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Mouth Diseases

Floor of mouth lumps

05/28/2009

Question:

Hi Doctor, I sent you a question a few days ago but unsure weather you understood what I was saying. 39Yr old female, I went to my doctor because I had this 3-5mm small raised area on the sublingual fold right side. Also when the doctor was checking my mouth he felt the right side which had a small 3-4mm round very movable soft to firm lump towards the Wharton’s ducts under the mucous membrane also near sublingual fold. He sent me to ENT specialist who felt both sides of my mouth and stated right side was overlap of mucosa and left side was a salivary stone. My doctor disagreed saying the lump on the left felt more like a cyst as it is not hard. He sent me for second opinion to another specialist who said he was 90% sure it was benign. I had an intra oral ultrasound and the doctor doing it felt the areas of concern and stated it feels like a duct. My doctor said he believes it’s nothing to worry about, and just watch it. All the doctors I went to wont do FNA as it’s too small they said. I am just feeling a little bit confused over different doctor’s opinions on this matter. My ultrasound was a High resolution ultrasound using a hockey-stick ultrasound transducer probe. Ultrasound stated normal floor was seen within the submucosal veins of the floor of the mouth and sublingual regions. These were of symmetrical size and appearance. Normal symmetrical appearance of the accessory sublingual salivary glands was demonstrated. No soft tissue mass lesions were seen. No collections or cysts were identified. No other abnormalities. There are no obvious abnormalities seen in visual inspection of the floor of mouth and sublingual regions. Conclusion: Normal sonographic findings. How accurate are these types of ultrasounds? All of the docs I been to say clinical it feels like a benign condition. Please give me some advice as I am worried sick over it with so many different opinions. Kindest regards

Answer:

Did the physicians acquire any other forms of intra oral imaging?

Ultra sonography is ideal for some imaging but a regular old occlusal film may be all that is required. If indeed it is a sialolith (salivary stone), the composition of the stone is high in calcium salts and is radio-opaque and will show up on x-ray. In some cases the stones can move, especially during manipulation with an ultrasound probe.

FNB would not be my initial means of assessing the lesion, and if it is a stone, surgical removal by marsupulaization usually is indicated. In the old days when I was doing my training, we performed sialography to identify the obstruction. The ducts are cannulated and radiographic dye is injected and cine radiography is performed (just like coronary angiograms) to visualize the salivary ductal circuit.

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Response by:

Richard J Jurevic, DDS, PhD Richard J Jurevic, DDS, PhD
Formerly, Assistant Professor of Biological Sciences
School of Dental Medicine
Case Western Reserve University