1. INFLAMMATORY
PAPILLARY HYPERPLASIA
&
RANULA
Presented By :Irfan Zunzani
III rd Year

2. INFLAMMATORY PAPILLARY
HYPERPLASIA /PALATAL OR
DENTURE PAPILLOMATOSIS

3. Introduction
• Papillary hyperplasia is a unusual condition
involving the mucosa of the palate.
• It is of unknown etiology.
• It may be considered a from of inflammatory
hyperplasia associated in instances with ill
fitting denture.

4. ETIOLOGY
• Exact pathogenesis is not known.
• An ill-fitting denture.
• Poor denture hygiene.
• Wearing the denture 24 hours a day. (20% OF
PATIENTS).
• Candida also has been suggested as a cause.

5. CLINICAL FEATURES
• SITE –
 Hard
palate beneath a denture
base.
 Edentulous mandibular alveolar
ridge.

6. • The lesion presents itself as
numerous, closely arranged, red, edematous
papillary projections.
• The individual papillae are seldom over a
millimeter or two in diameter.
• The tissue exhibit varying degrees of
infllamation, but sometimes there is
ulceration.

8. HISTOLOGICAL FEATURES
• Microscopic section shows numerous, small vertical
projections each composed of parakeratotic or
sometimes orthokeratotic stratified squamous
epithelium and a central core of connective tissue.
• Pseudoepitheliomatous hyperplasia, in varying
degrees, is seen in most of the cases.
• Severe inflammatory cell infiltration is nearly always
present in the connective tissue.
• Chronic inflammatory cell consist of lymphocytes
and plasma cells.

11. Treatment
• Discontinuing the use of ill fitting denture or
construction of new denture without surgical
removal of the excess tissue will generally result
in regression of edema and inflammation, but
papillary hyperplasia persists.
• Surgical excision of the lesion prior to new
denture construction will return the mouth to a
normal state.
• Use of conditioner to rebase an old denture often
results in some improvement of the lesion .

12. RANULA
Frog belly

13. Definition
• Name derived from Latin word rana, which
means frog, because the swelling may
resemble a frog’s translucent underbelly.
• It is a form of mucocele that specifically
occurs in the floor of the mouth in association
with ducts of the submaxillary or sublingual
gland.
• It may arise through duct blockage or through
development of ductal aneurysm.

14. CLINICAL FEATURES
• Appears as blue, dome-shaped, fluctuant
swelling in the floor of mouth.
• Deeper ranulas are normal in color.
• Lesion develops as a slowly enlarging painless
mass located lateral to the midline of the floor
of the mouth.
• Ranulas can develop into large masses that are
many centimeters in diameter, fill the floor of
mouth and elevate the tongue.

16. • An unusual clinical variant.
• The PLUNGING or
CERVICAL RANULA.
• Occurs due to herniation of
spilled mucin through the
mylohyoid muscle,
producing swelling
within the neck.

17. Differential diagnosis
•
•
•
•
•
Dermoid cyst,
Abscess,
Hemangioma,
Lymphangioma,
Lymphoepithelial cyst.

18. HISTOPATHOLOGIC
FEATURES
• Variable epithelial lining of cuboidal,
columnar, or atrophic squamous cells,
surrounding the thin or mucoid secretions
in the lumen.
• Some cysts (more commonly those
arising due to ductal obstruction)
demonstrate oncocytic metaplasia of the
epithelium.

19. EPITHELIAL LINING SHOWS CUBOIDAL TO COLUMNAR EPITHELIUM
WITH SCATTERED MUCIN – PRODUCING CELLS

20. TREATMENT AND
PROGNOSIS
• Removal of the feeding sublingual gland
& marsupialization (i.e. to unroof the
lesion rather than to excise it totally).
• Occasionally the lesion recur if the entire
sublingual gland or other gland causing
them is not excised with the lesion