Elsevier

American Journal of Otolaryngology

Volume 33, Issue 6, November–December 2012, Pages 756-757
American Journal of Otolaryngology

Pediatric otolaryngology: principles and practice
Nipple trauma in infants? Bednar aphthae,☆☆

https://doi.org/10.1016/j.amjoto.2012.06.009Get rights and content

Abstract

Introduction

Bednar aphthae are infected wounds caused by trauma, localized to the hard palate in infants. They do not require specific treatment because they regress spontaneously in a few days. They often remain undiagnosed; other times, because of the pain they caused, they may worsen the nursing.

Case report

We describe the clinical case of a healthy infant of 2 months, fed with formula, who has 2 aphthous lesions in the oral cavity associated with irritability and inconsolable crying during feeding. We excluded the influence of infectious factors or underlying diseases. The hypothesis of a traumatic factor was supported by the anatomical features of aphthae and then confirmed by the gradual resolution of lesions after some advices on breastfeeding.

Conclusions

Our intent is to provide a photographic record of Bednar aphthae, which are quite common but often misdiagnosed also because of lacking of photographic material. Improved knowledge of this condition helps physicians in the differential diagnosis of a traumatic condition that is not as unusual as it seems in newborns.

Section snippets

Case report

In November 2010, a 2-month-old infant was admitted to the pediatric emergency department for frequent crying episodes, nursing difficulty, and irritability for the last month. He had no fever and was in general good conditions, and all vital signs were normal. At palate examination with tongue depressor, 2 big ulcers were observed. They were symmetrical, 2 × 1 cm in diameter, located between the hard and soft palate superiorly to the palatine tonsils. They presented with a hyperemic halo and

Discussion

Diagnosis was consistent with traumatic ulcer, better known as Bednar aphthae. Bednar, an Austrian pediatrician, described them in 1850 [1]. The mucosal lesion is usually symmetric, seldom unilateral, and located in the posterior hard palate where the soft palate begins, medial to the retromolar trigon. Most descriptions of these lesions were published in the 19th and the beginning of the 20th century [2], but clear pictures of Bednar ulcers are lacking in international literature. A clear

Conclusion

Bednar aphthae are seldom reported in international literature, although quite common in newborn. Bilateral palatine ulcers in infants should be well known by both pediatricians and otolaryngologists to avoid useless examinations and to suggest the simple but useful information for parents.

References (3)

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☆☆

Conflict of interest: none.

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