Photoclinic: Bohn Nodules

The lesions in this newborn's mouth are Bohn nodules. These mucous gland cysts manifest as firm, small (less than 3 mm) grayish white nodules--usually in the mouth on the buccal or lingual aspect of the alveolar ridges. They occasionally occur on the palate, and may be confused with large Epstein pearls.

Most Bohn nodules resolve spontaneously, write John Harrington, MD, and Danielle Tetro, MD, of New York Medical College in Valhalla. On rare occasions, excision may be necessary if the nodules interfere with feeding or become enlarged.

Differential diagnostic considerations include:

•Epstein pearls. These are the most common oral cavity finding. They are white and can be found on the gingiva or palate and are filled with keratin. They resolve spontaneously.

•A congenital epulis or granular cell tumor.¹ This firm pedunculated mass, also found on the alveolar ridge, can be as large as 9 cm. Excision may be necessary.

•Natal teeth. These usually come in pairs and are found along the incisor area. They should be extracted if they are loose or if there is poor crown formation.

•A ranula or mucocele is a retention cyst found underneath the tongue that may require excision if it does not resolve spontaneously.

In neonates, most oral masses are benign: the only required treatment is watchful waiting. Occasionally, some lesions may need to be excised or extracted if they do not resolve spontaneously or if they compromise nutrition or breathing.

References:

REFERENCE:

1.

Willies-Jacobo LJ, Isaacs H Jr, Stein MT. Pyogenic granuloma presenting as a congenital epulis.

Arch Pediatr Adolesc Med.

2000;154:603-605.