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Pre-malignant lesions of Oral cavity

Pre-malignant lesions of Oral cavity. Dr.SHANKHASHUBHRA GHOSH DLO,2 ND YR Stanley Medical College Chennai. Benign lesions. Solid- papilloma fibroma hemangioma granuloma torus palatinus

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Pre-malignant lesions of Oral cavity

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  1. Pre-malignant lesionsof Oral cavity Dr.SHANKHASHUBHRA GHOSH DLO,2ND YR Stanley Medical College Chennai www.nayyarENT.com

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  3. Benign lesions • Solid- papilloma fibroma hemangioma granuloma torus palatinus • Cystic - retention cyst ranula dermoid www.nayyarENT.com

  4. Premalignant lesions • Leukoplakia • Erythroplakia • Submucous fibrosis • Lichen planus • Laryngeal keratosis • Actinic cheliosis • Smooth,red tongue of Plummer-Vinson syndrome www.nayyarENT.com

  5. Predisposing factors • EIGHT -- “S” • Smoking • syphilis • spices • sharp tooth • submucosal fibrosis • siderophenic dysphagia • sepsis • spirit(alcohol) www.nayyarENT.com

  6. Leukoplakia -etiology • Tobacco chewing and smoking • Alcohol • Local irritants • Vitamin deficiency-vit A & B • Endocrine disturbances • Syphilis www.nayyarENT.com

  7. leukoplakia www.nayyarENT.com

  8. leukoplakia • White patch in mucosa that does not rub off & cannot be clinically identified • Most are asymptomatic,only 20% show evidence of dysplasia or carcinoma. • Buccal mucosa and oral commissures are most common sites • Mostly fourth decade, male>female www.nayyarENT.com

  9. Non –homogenous leukoplakia www.nayyarENT.com

  10. Management • Proper history • Prevention of cause • Surgical excision of small lesion • Topical chemotherapy and radiation www.nayyarENT.com

  11. Erythroplakia • Red lesion that cannot be classified as another entity. • 91% shows signs of dysplasia • Flat, macular, velvety appearance and may be speckled with white spots representing foci of keratosis • Most common site-lower alveolar mucosa, gingivobuccal sulcus www.nayyarENT.com

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  13. Types:- • A)Homogenous type: appears as bright red soft velvety lesions and extensive in size. commonly found-buccal mucosa and soft palate. B)Speckled type: soft red lesions,slightly elevated with irregular outline surface being granular-speckled www.nayyarENT.com

  14. Submucous fibrosis • Subepithelial inflammatory response to the irritants mainly due to betel nut chewing • Arecoline-active alkaloid found in betel nuts-stimulate fibroblasts to increase production of collagen by 150% • White fibrotic bands extending from retromolartrigone to soft palate,buccal mucosa , tongue. • It continues even after cessation of areca nut chewing www.nayyarENT.com

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  18. Clinical features • The most common initial symptom-burningsensation of oral mucosa aggravated by spicy food followed by either hypersalivation or dryness of mouth • In advanced cases,the mucosa becomes tough and leathery, with numerous vertical fibrous band. www.nayyarENT.com

  19. Clinical staging • Stage1-stomatitis..vesicles,mucosal ulcers, mucosal petechie • Stage2-fibrosis in ruptured vesicles and ulcers. a)early-blanching.. b)late-vertical and circular palpable fibrous bands, trismus, blanched leathery floor of mouth, fibrotic and depigmented gingiva. • Stage3-leukoplakia(>25%) and speech & hearing deficits. www.nayyarENT.com

  20. Treatment • Prescription of chewable pellets of hydrocortisone • Absteinence from alcohol,tea,coffee • Submucosalinj of hydrocortisone • Submucosalinj of human chorionic gonadotropin • Surgical treatment-multiple release deep to mucosa,submucosa and fibrotic tissue & suturing the gap so created by mucosal flap obtained by tongue and Z-plasty. www.nayyarENT.com

  21. Cont….. • In this procedure,multiple deep z shaped incisions are made into fibrotic tissue and sutured in straight fashion • Pentoxifylline-vasodilating properties and increased mucosal vascularity used as adjunct therapy. • Stem cell therapy-intralesionalinj of autologus bone marrow stem cell –angiogenesis of area and decreases fibrosis. www.nayyarENT.com

  22. Lichen planus • Malignant potential is matter of dispute • Prudent practice to biopsy the lesion at first visit to confirm diagnosis or monitor changes. • Lesion appear white lace like pattern in buccal mucosa. www.nayyarENT.com

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  24. Relative risk factors for oral cancer • None 1% • Bettle nut Chewing 4% • Smoking only 3-6% • Bettelchewing+Tobacco chewing 15% • Bettelchewing+Smoking 25% • Bettel+Tobacco+smoking 20% www.nayyarENT.com

  25. Treatment • If carcinoma-in-situ proved—excision by CO2 or KTP532 laser • Chemoprevention-beta-carotene and retinoids as antioxidant supplements www.nayyarENT.com

  26. Thank you For more presentations, please visit www.nayyarENT.com www.nayyarENT.com

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