There is an ancient axiom that "all trouble comes from the mouth, but not all troubles leave.'' True to that axiom, numerous disfiguring developmental abnormalities, infections, and neoplasms take seed and remain in the oral and perioral tissues. Not only does the mouth have its own unique diseases, but also it often provides clues to wider problems. For example, failure of the immune system may initially be announced by oral candidiasis or hairy leukoplakia. Oral ulcers may signal inflammatory bowel disease before it is discovered in the bowel. The majority of substances that enter the body pass through the mouth, exposing the oral cavity to various elements such as cigarette smoke, which makes contact with oral tissues during inhalation and exhalation. Hematopoietic diseases such as leukemia, lymphoma, and myeloma and a host of venereal diseases are often initially evident in oral tissues. Thus, this chapter is devoted to benign, but not always harmless, lesions of this complicated structure.

Mucosa and Soft Tissue Traumatic Fibroma (Irritation Fibroma)

Nodules of hyperplastic fibrous connective tissue are among the most common of oral mucosal lesions. Their occurrence at sites that are easily bitten is circumstantial evidence that trauma is the causative factor. They are found mostly in adults and their duration is months to years with little change in size. The usual presentation is a broad-based, normal colored nodule, seldom larger than 1.5 cm. Patients are aware of the lesion but are asymptomatic unless the site has been recently irritated. Histologically the lesions consist of collagenous, acellular fibrous connective tissue covered by unremarkable squamous epithelium. The collagen fibers are coarse, interlacing, and brightly eosinophilic with few identifiable fibroblast nuclei. The term "collagenoma" would be an apt description for these lesions. Treatment is usually elective surgical excision. Tumors of minor salivary gland and soft tissue tumors such as neurofibroma may have a similar appearance and should be considered in the differential diagnosis.

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