Case #5

A 3-month-old male visited a pediatric dentist for the evaluation of tiny white papules located at the midline of the hard palate.

May 1st, 1997

A 3-month-old male visited a pediatric dentist for the evaluation of tiny white papules located at the midline of the hard palate.

Joen Iannucci Haring, DDS, MS

History

The patient`s mother first noticed the small white bumps shortly after birth. Since that time, the lesions had not appeared to change in size or shape. At the time of the evaluation, the infant appeared to be in an overall good state of health.

No significant findings were identified in the medical history and no medications were being administered to the patient at the time of the examination.

Examinations

No unusual or abnormal findings were identified during the extraoral examination. Intraoral examination revealed a cluster of small white papules, firm to palpation, located at the midline of the hard palate (see photograph). Further examination of the oral soft tissues revealed no other abnormalities.

Clinical diagnosis

Based on the clinical information presented, which of the following is the most likely diagnosis?

* palatine mucoceles

* lymphoepithelial cysts

* gingival cysts of the newborn

* nasopalatine duct cysts

* palatal cysts of the newborn

Diagnosis

_ palatal cysts of the newborn

Discussion

As the name palatal cysts of the newborn suggests, these tiny cysts are found on the hard palate of newborns. Such cysts are a common intraoral finding and occur in 65 to 85 percent of all infants.

Palatal cysts of the newborn are developmental in origin. Some of these cysts occur at the midline of the hard palate (such as Epstein`s pearls) and arise when small islands of epithelium become entrapped as the palatal shelves meet and fuse.

Others occur scattered over the hard palate away from the midline and near the junction of the hard and soft palates (such as Bohn`s nodules) and arise from epithelial remnants derived from minor salivary glands.

Clinical Features

Palatal cysts of the newborn appear as tiny white or yellowish-white, firm papules ranging in size from one to three millimeters. The cysts may occur singly or cluster in groups of two to six.

Although most palatal cysts of the newborn are found posteriorly at the midline near the junction of the hard and soft palates, some may be found in the anterior region along the palatine raphe. When examined histologically, palatal cysts of the newborn contain keratin and exhibit a lining of stratified squamous epithelium.

Diagnosis

The diagnosis of palatal cysts of the newborn is established based on the characteristic clinical presentation of the lesions. A biopsy is not required to establish a definitive diagnosis.

Treatment

Palatal cysts of the newborn are innocuous lesions and do not require treatment. In most instances, the lesions resolve shortly after birth without complication.

It is presumed that the epithelium degenerates, or the cysts rupture and empty the keratin contents.

Joen Iannucci Haring, DDS, MS, is an associate professor of clinical dentistry, Section of Primary Care, The Ohio State University College of Dentistry.

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