHIC FEATURES
 Intrabony tumours create
radioluscent defects that usually
tend to be poorly defined
 Some may be well defined or
multilocular
 TREATMENT
 Surgical excision

17.  It is a common tumour like growth of the oral
cavity
 Exuberant tissue response to local irritation or
trauma
 CLINICAL FEATURES
 Common in maxilla
 Mostly occurs in young adults
 Female predilection because of the vascular
effects of female hormones

18.  Gingival irritation and inflammation due to
poor oral hygiene may be a precipitating factor
 Oral PG show striking predilection for gingiva
 Lips,tongue ,buccal mucosa ,vestibule,and
alveolar mucosa in edentulous regions are
other common sites
 Mass is painless and bleeds often
 Exhibit rapid growth
 No pus in the lesion

19.  Smooth or lobulated mass that is usually
pedunculated or sessile
 Surface is characteristically ulcerated and ranges
from pink to red
 Young PG are vascular in appearance which are
soft and bleeds easily but older lesions are more
collaginized and pink
 They may vary from small growth only a few
millimeter in size to larger lesions that cause
several cm in size
 Strong tendency to recur after simple excision

21.  Frequently occurs in pregnant women so also
termed pregnancy tumour or granuloma
gravidarium
 These lesions develop in first trimester and
their incidence increases upto 7th month of
pregnanacy
 AFTER PREGNANCY AND THE RETURN
OF NORMAL HORMONE LEVELS ,SOME
OF THESE GRANULOMAS RESOLVE
WITHOUT TREATMNET

22.  DIFFERENTIAL DIAGNOSIS
 Traumatised fibromas
 Epulis fissuratum
 Parulis
 Myxofibroma
 Exophytic capillary hemangioma
 Peripheral ginat cell granuloma-more bluish
 Peripheral fibroma with calcification-
radiograph shows small radio opaque foci

23.  Radiographic features
 Does not show seperation of adjacent teeth
 TREATMENT
 Conservative surgical excision
 For gingival lesions,the excision should extend
down to periosteum and the adjacent teeth
should be thoroughly scaled to remove any
source of irritation

24.  It is a reactive lesion caused by local irritation
or trauma
 It originate from PDL,mucoperiosteum
 CLINICAL FEATURES
 Female predilection,in the age group above 20
yrs
 Presents as red or red blue nodular mass
 Occurs as an exophytic lesion in gingiva and
edentulous alveolar mucosa
 Develop either in the anterior and posterior
regions of the gingiva or alveolar mucosa

25.  Smaller than 2cm diamter
 Sessile or pedunculated
 Mandible is affceted more than maxilla
 Cuffing resorption of underlying bone is seen
 It may feels soft to hard depending upon the relative
proportions of collagen and inflammatory component
 The lesion may be vascular or haemorragic with ulcerations
and tenderness
 On microscopic examination ,multinucleated giant cells are
scattered through out the granulation tissue

26.  RADIOGRAPHIC FEATURES
 In dentulous cases there may be superficial
destruction of the alveolar margins of crest of
interdental bone
 In the edentulous areas,exhibits superficial
erosion of bone with periapical cuffing of bone

27.  DIFFERENTIAL DIAGNOSIS
 haemangioma-present at birth
 Pyogenic granuloma:-no seperation of tooth
 Lymphangioma-rarely occurs in gingiva,much
paler colour
 Metastatic carcinoma-history of primary
tumour,evidence of bone destruction under
exophytic lesions
 Oral nevi-darker in colour,firmer to palpation
 TREATMENT
 Local surgical excision down to the underlying
bone

28.  Common benign gingival overgrowth which is
considered to be inflammatory hyperplastic lesion
 It involves the PDL superficially and it often contains
odontogenic epithelial nests,deposits of cementum,bone
and dystrophic calcification scatterd throughout a
background of fibrous tissue
 Some POF initially start as pyogenic granulomas that
undergo fibrous maturation and subsequent calcification
 CLINICAL FEATURES
 Predominantly seen in the ages of 10 and 19
 Female predilection
 More in maxilla

30.  Occurs exclusively on gingiva
 Lesions less than 2cm in size
 Color ranges from red to pink
 It appears as nodular mass which is either
pedunculated or sessile
 Surface is frequently ulcerated
 Growth begins as an ulcerated lesion ,older
ones are more likely to demonstrate healing of
ulcer and an intact surface

31.  DIFFERENTIAL DIAGNOSIS
> Chondrosarcoma and osteogenic sarcoma
-less frequent gingival lesions than PF
-widening of PDL space of involved teeth
> Gingival inflammatory hyperplastic lesions-
Pyogenic granuloma,hormonal tumour( does
not show seperation of adjacent teeth and
calcified foci are present in gingival
inflammatory hyperplastic lesions)

32.  RADIOGRAPHIC FEATURES
 Superficial erosion may be seen
 Presence of radiopaque foci within the tumour
mass,due to calcifications within the tumour
 Causes seperation of adjacent teeth
 Minimal bone resorption beneath the lesion
 TREATMENT
 Local surgical excision

33.  Lipoma is a benign tumour of mature fat cells
 When occuring in the superficial soft
tissue,lipoma appears as a yellowish mass with
a thin surface epithelium and presents delicate
pattern of blood vessels on the surface
 CLINICAL FEATURES
 Majority of lipomas are found in buccal
mucosa and tongue
 Occur in individuals over 40 years of age
without sex predilection

35.  Less than 3cm in size
 Lesion may varies from well contoured,well
defined round swelling to large ill defined
,lobulated mass
 Solitary lesion may be sessile ,pedunculated or
submerged
 Multiple lesions are also present
 On palpation,the lesion is
nontender,soft,cheesy in consistency
 It may be fluctuant

36.  DIFFERENTIAL DIAGNOSIS
 Focal aggregats of fordyce’s granules
 Buccal pad of fat
 Superficial cavernous haemangioma
 Lymphangioma
 Myxomas
 Superficial retention phenomena
 TREATMENT:-
 surgical excision

37.  Proliferation of nerve tissue caused by injury to a
peripheral nerve
 CLINICAL FEATURES
 Traumatic nueromas can occur in anywhere in the
oral cavity
 Mental foramen, area ,tongue ,lower lip are the
common location
 Most often in middle age
 Slow growing,seldom grows beyond 1cm in dm
 Pain on palpation to severe constant radiating pain
 The patient may have reflex nueralgia with pain
referred to eyes,face,head

39.  RADIOGRAPHIC FEATURES
 Seen as radioluscent lesion with well defined
corticated borders
 Shape may vary depending upon the amount
of resistance to expansion
 Expansion of inferior dental canal
 DIFFERENTIAL DIAGNOSIS
 Odontogenic cyst-no history of trauma
 Other benign nueral tumours
Diagnosis:-biopsy,microscopic examination
 Treatment:-
 surgical excision

40.  It is a benign tumour of peripheral nerve
 Contains schwann cells,perinueral cells and
axons
 Also called solitary circumscribed nueroma
 CLINICAL FEATURES
 Predilection for face,nose and cheek are the
most common sites
 5th and 7th decade of life
 Lesion appears in hard palate and maxillary
labial mucosa

41.  Smooth surfaced painless dome shaped papule
or nodule usually less than 1cm in diameter
 No sex predilection
 Well circumscribed,partially encapsulated
nodule composed of spindle shaped cells
 TREATMANT
 conservative local surgical lesion

42.  Benign nueral neoplasm of schwann cell origin
 CLINICAL FEATURES
 No sex predilection
 slow growing encapsulated mass
 Asymptomatic
 Tenderness or pain in some case
 Mandible and saccrum are the common sites

43.  Tongue and buccal mucosa are the most
common intraoral sites
 RADIOGRAPHIC FEATURES
 Tumour is radioluscent with well defined
corticated margins
 Sometimes lesion may have a scalloping
outline gives a false multilocular appearance

44.  It usually located in inferior alveolar nerve
canal
 DIFFERENTIAL DIAGNOSIS
Cysts:-no expansion of inferior alveolar canal
Ameloblastoma:-occurs above inferior alveolar
canal
 TREATMENT
 LOCAL SURGICAL EXCISION

45.  Most common type of peripheral nerve neoplasm
 Arises from schwann cells and perinueral
fibroblasts
 CLNICAL FEATURES
 Common in young adults
 It may expand and perforate the cortex causing a
swelling that is hard to firm on palpation
 Present as slow growing ,painless lesions that vary
in size from small nodules to large masses
 Those associated with mandibular nerve may
produce pain and parasthesia
 Occur as solitary components or be a component of
nuerofibromatosis

46.  RADIOGRAPHIC FEATURES
 Unilocular radioluscency with
sharpely defined corticated border
 Sometimes appear multilocular
 NF of inferior dental canal shows Fusiform
enlargement of inferior dental canal
 DIFFERENTIAL DIAGNOSIS
 Vascular lesions-enlarges
whole canal and alter its path
 Other nueral lesions
TREATMENT
Surgical excision

47.  This is a syndrome consisting of café au lait
spots on the skin ,multiple peripheral nerve
tumours and other abnormalities of
skin,nervous system ,skin
 NF1:-this is a generalised form
 NF2:-central form
 Oral lesion may occur as part of NF1

48.  CLINICAL FEATURES
 Genetic disease manifest
gradually during childhood and adult life
 Most common in skin
 Clinical appearance
vary from small papules to
larger soft nodules to
massive pendulous mass

49.  Accelerated growth seen at pregnancy
 Another highly characteristic feature is the
presence of “café au lait “ pigmentation on the
skin
 “café au lait” spots become larger with age
usually 6 spots larger than 1.5cm
 Lisch nodules ,transluscent brown pigmented
spots on the iris are also found in affected
individuals
 Central form is rare

50.  RADIOGRAPHIC FEATURES
 Alterations in shape of mandible
 Enlargement of mandibular canal
 Erosive changes to the outer contour of
mandible
 Interference with the normal eruption of
molars

51.  TREATMENT
 No specific therapy NF
 Treatmnet done to reduce complications
 facial nuerofibromas are removed for cosmetic
purposes with co2 laser and dermabrasion

52.  This is a group of rare conditions characterised
by tumours or hyperplasia of the
nueroendocrine tissues
 MEN TYPE1:-benign tumours of pancreatic
islets,adrenal cortex,parathyroid glands
 MEN TYPE 2:- (sipple syndrome) includes
devolopment of adrenal
pheochromocytomas,Medullary Carcinoma
Thyroid

53.  CLINICAL FEATURES
 Marfanoid body characterised by thin
,elongated limps with muscle wasting ,narrow
face,thick lips
 Oral mucosal nueromas are usually first sign of
the condition
 Nueromas appear as soft,painless papules or
nodules that prinicipally affcet the lips and
anterior tongue,buccal mucosa,gingiva

54.  Bilateral nueromas of the commissural mucosa
are highly characteristic feature.
 pheochromocytomas develop in 50% of all
patients
 The tumour cells secrete catecholamines which
result in symptoms such as profuse
sweating,intractable diarrhoea,headaches ,heart
palpitations,hypertension

55.  The most significant aspect is the development
of MCT of thyroid gland
 LABORTARY VALUES
 If MCT present serum or urinary levels of
calcitonin are elevated
 Pheochromocytomas may result in increase
levels of urinary vanillylmandelic acid and
increased epinephrine to norepinephrine ratios

56.  TREATMENT:
 Prophylactic removal of thyroid gland because
MCT is most certain to occur
 Patient observed for development of
pheochromocytomas

57. GRANULAR CELL TUMOUR CONGENITAL EPULIS
 Benign tumour composed
of large cells with a
granular cytoplasm
 Arises from schwaann cells
or their primitive
mesenchymal precursors
 Common in tongue(dorsal
surface),also seen in buccal
and labial mucosa
 Painless,non ulcerated
nodule
 The mass is typically pink
but occasionaly yellow also
 Benign neoplasm
composed of cells
resembles granular cell
tumour
 Arises from primitive
mesenchymal cells
 Common in anterior
maxilla,alveolar ridge
 Smooth surfaced,polypod
mass which is sessile or
pedunculated mass on
gingiva
 Appears pink to red

58.  2cm or less in size
 Occurs in adults
 Female predilection
 Treatment:surgical
excision
 2cm or less in size
 Present at birth
 Female predilection
 Surgical excision

59.  Additional points for congenital epulis:-
 Can be also seen in tongue(rare) thus called
congenital granular cell lesion
 More common in maxillary ridge than in
mandibular ridge
 Most frequently occurs lateral to the midline in
the area of developing lateral incisor and
canine teeth
 Predilection for female due to hormonal effects

60. Granular cell tumour
Congenital epulis

61.  Vascular malformations may be clinically apparent
at birth,grow slowly proportional to the growth of
child and never involute
 Vascular malformations are classified basis on the
type of vessel involved:-
 Arterial and arteriovenous-high flow
 Capillary or cavernous- low flow Arterial and
arteriovenous malformation may devolop
following hormonal changes ,infections or
trauma,clinically they are firm,pulsatile,warm
 Venous malformations appear in early adulthood
,clinically they are soft and easily compressible

62.  DIAGNOSIS
 Diascopy-is the technique of applying pressure
to a suspected vascular lesion to visualize the
evacuation of coloration and may facilitate the
differensiation from a pigmented lesion
 Angiography
 CT,MRI are useful imaging techniques

63.  Treatment:-superselective intra-arterial
embolisation,sclerotherapy,radiotherapy,surgic
al excision using cryosurgery or laser surgery
or electrocoagulation
 Vascular malformation associated syndromes:-
 Osler weber rendu syndrome
 Blue rubber bleb nevus syndrome
 Sturge weber
 Maffuci’s syndrome

64.  Osler weber rendu syndrome –
 Also called heriditary haemorragic telangiectasia
 Autosomal dominant trait
 Characterised by numerous vascular
hamartomas affectng skin ,mucosa,
 Arteriovenous fistula seen,
 greater dgree of pulmonary and hepatic
involvement
 Telangiectasia
 Blue rubber bleb nevus syndrome –
 Rare condition
 Characterised by numerous malformations of
venous system involving the skin and viscera

65.  Sturge weber syndrome –
 Non heriditary developmental condition
 Characterised by hamartomatous vascular
proliferation involving the face and brain
 Maffuci’s syndrome –
 Skeletal chondromatosis
 soft tissue angiomas

66.  It is a benign tumour of patent blood vessels
that may be congenital or traumatic in origin
 Frequently noticed in skin and subcutaneous
tissues
 Hemangiomas of and and neck appear a few
weeks after birth and grow rapidly
 It may be superficial or deep
 Commonly appear as solitary lesions but also
appear as multiple lesions

67.  There are different types:-
 Central:-occurs in bone
 Capillary:-is a mass of
intercommunicating capillary vessels
-strawberry angioma
- port wine stain
- salmon’s patch
 Cavernous:-consists of dilated blood containing
spaces lined with endothelium
 Arterial or plexiform haemangiomas-arises from
arteries

68.  CLINICAL FEATURES
 Central haemangioma
 More common in females in the 1st to 3rd
decade
 More common in mandible {ramus and body}
 The lesion may originate form the periosteum
and resorb the underlying bone
 Non tender,hard swelling
 Throbbing type of pain
 Lesion may cause loosening and migration of
involved teeth
 Aspiration produces blood

69.  Strawberry angioma
 Red patch which is noticed at birth
 Usually regresses in size and involution
completed by 7-8 years
 Involves skin and subcutaneous tissues
 Dark red or strawberry coloured
 Compressible
 Small areas of ulceration with stabs may be
present

70.  Port wine stain
 Reddish deep purple coloured
 Not more than 5mm
 Occurs at birth and darkens as the child grows
 Found on face,shoulders.necks,buttock
 Blanches on pressure

71.  Salmon’s patch
 Present at birth over the forehead and occiput
or anywhere in the midline of the body
 Disappears before the 1st birthday

72.  Cavernous haemangioma
 More common in females in the 1st to 3rd decade of
life
 Commonly seen on the lip,tongue,buccal mucosa
and palate
 Swelling is Compressible
 Superficial lesion are lobulated and Blanch on
pressure
 Swelling may increase in size and burry the
involved teeth causing disfigurement
 In case of haemangioma of tongue there is loss of
mobility of tongue

73.  Arterial or plexiform hemangioma
 This is congenital arteriovenous fistula with
pulsatile swelling of the arteries
 Veins become tortuous and thick walled
 Lesion is pulsatile

74.  RADIOGRAPHIC FEATURES
 Central
 The periphery may be well defined
radioluscency within which trabecular spaces
get enlarged and corticated or it may be ill
defined
 Larger lesion may be cause cortical expansion
with radiating spicules at the expanding
periphery producing sun ray or sun burst
appearance

75.  Some lesions are totally radioluscent
 Roots of the involved area are resorbed or
displaced
 Involved bone may enlarge and have coarse
internal trabaculae ,developing teeth may be
larger and erupt earlier

76.  Associated with:-
 Sturge weber angiomatosis
 DIFFERENTIAL DIAGNOSIS
 Central giant cell granuloma:-crosses midline
 Ameloblastic fibroma:-no local gingival
bleeding
 Mucoceole,ranula,superficial cyst-which are
fluctuant and nonemptiable

77.  Cherubism:-seen in children,typical facial
apperance and is bilateral
 Giant cell lesions of hyperparathyroidism:-
biochemical investigations
 Metastatic tumour:-history of primary tumour
 DIAGNOSIS
 Diascopy
 TREATMENT
 Surgery
 Sclerosing techniques

78.  Rare non heriditary developmental condition
characterised by vascular proliferation
involving tissues of brain and fcae
 Caused by the persistence of vascular plexus
around the cephalic portion of the nueral tube
 CLINICAL FEATURES
 Patients with SWA born with dermal capillary
vascular malformationof the face known as
port wine stain or nevus flammeus because of
its deep purple colour

79.  Port wine stain has unilateral distribution
along one or more segments of trigeminal
nerve
 Bilateral involvement is also seen
 Affected individuals have leptomeningeal
angiomas which usually associated with
convulsive disorder and often results in mental
retardation or contralateral hemiplegia

80.  Intra oral involvement in SWA is common
 Gingiva exhibit slight vascular hyperplasia or
massive haemangiomatous proliferation that
resemble PG

81.  TREATMENT
 Facial port wine nevi can be improved by using
newer flashlamp pulsed dye lasers
 Cortical excision of angiomatous meningeal
lesion may be necessary
 Patient with intractable epilepsy and
progressive mental retardation require
extensive nuerosurgical treatmnet

82.  It is a lymphatic malformation characterised by
abnormal proliferation of lymphatic vessels
 CLINICAL FEATURES
 Common extraoral site:-neck
intraoral site:-tongue(dorsal and
lateral surface)
 Intraosseous lymphangiomas are also reported
 Commonly arise with in first 2 years of life and
cause macroglossia
 Lymphangiomas are slow growing ,painless soft
tissue mass

83.  Colour ranges from normal mucosal pink to bluish
 Aspiration yields lymph fluid that is high in lipid
content
 Dilated lymph channels of a lymphangioma
characterstically reach high into the lamina propria
and often contact epithelial basement membrane
,this imparts a pebbly appearance to the surface of
the lesion
 Large lymphangiomas may become life
threatening if they comprise the airway or vital
blood vessels and those spreading the neck are
macrocystic are reffered to as cystic hygroma

84.  Differential Diaagnosis
 Cavernous hemangioma-more
bluish,aspiration with fine gauge needle
 Mucocoele
 Ranula
 Superfiicial cyst
 Treatment:- surgical
excision,sclerotherapy

85.  Benign neoplasms of skeletal muscles are called
rhabdomyoma
 Extracardiac rhabdomyomas are show striking
predilection for the head and neck
 Rhabdoomyomas of head and neck are
classified into:-
 Adult rhabdomyoma
 Fetal rhabdomyoma

86.  ADULT RHABDOMYOMA
 CLINICAL FEATURES
 Occur in middle aged and older patients
 Men predilection
 Most frequent sites are pharynx,oral
cavity,larynx
 Intra oral lesions are:-floor of mouth,soft
plate,base of tongue
 Tumour appear as a nodule or mass that can
grow into several centimeters

87.  FETAL RHABDOMYOMAS
 CLINICAL FEATURES
 occur in children
 male predilection
 common location:-face and periauricular region
 TREATMENT
 local surgical excision

88.  Choristoma is a tumour like growth of
microscopically normal tissue in an abnormal
location
 CLINICAL FEATURES
 Osseous and cartlaginous choristomas show
predilection to tongue
 The most common location is the posterior
tongue near the foramen caecum

89.  The lesion is usually firm,smooth surfaced
,sessile or pedunculated nodule between 0.5
and 2.0 cm diameter
 TREATMENT
 local surgical excision