What Is Causing a Boy’s Palatal Swelling?

AUTHORS:
Giridhar Guntreddi, MD¹ • Jayasree Vasudevan Nair, MD² • Swayam P. Nirujogi, MD, MBA³ • Neelima P. Theella, MD

AFFILIATIONS:
¹Sanford Bemidji Medical Center, Bemidji, Minnesota
²Sutter Health, Jackson, California
³Tower Health, Reading, Pennsylvania

CITATION:
Guntreddi G, Nair JV, Nirujogi SP, Theella NP. What is causing a boy’s palatal swelling? Consultant. 2021;61(5):e12-e16. doi:10.25270/con.2020.10.00009

Received May 19, 2020. Accepted August 28, 2020. Published online October 6, 2020.

DISCLOSURES:
The authors report no relevant financial relationships.

CORRESPONDENCE:
Giridhar Guntreddi, MD, Pediatric Hospitalist, Sanford Bemidji Medical Center, 1300 Anne St NW, Bemidji, MN 56601 (giridhar.guntreddi@sanfordhealth.org)

An 8-year-old boy with no significant medical history presented to the emergency department (ED) with a 2-day history of acute worsening of oral cavity pain. He was accompanied by his father, a reliable historian, who denied any trauma, falls, accidents, or penetrating injuries in the boy. The patient had developed fever, discomfort over the palate, and difficulty swallowing food for 1 day. He had been in his usual state of health prior to this condition. He had received 1 dose of Ibuprofen at home. The father noted a bright pink swelling over the boy’s hard palate at the midline, which had prompted this ED visit. The father denied any similar lesions, bleeding, any other visible swelling, loss of weight, or previous dental caries in the boy.

Physical examination. At presentation, the boy’s vital signs were within normal limits, and he was not toxic-appearing. Oral examination revealed a bright pink swelling with overlying bluish veins, measuring 3 × 2 cm, over the midline hard palate (Figure 1). The lesion was soft, tender, and slightly indurated, not fluctuant, and without any local rise of temperature. Another smooth, soft, indurated, nontender, horseshoe-shaped swelling, measuring 4 cm in size, was present over the left half of the hard palate, extending from the midline lesion to the second maxillary molar tooth (Figure 2). This lesion was the same color as the surrounding oral mucosa. The right half of the palate and teeth appeared normal. One large deep caries was noted at left maxillary molar tooth, which was tender to percussion (Figure 3). A few enlarged 1- to 2-cm nontender submandibular lymph nodes were palpable on the left side. No other neck masses were palpable. No trismus was present. Other systemic examination findings were normal and noncontributory.

 
Figure 1. A bright pink-colored swelling over the midline of the hard palate.

 
Figure 2. A horseshoe-shaped swelling over the left side of the hard palate (arrow).

Figure 3. Midline swelling with thick pus (black arrow) and a visible caries in the left second maxillary molar (red arrow).