GOOD

MORNING
ORAL SOFT TISSUE
ABNORMALITIES

PRESENTED BY
ZULEKHA BEGUM
II MDS
CONTENTS

• Introduction • Mucocele

• Congenital epulis • Ranula

• Lesions of the newborn • Pyogenic granuloma

• Riga-Fide disease • Prominent frenum

• Eruption cyst • Ankyloglossia

• Eruption gingivitis • Irritation fibroma

• Pericoronitis • Conclusion
INTRODUCTION
 CONGENITAL EPULIS

 Reactive or degenerative lesion - Mesenchymal origin

 Aka

- Congenital gingival granular cell tumour of unknown etiology

- Congenital epulis of newborn.

 Epoulis, Greek word - on the gum or gum boil.

 Neuman - first case - 1871

 Recent classification by WHO,

Congenital granular cell epulis

(CGCE) - Alveolar ridges of

neonates
 Etiology: Uncertain

 Origin
- Undifferentiated mesenchymal cells
- Fibroblasts & Myofibroblasts,
- Histiocytes,
- Pericytes,
- Schwann cells or odontogenic epithelial cells.

 Immunohistochemical studies - Mesenchymal origin

 Rohrer & Young – Pericytic origin

 Tucker et al - Myofibroblastic origin

Clinical Features:

 Presentation - smooth normal coloured surface, pedunculated,

lobulated, and varying in size (Few mm to 9cm)
Gender predilection – F > M (8 : 1)
Site Predilection:
 Prenatal complications
- Obstructed deglutition of amniotic fluid
 Postnatal complications
 Prenatal diagnosis – prerequisite – Ultrasonography
Differential Diagnosis:

 Prenatally
Management:
ANESTHESIOLOG
IST

Multidisciplinary
Team
Approach

PEDIATRIC
PEDIATRICIAN
SURGEON
 Spontaneous regression (Few cases)

 Surgery (Excision)

- Airway Obstruction (Emergency)

- Oral Feeding Interference

- Mouth Closure Interference

- Massive bleeding
 During the delivery or after birth - General anesthesia/local anesthesia

 No recurrence or malignant changes

 Some authors – X surgical excision, → spontaneous regression

 Carbon dioxide laser and Er, Cr: YSGG laser

 LESIONS OF THE NEWBORN

EPSTEIN PEARLS:
• Alois Epstein (1880) - Epstein disease

• Alfred Fromm (1967) – Classification

• Etiology: Keratin entrapment 

• 60% to 85% of newborn infants
BOHN’S NODULES:

• Heinrich Bohn, 1886 (German physician)

• Mucous gland cysts

• Site: Junction of soft and hard palate, buccal or lingual aspects of the
alveolar ridges 
 RIGA-FEDE DISEASE

• Natal teeth: At birth

• Neonatal teeth: Within 30 days after birth

• Riga-Fede disease (RFD) is a benign and uncommon mucosal disorder,

characterized by an ulceration of the tongue, often caused by repetitive
traumatic injuries due to backward and forward movements of the
tongue over the mandibular anterior incisors

• First identified - Antonio Riga, an Italian physician in 1881

• Described by F. Fede, 1890 – Histological studies

• Aka
- Traumatic lingual ulceration
- Eosinophilic granuloma
- Sublingual fibrogranuloma
- Sublingual growth in infants
- Traumatic atrophic glossitis
• Site: Tongue (60% of the lesions), lip, palate, gingiva, vestibular mucosa
and floor of the mouth
Treatment:
 ERUPTION CYST

 Benign soft tissue cyst + erupting primary or permanent teeth

 Counterpart of Dentigerous cyst in soft tissues

Prevalence:
 Reported average age - 6 to 8 years.

 Gender predilection: M > F

 Pinkham - no gender predilection

 Non keratinizing stratified, squamous epithelium.

Etiology:

 Origin

- Degenerative changes in the REE

- From the remnants of dental lamina

- Accumulation of tissue fluid or blood in the dilated follicular space around

the crown of the erupting tooth.

 Inheritance is the main etiological factor

Clinical features:

 0.6cm in diameter

 Radiographic examination: For evaluation of the morphology of the

associated erupting tooth or its surrounding jaw bone.
Diagnosis:

 Needle aspiration biopsy (FNAC)

 Cystic fluid - slightly yellow color and low viscosity,

 Polarized light microscopy - Cholesterol crystals

Differential diagnosis:
Treatment: Case specific

 Subsides spontaneously

 Simple incision or partial excision of the overlying tissue to expose the

crown and drain the fluid

 Boj et al - Er, Cr-YSGG laser

 ERUPTION GINGIVITIS

Treatment:

• Mild - no treatment + improved

oral hygiene

• Painful eruption gingivitis – OHI +

Systemic Antibiotics and NSAIDs.
 PERICORONITIS

• An inflammatory condition of gingiva & other supporting tissues that

surround crown of an incompletely or completely erupted tooth,
especially distal to the arch – Kay, 1966

• First described by Gunnell in 1844

• Term – Bloch 1921

• Sites: Mand 3rd molar > Mand 2nd molar > Mand 1st molars > Max 3rd
molars
• Complications:
- Pericoronal abscess
- Spread to oropharyngeal area
- Dysphagia
- Lymph node involvement
- Peritonsillar abscess
- Ludwig’s angina
Operculectomy

• Indications:
- Availability of space for eruption
- Presence & proper alignment of opposing tooth
- Angulation of impaction: Vertical – Most favourable
- Position or depth of impaction
- Prosthetic consideration: requirement of 3rd molar as abutment for prosthesis
- Socioeconomic reasons
PREPARATION FOR OPERCULECTOMY

• NSAIDs to relieve pain. -Acetaminophen, Ibuprofen etc.

• Systemic Antibiotics - fever and lymph node enlargement - Penicillin,

Erythromycin, Cephalosporins etc.

• Oral Hygiene Instructions.

Operculectomy is done by either of the 3 procedures:
• Scalpel
• Laser- assisted
• Electrocautery
MUCOCELE
Retention
Extravasation
RETENTION MUCOCELES

• Well-defined cystic cavity + Epithelial wall

• Elderly patients.

• Site predilection: Upper lip, hard palate, floor of mouth and maxillary

sinus.

Harsha, S. K., Somani, R., Student, P., Dentistry, P., Dentistry, P., & Dentistry, P. (2019).
MINOR ORAL SURGICAL PROCEDURES.
International Journal of Advanced Research, 7(10), 979–1021.
 Etiopathogenesis

Singh S, Singh ID, Alok A, Kishore M, Jha PC, Iqubal Md.A. Mucous Extravasation Cyst: A
Case Series and Review of Literature. Int J Dent Med Res 2015;1(5):76-79
EXTRAVASATION MUCOCELES

• Pseudocysts

• 80% of all mucoceles

• < 30 years of age

• Girish et al, 2016 - Lower lip (80%)

Harsha, S. K., Somani, R., Student, P., Dentistry, P., Dentistry, P., & Dentistry, P. (2019).
MINOR ORAL SURGICAL PROCEDURES.
International Journal of Advanced Research, 7(10), 979–1021.
 Etiopathogenesis

Singh S, Singh ID, Alok A, Kishore M, Jha PC, Iqubal Md.A. Mucous Extravasation Cyst: A
Case Series and Review of Literature. Int J Dent Med Res 2015;1(5):76-79
Evolutionary phases:

• Spillage of mucus from salivary duct into the

surrounding tissue in which some leucocytes and
I histiocytes are seen

• Resorption phase: Appearance of granulomas

associated with foreign body reaction
II

• Formation of pseudocapsule without epithelium around

the mucosa due to connective cells.
III

Sinha R, Sarkar S, Khaitan T, Kabiraj A, Maji A. Nonsurgical Management of Oral

Mucocele by Intralesional Corticosteroid Therapy. Int J Dent. 2016;2016:2896748
Clinical Characteristics:

 Bluish, soft and transparent cystic swelling

 Site predilection: Lower lip > buccal mucosa > palate > retromolar

region > posterior dorsal area of the tongue.

 Occasionally - glands of Blandin-Nuhn.

 In the Minnesota oral disease prevalence study, Blandin- Nuhn

mucoceles had a lower prevalence than mucoceles at other locations

with increased predilection for females.

Diagnosis:

 Fine needle aspiration biopsy (FNAB)

 Localization – CT & MRI

 Chemical analysis - High amylase and protein content

 Ultrasonography - Cystic masses

Differential Diagnosis:

Singh S, Singh ID, Alok A, Kishore M, Jha PC, Iqubal Md.A. Mucous Extravasation Cyst: A
Case Series and Review of Literature. Int J Dent Med Res 2015;1(5):76-79
 RANULA

 Hippocrates & Celsius

 Latin word “Rana”

 Extravasation cyst – Sublingual gland

Rupture of excretory duct

Spillage of saliva into surrounding tissues

Stimulation of inflammatory reaction – High protein content

Pseudocyst formation
• Prevalence:
- 0.2 per 1000 persons
- F > M (1.15:1)
- Teenagers & young children

• Etiology
- Trauma to excretory duct
- Obstruction of the duct
- Chronic inflammation – Sarcoidosis & Sjogren syndrome

Packiri, S., Gurunathan, D., & Selvarasu, K. (2017). Management of Paediatric Oral
Ranula: A Systematic Review. Journal of clinical and diagnostic research :
JCDR, 11(9), ZE06–ZE09.
 CLASSIFICATION

• Epithelial lining
• Obstruction Pathogenesis

True Cyst
Pseudocyst

• No Epithelial lining
• Ductal injury
• Granulation tissue or
condensed CT
 Clinical

• Floor of the mouth

Simple
Cervical

• Sublingual SG
Mechanisms of Plunging Ranula:

1. Defect in mylohyoid muscle

2. Hiatus or dehiscence in mylohyoid muscle

3. Ectopic salivary gland – draining into neck mass

4. Iatrogenically
- Oral ranulas
- Implant placement
- Sialolith removal
- Duct transposition

5. Ductal communication between Sublingual & submandibular

gland or ducts
 Extension

Sublingual +
Sublingual Submandibular
Submandibular
Neonate ranula
• Unknown etiology

Failure of Non-patent duct Congenital

canalization orifice sialocele
CLINICAL PRESENTATION

• Smooth cystic swelling

• Transparent or bluish
• Asymptomatic
• Large swellings
- Speech
- Mastication
- Respiration
- swallowing
DIAGNOSIS
• Clinical examination
• Needle aspiration
• Sialographic examination
• Ultrasonography
• Computed tomography
• Magnetic resonance imaging
• Pathologic examination .
Plunging Ranula
TREATMENT OF MUCOCELE AND RANULA

• Size of the lesion

• Excision of the submandibular gland or combined excision of both the

ranula and sublingual gland
• Other treatment options include
- Drainage

- CO2 laser ablation

- Cryosurgery
- Intralesional corticosteroid injection
- Micromarsupialization
- Electrocautery
- Intralesional Injection Of Ok 432 (Picibanil)
- Homotoxicological Drug
DRAINAGE

• Conventional

LA administration

Wide bored needle – saliva aspiration or Incision

11 size scalpel

Decompression

• Recurence Rate: 70% to 100%.

Verma G. Ranula:A Review of Literature. Arch CranOroFac Sc 2013;1(3):44-49

MARSUPIALIZATION

• The opening of a cyst to the surface

• Indication: < 2 cm in diameter.

• Armamentarium:
- Mersilk 3/0 suture material
- hemostat,
- white head varnish
- gauze piece.
Advantages
• Simplicity,
• Low morbidity,
• Minimal removal of normal tissue.
Disadvantage
• Difficulty in identifying the cut surface of the collapsed cyst for
suturing.
• High recurrence rate
Recurence Rate: 36.4% to 80%.

Verma G. Ranula:A Review of Literature. Arch CranOroFac Sc 2013;1(3):44-49

ENUCLEATION

• Complete removal of the lesion

• Indication: > 2cm.
• Armamentarium:
- Carpule syringe
- Halsted tweezers
- Scalpel blade #15
- Suture material.
• Recurence Rates: 18.7% to 85%

Verma G. Ranula:A Review of Literature. Arch CranOroFac Sc 2013;1(3):44-49

ELECTROCAUTERY
• Low voltage and relatively high
• Heating the tip: Step-down transformer or by a battery
• Procedure:

Topical + infiltration LA

Digital pressure – everted lip - prominence

Silk suture passed through lesion

Excision using electrosurgery

CRYOSURGERY

• Gas expansion cryoprobe with a 10-mm-diameter round tip.

• Selected cryodose - 30-s freeze at -81°C + 1-min thaw ( Freeze-thaw

cycle)

• Indication: Patient unwilling for surgery

• Recurrence rate: 15%

Kurozu T. Clinical and pathological studies of oral mucous cyst. Japanese Journal of Oral
and Maxillofacial Surgery. 1983 Mar 20;29(3):393-403.
• Procedure

LA administration, Cryotip + Liquid nitrogen

Direct application of liquid nitrogen – 5 to 6 freeze

thaw cycles – 5 -10 secs

White frozen appearance

Completely disappears without scar, bleeding or

infection
MICRO-MARSUPIALIZATION

• Morton & Bartley

• Suture - Formation of an epithelial tract between the surface and the

underlying salivary glandular tissues.

• Indications: Mucocele > 1cm, Ranula

• Armamentarium: 3-0 silk suture material, gauze piece.
• Procedure

• Recurrence rate: 20%

Giraddi GB, Saifi AM. Micro-marsupialization versus surgical excision for the treatment of
mucoceles. Annals of maxillofacial surgery. 2016 Jul;6(2):204.
LASER

• Frame JW (1985)

• Limited side effects.

• Types:
- CO2 laser

- Diode laser
- Argon lasers
- Nd:YAG lasers
- Er,Cr:YSGG lasers
Procedure
Soft tissue diode laser
- Wavelength 940 nm, 400 μm diameter tip at 1.5 W in continuous mode

Ehsan Azma, Nassimeh Safavi. Diode Laser Application in Soft Tissue Oral Surgery
J Lasers Med Sci 2013; 4(4):206-11
SCLEROSING AGENT

• OK-432 (Picibanil)
- Potential sclerosing
- Immunostimulating
- Antineoplastic activity

• Ikarashi et al (1987)

• Recurrence Rate: Arunachalam et al (2010) - 14.3%

Mechanism Of Action
• Procedure

Aspiration of cystic fluid – 18-27 gauge

Preparation 0.1mg OK-432 + 10ml saline

Change syringe

Injection of OK-432 + Analgesics

Kono M, Satomi T, Abukawa H, Hasegawa O, Watanabe M, Chikazu D.

Evaluation of OK-432 Injection Therapy as Possible Primary Treatment of Intraoral Ranula.
J Oral Maxillofac Surg. 2017 Feb;75(2):336-342.
 Advantages
Disadvantages
• No local anesthesia
• Expensive
• painless
• Drug is not readily available
• Less time consuming
• Post-operative symptoms -
• Nerve injury and cosmetic
fever
problems X
• Secondary infection and
hemorrhage are rare.
• Less recurrence
HOMOTOXICOLOGICAL DRUG

• Nickel gluconate- mercurios heel- potentised swine organ preparation

• Dosage
- Nickel gluconate: 0.5mg on alternate days
- Mercurios heel: 1 tablet 3 times a day (for unweaned 1/3 dosage, for early
childhood ½ dosage)
- Potentised swine organ preparation: 0.1 ng twice a week for 4-6 weeks, then
once in 10 days

• Accelerate
- Pseudocyst resorption
- Glandular repairing
- Physiological function
 PYOGENIC GRANULOMA

 Poncet and Dor (1897) - Botryomycosis hominis.

 Term - Crocker (1903)

 Angelopoulos AP - Hemangiomatous granuloma

  Cawson et al. - Granuloma telangiectacticum

Incidence and prevalence:

• Bhaskar et al. - 1.85% of all oral pathoses (US Army Institute of Dental
Research)

• Cawson et al. - 0.5% of all skin nodules in children

Etiological factors: Non-specific local irritation or trauma.

Precipitating factors include:

- Poor oral hygiene and compromised periodontal health

- Dental injuries

- Tooth extractions particularly third molars

- Microtrauma due to tooth brushing

- Hormonal influences

- Oral contraceptives

Kamal, R., Dahiya, P., & Puri, A. (2012). Oral pyogenic granuloma: Various concepts of
etiopathogenesis. Journal of oral and maxillofacial pathology : JOMFP, 16(1), 79–82.
Clinical Features

 Age: 2nd & 5th decades, F > M

 Elevated, smooth or exophytic, sessile or pedunculated growth

 Red, reddish purple to pink (Vascularity)

 Site: Gingiva (marginal-75%), Lips, tongue, buccal mucosa

 Usually painless, tend to bleed

Treatment:

•Excision and biopsy

•Incisional biopsy

•Conservative surgical excision + removal of irritants.

•Laser

•Cryosurgery

•Electrodessication

•sodium tetradecyl sulfate sclerotherapy

•Intra lesional steroids

PROMINENT FRENUM
• Pathophysiology

Insertion of labial frenum – notch in the alveolar bone

Heavy band of fibres b/w central incisors

Widely separated incisors

V – shaped bony cleft below the frenum

Failure of space closure

Classification

• Placek et al., 1974

1. Mucosal: Mucogingival junction.

2. Gingival: Attached gingiva.
3. Papillary: Extending into interdental papilla.
4. Papilla penetrating: cross the alveolar process and extends up to
the palatine papilla.

Priyanka, M., Sruthi, R., Ramakrishnan, T., Emmadi, P., & Ambalavanan, N. (2013). An
Overview of frenal attachments. 
Journal of Indian Society of Periodontology, 17(1), 12–15.
• Prevalence: Jonnathan et al(2018)
- Alveolar mucosa - 10–12 years (58.3%)
- Gingival and incisive papillary insertion - 6–9 years and 3–5 years

• Syndromes Associated With Abnormal Frenum

- Ehlers-Danlos syndrome
- Ellis-van Creveld syndrome, and
- Orofacial-digital syndrome
- Holoprosencephaly (absence of frenum is seen)
Clinical Features

• Loss of papilla

• Gingival recession

• Midline diastema

• Malocclusion of the teeth

• Difficulty in brushing

• Psychological disturbances to individual

• Diagnosis:

1. Tension test: The frenum is characterized as pathogenic when it is

unusually wide or when there is no apparent zone of the attached gingiva
along the midline or the interdental papilla shifts when the frenum is
extended.

2. Blanch test: Lift the upper lip and pull in outward and look for blanching
of the soft tissues lingual to and between two central incisors
 GOOD
MORNING
 ANKYLOGLOSSIA

• Greek "ankylos" - tied and "glossa" - tongue

• Prevalence:
- Patil et al (2013) 3.5% of the tongue lesions
- M > F (2.5:1)
Associated Syndromes

• Simpson-Golabi-Behemel Syndrome

• Optiz Syndrome

• Beckwith-Wiedemann Syndrome

• Orofacial-digital Syndrome

• Vander woude syndrome

• Pierre robin syndrome

Clinical Symptoms

Infant symptoms and signs include

- Poor nipple latch and suck

- Clicking sound - poor suction

- Ineffective milk transfer

- Inadequate weight gain

- Irritable, Colic

- Fussiness and arching away

- Difficulty grasping on the breast

Maternal symptoms and signs

- Nipple pain

- Mastalgia

- Low milk supply

- Mastitis

- Untimely weaning

- Blocked ducts

- Disappointment with breastfeeding

Symptoms in adults
CLASSIFICATION
• Anatomical Classification : Wallace in 1960

Decreased length –
change of shape of
tongue

Partial
Complete

Extensive fusion of the

tongue to the floor of the
mouth
 Normal Range
of free tongue
KOTLOW(1999)
Diagnosis
• Speech Articulation Test
• Tongue sounds - “t”, “d”, “l”, “th” and “s”
Treatment for ankyloglossia:

• Speech therapy

• Otolaryngotherapy

• Frenotomy

• Frenectomy

• Frenuloplasty

• Laser frenectomy
Treatment

1. Frenectomy

• Indications:
- Aberrant frenal attachment → Midline diastema.

- Flattened papilla → gingival recession and a hindrance in maintaining the oral

hygiene.
- Aberrant frenum + inadequately attached gingiva and a shallow vestibule
Conventional Technique:
• Archer (1961) and Kruger (1964)

Armamentarium
• Haemostat
• scalpel blade no.15
• gauze sponges
• 4-0 black silk sutures
• suture pliers
• Scissors
• periodontal dressing (Coe-pak).
Technique
• Modifications Of Conventional Frenectomy
1. Paralleling technique
2. Miller‟s technique,
3. V-Y plasty and
4. Z-plasty
• Paralleling technique
• Miller’s Technique
- Miller PD (1985)
- Post-orthodontic diastema cases
• Z plasty
• V-Y Plasty

Devishree, Gujjari, S. K., & Shubhashini, P. V. (2012). Frenectomy: a review with the
reports of surgical techniques. Journal of clinical and diagnostic research
JCDR, 6(9), 1587–1592.
• Electrosurgery : William Cameron - first dental electrosurgical unit
(1928)

• Types Of Electrodes

• There are 3 classes of electrodes:

- Single-wire electrodes for incising or excising
- Loop electrodes for planing tissue
- Heavy, bulkier electrodes for coagulation procedures.
• Armamentarium: An electrocautery unit with the loop electrode and a
hemostat.
• Technique

Devishree, Gujjari, S. K., & Shubhashini, P. V. (2012). Frenectomy: a review with the
reports of surgical techniques. Journal of clinical and diagnostic research
JCDR, 6(9), 1587–1592.
• Diode Laser
- Mid-90s.
- Wavelengths - 810 to 980 nm, continuous or pulsed mode
- Based on the photothermal effect of the diode laser, the lesions of the oral
mucosa are removed with an excision technique, or by ablation/vaporization
procedures.
• Armamentarium: Diode laser unit
• Technique
 Advantages
• Relatively bloodless surgical and
postsurgical event,
• Precision Disadvantages

• Sterilization of the wound site, • Lateral heat damage.

• Minimal swelling and scarring, • Delayed wound healing

• No suturing • Additional training and education

• Little mechanical trauma, • Expensive

• Reduction of surgical time

• Decreased postsurgical pain
• High patient acceptance
FRENOTOMY
• Armamentarium: Gauze piece, sterile blade or Goldman Fox
scissors.
• Procedure
 IRRITATION FIBROMA

Treatment: Excision

• Circular incision - around the lesion,

• Hemostasis – Electrocautery

• The tissue is relaxed and the wound

becomes elliptical

• Oriented perpendicular to the direction

of contraction of the underlying
muscle.

• 4-0 or 5-0 chromic catgut sutures

CONCLUSION
 REFERENCES

• Shafers WG, Hine MK, Levy. A textbook of Oral Pathology, 6th Ed

• Neville BW, Damm DD, Allen CM. Bouquot JE. Oral & Maxillofacial Pathology, 2 nd Ed

• Cassamassimo, Fields, Mctigue, Nowak. Pediatric Dentistry, Infancy through adolescence, 5 th

Ed

• Leonard B.Kaban, Maria J. Troulis Pediatric Oral and Maxillofacial Surgery

• S.G.Damle- Textbook of Pediatric Dentistry, 4th edition

• Verma, G. (2013). Ranula : A Review of Literature. I(Iii), 44–49.

• Zancopé, E., Pereira, A. C., Ribeiro-Rotta, R. F., Mendonça, E. F., & Batista, A. C. (2009).
Mucocele in Posterior Dorsal Surface of Tongue: An Extremely Rare Location. Journal of Oral
and Maxillofacial Surgery, 67(6), 1307–1310.

• Velonis, D. A., & Tsolakis, K. (2017). Minimally Invasive Surgery in Pediatric Dentistry using
Dental Lasers. Journal of the Laser and Health Academy, 2017(1), 28–32.
• Merglová, V., Mukensnabl, P., & Andrle, P. (2012). Congenital epulis. BMJ Case Reports,
739–741.

• Abe, A., Kurita, K., Hayashi, H., & Minagawa, M. (2019). Multiple mucoceles of the lower
lip: A case report. Clinical Case Reports, 7(7), 1388–1390.

• Amil, J. V, & Dixit, U. B. (2018). Management of Eruption Cyst with High Maxillary Labial
Frenum : A Case Report. 2(5), 87–89.

• Cheong, S. P., Fahy, C. J., & Craigie, M. J. (2008). Anaesthesia for excision of an intraoral
mass in a neonate: Use of a laryngeal mask during removal of congenital epulis. Anaesthesia
and Intensive Care, 36(1), 116–118.

• Journal, I., & Care, D. (2017). Indian Journal of Comprehensive Dental Care 1. 7(2), 1002–
1005.

• Diebold, S., & Overbeck, M. (2019). Soft Tissue Disorders of the Mouth. Emergency
Medicine Clinics of North America, 37(1), 55–68
• Fukase, S., Ohta, N., Inamura, K., & Aoyagi, M. (2003). Treatment of ranula with intracystic
injection of the Streptococcal preparation OK-432. Annals of Otology, Rhinology and
Laryngology, 112(3), 214–220.
• Council, O. (2009). Guideline on pediatric oral surgery. Pediatric Dentistry, 31(6), 218–224.
• More, C. B., Bhavsar, K., Varma, S., & Tailor, M. (2014). Oral mucocele: A clinical and
histopathological study. Journal of oral and maxillofacial pathology : JOMFP, 18(Suppl 1),
S72–S77.
• Kamal, R., Dahiya, P., & Puri, A. (2012). Oral pyogenic granuloma: Various concepts of
etiopathogenesis. Journal of oral and maxillofacial pathology : JOMFP, 16(1), 79–82.
https://doi.org/10.4103/0973-029X.92978
THANK YOU