1 / 111

Non-neoplastic diseases of oral cavity

Non-neoplastic diseases of oral cavity. Dr. Vishal Sharma. Common diseases.  Sub-mucous fibrosis  Aphthous ulcer  Leukoplakia  Erythroplakia  Oral candidiasis  Oro-labial Herpes  Vincent’s infection  Infectious mononucleosis  Tongue tie  Geographic tongue

zahavah
Download Presentation

Non-neoplastic diseases of oral cavity

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Non-neoplastic diseases of oral cavity Dr. Vishal Sharma

  2. Common diseases  Sub-mucous fibrosis Aphthous ulcer  Leukoplakia Erythroplakia  Oral candidiasis Oro-labial Herpes  Vincent’s infection Infectious mononucleosis  Tongue tie Geographic tongue  Ranula Mucocoele

  3. Oral pre-malignant conditions • Oral sub-mucous fibrosis • Leukoplakia & Erythroplakia • Oral candidiasis • Lichen planus • Nicotinic stomatitis (smoker’s palate) • Tertiary syphilis • Mucosal hyper-pigmentation (melanosis)

  4. Ulcers of oral cavity

  5. Infection:Herpes, Vincent’s infection, Candidiasis • Auto-immune:Aphthous ulcer, Behcet’s syndrome • Trauma:cheek bite, jagged tooth, ill-fitting denture chemical burn, thermal burn • Skin disorder:Lichen planus, erythema multiforme • Blood disorder:Leukemia, agranulocytosis, pancytopenia, sickle cell anemia • Drug allergy:mouth wash, toothpaste • Neoplasm: benign, malignant • Others:Radiation, chemotherapy, diabetes, uremia

  6. Oral sub-mucous fibrosis

  7. Definition • Term coined byS.G. Joshiin 1953 • Chronic pre-malignant disease of oral cavity, characterized by juxta-epithelial inflammation + progressive fibrosis of lamina propria & deeper connective tissues, followed by stiffening of mucosa resulting in difficulty in mouth opening

  8. Etiology (multi-factorial) 1.Areca nut (betel nut) chewing 2.Tobacco & Paan masala chewing 3.Genetic predisposition 4.Auto-immune injury 5.Nutritional deficiency of vitamins, iron, anti-oxidants 6.Excessive alcohol consumption 7.Excessive consumption of chilies (controversial)

  9. Etiology

  10. Presenting symptoms • Burning pain on consumption of spicy food • Dryness of mouth • Impaired mouth movements while eating & talking • Progressive inability to open the mouth (trismus) • Hearing loss (stenosis of Eustachian tubes) • Nasal intonation (ed soft palate mobility)

  11. Clinical Staging Stage of stomatitis:red mucosa  vesicles  rupture to form mucosal ulcers Stage of fibrosis (healing):blanching of mucosa, fibrous bands in oral mucosa, trismus, ed soft palate mobility Stage of sequelae:difficult speech, hearing loss, leukoplakia, malignancy (3 - 8 %)

  12. Blanched mucosa

  13. Early fibrosis in lower lip

  14. Early & advanced trismus

  15. Medical Treatment 1. Bi-weekly submucosal intra-lesional injections ofDexamethasone4 mg +Hyaluronidase1500 IU for 6- 8 wks 2. Submucosal injection of human placental extract 3. Vitamin B complex + anti-oxidant supplement 4. Avoid consumption of mucosal irritants 5. Increased intake of fruits & vegetables

  16. Dynamic splints for trismus

  17. Surgical treatment for trismus 1. Simple release of fibrous bands + skin grafting 2. Laser-assisted release of fibrous bands 3. Excision of lesions & reconstruction with: buccal fat pad, naso-labial flap, lingual flap, palatal muco-periosteal flap, radial forearm flap 4. Temporalis muscle myotomy + mandibular coronoidectomy

  18. Aphthous ulcer (canker sore)

  19. Introduction Recurrent, superficial ulcers, with necrotic centre + red margin, involving movable mucosa of inner surface of lips, cheeks, tongue & soft palate Differences from viral ulcer 1. Frequent recurrence 2. Selective involvement of movable mucosa 3. Absence of fever, malaise, lymph node enlargement

  20. Types 1. Minor aphthous ulcer:2 – 10 mm in size, multiple, heal with no scar in 1 - 2 weeks 2. Major aphthous ulcer:20 – 40 mm in size, usually single, heal with scar over months 3. Herpetiform aphthous ulcer:< 1 mm in size, multiple, heal with no scar in 1 week

  21. Minor aphthous ulcer

  22. Major aphthous ulcer Rule out HIV & malignancy

  23. Herpetiform aphthous ulcers

  24. Trigger factors for auto-immune injury Deficiency:vitamin B complex, iron, folic acid, zinc Stress:emotional & physical Trauma:cheek bite, ill-fitting dentures Hormonal imbalance:changing progesterone level Allergy:sodium lauryl sulphate (mouth wash & paste) Drugs:NSAIDs, cancer chemotherapy Others:Behcet’s syndrome, HIV, Crohn’s disease Infection:controversial

  25. Treatment of aphthous ulcer

  26. 1. Avoid trigger factors 2. Supplement:vitamin B complex + folic acid + iron 3. Topical gel combination:ZYTEE, QUADRAJELa. steroid:triamcinolone b. antibiotic:chlorhexidine, metronidazole, benzalkonium, cetalkonium, tannic acid c. analgesic:benzydamine, choline salicylate d. anesthetic:lignocaine, benzocaine 4. Mouth rinse:betamethasone, tetracycline 5. Immuno-modulator:thalidomide 50 -100 mg daily

  27. Behcet’s syndrome • Uveitis + Aphthous ulcer + Genital ulcer • Oculo – Oro - Genital syndrome • Tx:steroid

  28. Leukoplakia

  29. Introduction Definition:pre-malignant condition with white patch or plaque that cannot be rubbed off with gauze swab & cannot be characterized clinically or pathologically as any other disease Malignant transformation:1 - 20%(average 5 %) Sites:Buccal mucosa, tongue, lips, palate, floor of mouth, gingiva, alveolar mucosa

  30. Etiology • Chronic smoking • Chronic tobacco chewing • Irritation from jagged teeth or ill-fitting dentures • Chronic alcohol consumption • Sun exposure to lips • Associated: submucous fibrosis, hyperplastic candidiasis, Plummer-Vinson syndrome, AIDS

  31. Types of leukoplakia 1. Homogeneous leukoplakia:smooth, white 2. Nodular leukoplakia:nodular, white 3. Verrucous leukoplakia:warty, white 4. Speckled (erythro) leukoplakia:white + red Malignant potential: speckled >> nodular & verrucous >> homogenous

  32. Homogenous Leukoplakia

  33. Nodular Leukoplakia

  34. Verrucous leukoplakia

  35. Speckled (erythro) leukoplakia

  36. Layers of epidermis

  37. Pathological stages • Hyperkeratosis:thickening of stratum corneum • Parakeratosis:keratinization with retention of nuclei in stratum corneum(homogeneous leukoplakia) • Acanthosis:thickening of stratum spinosum(verrucous & nodular leukoplakia) • Dyskeratosis:abnormal keratinization present below stratum granulosum(speckled leukoplakia)

  38. Investigations 1. Supra-vital staining / Ora-screen:Toluidine blue solution stains areas of malignancy 2. Biopsy:to rule out malignancy

  39. D/D of oral white lesions • Leukoplakia • Hyperkeratosis • Hypertrophic candidiasis • Hairy leukoplakia (Epstein-Barr virus infection) • Lichen planus • Oral sub-mucous fibrosis • Lupus erythematosus • White sponge nevus • Carcinoma

  40. Treatment 1. Removal of causative agent 2. Supplement:Vitamin A (beta-carotene), C, E, B12, folic acid 3. Surgical excision:if HPE showsdysplasia Surgical excision modalities:cold knife, cryosurgery, laser surgery

  41. Cold knife excision AFTER BEFORE

  42. Laser excision AFTER BEFORE

  43. Erythroplakia (Erythroplasia)

  44. Definition:pre-malignant condition with red patch or plaque that cannot be rubbed off with gauze swab & cannot be characterized clinically or pathologically as any other disease Red colour due to vascular submucosal tissue shining through under-keratinized mucosa Malignant potential:17 times > leukoplakia Tx:excision biopsy

  45. Erythroplakia

  46. Oral candidiasis (Moniliasis)

  47. Etiology:Infection with Candida albicans Predisposing factors: 1. Chronic ill-health 2. Uncontrolled diabetes mellitus 3. Acquired immune deficiency syndrome 4. Prolonged use of steroids 5. Prolonged antibiotic therapy 6. Immuno-suppressant therapy (cyclosporine) 7. Anti-cancer chemotherapy

  48. Types of oral candidiasis • Chronic hyperplastic:white plaques, cannot be removed by scraping(Candidal leukoplakia) • Pseudo-membranous:loosely adherent white lesions, can be scraped off leaving red patches • Erythematous (atrophic):smooth, red patches • Cheilitis:white lesions on angle of mouth

  49. Hyperplastic

  50. Pseudo-membranous (thrush)

More Related