22. Oral Cavity + Oropharynx Diseases Flashcards
Cleft Lip and Palate
Etiology, Epidemiology, Genetics
Etiology: environmental factors, maternal ingestion/exposures (anticonvulsants, retinoic acid derivatives, folic acid antagonists, corticosteriods, tobacco/alcohol), maternal diabetes (uncontrolled)
Epi: Native American > Asian > European > African
Genetics: risk increases with number of affected children and relatives; 30% cleft lip pts have assoc genetic syndrome, 50% cleft palate pts have assoc genetic syndrome
Stickler Syndrome
what it is, genetics, clinical presentation
Defect in COL (collagen) genes
AD
CP: OCULAR ABNORMALITIES, hearing loss, flattened facial features
Van der Woude Syndrome
genetics, clinical presentation
AD
LIP PITS*** KEY FEATURE
Assoc with cleft lip/palate
22q11 Deletion Syndrome
other names, example, genetics, clinical presentation
AKA: velocardiofacial syndrome
DIGEORGE: variable expression of 22q11.2del = absent thymus (immunodeficiency), hypocalcemia, cardiac defects
AD
CP: cardiac defects, typical facies, minor learning disabilities, pharyngeal hypotonia (dysphagia)
Goldenhar Syndrome (Hemifacial Microsomia) (Genetics, what is it, Clinical Presentation)
AR
Abnormal unilateral craniofacial development of 1st + 2nd branchial arch derivatives
CP: auricular abnormalities (microtia) + hearing loss, cervical vertebral anomalies (fused/absent), ocular abnormalities, possible parotid gland agenesis with facial nerve paresis/paralysis
CHARGE Syndrome
what it is, clinical presentation
Random mutation in CHD7 gene
C - coloboma
H - heart defects
A - atresia of choana (between nasopharynx and nasal cavity)
R - retarded CNS development - intellectual disabilities
G - genitourinary abnormalities
E - ear abnormalities (LINEAR antihelical fold, not curvilinear)
Pierre Robin Sequence
what it is, what it causes
Mandibular hypoplasia = displacement of tongue superiorly, abnormal palate development (clefting), airway distress in infancy
Infectious Sialadenitis
what it is, risks, pathogens, clinical presentation, tx
Infection due to stasis of duct secretions
Risks: dehydration (elderly), post-operation, radiation/chemo, Sjogren’s
Bugs: Bacteria (S. aureus, Strep viridans, S. Pyogenes, H flu, E coli), Viruses (HIV, mumps, influenza, coxsackie)
CP: ear proptosis/bulging due to parotitis, warmth, erythema, tenderness, purulence
Tx: hydration, warm compress, sialogogue (sour candy to increase salivation), ABx, gland massage
I+D if no improvement
Autoimmune Sialadenitis (two types, what they are, sx, tx)
- Uvoparotid Fever (Heerfordt’s Syndrome)
Uveitis (red eyes), parotid enlargement, facial nerve dysfx, sensorineural hearing loss, fever
EXTRAPULMONARY FORM OF SARCOIDOSIS
Tx: corticosteroids, eye care - Sjogren’s Syndrome
Lymphocytic infiltration of exocrine salivary glands (inflammation = fibrosis = atrophy)
More common in middle age women, assoc with lymphoma, keratoconjunctiva sicca with dry eyes, xerostomia
Post-Obstructive Sialadenitis
what causes it, pathophysiology, risk factors, clinical presentation, imaging, tx
Submandibular stones most common
Path: precip of Calcium carbonate/phosphate due to LOW FLOW
Higher incidence in Gout pts and smokers
CP: swelling/tenderness, painful with eating
imaging: 90% submandibular stones radiopaque; 90% parotid stones radiolucent (hard to see)
Tx: sialendoscopy with stone removal, stone excision, or gland removal
Pediatric vs. Adult OSA
most common causes, effects, tx
Pediatric
Most common cause: hypertrophy of tonsils (palatine/adenoids/lingual)
Effects: increased systemic inflammation, insulin resistance, HTN, high cardiac load, ADD, behavior issues (HYPERACTIVITY)
Tx: surgical removal of tonsils, PPV
Adult
Most common cause: Obesity
Mallampati Score: how clear/open airway is
Tx: PPV, UPPP (uvulopalatopharyngoplasty), tongue base advancement, lingual tonsillectomy, partial glossectomy, electrical stimulation of tongue
Benign Pigmented Lesions: Leukoplakia Erythroplakia Anemia Bismuth Intoxication Lead Intoxication (What they look like, cause, complications)
Leukoplakia - white plaques, always consider malignancy, can be due to local trauma (ill-fitting dentures)
Erythroplakia - red plaques, focal lesions have 25% chance of being malignant
Anemia = atrophic glossitis = lighter color, smoother surface
Bismuth Intox = (Pepto-bismol for dyspepsia), resembles arsenic, can result in acute renal failure, post. tong and gingival hyperpigmentation
Lead Intox = dark pigmented lesions on gums (usually lead paint)
Benign Pigmented Lesions: Puetz-Jeghers Syndrome (genetics, CP, assoc) Black Hairy Tongue (CP, risk factors) Telangiectasia (Osler Weber Rendu): (CP) Addison's Disease: CP, what is it
PJS: AD
Hyperpigmentation around mouth, eyes, perineum in many small lesions
Assoc with GI polyposis
Increased risk of malignancy (colorectal, gastric, pancreatic, breast, ovarian)
BHT: elongated filiform papillae - benign, risk factors are smoking, immunocompromised, poor oral hygeine
T (OWR): capillary dilations or AV malformations; may cause epistaxis, subclinical GI bleeds, hypoxemia, hemoptysis (occur in resp/GI/brain/liver)
AD: hypercortisolemia, hyperpigmented gums
Infectious Lesions of Oral Cavity: Herpetic Gingivostomatitis (sx, CP) vs. Oral Candidiasis (cause, cp, dx, tx) vs. Squamous Papilloma (cp, cause, tx) vs. Syphilis
Herpetic Gingivostomatitis: primary/reactivation of HSV1
Primary - fever, malaise, anorexia, cervical adenopathy
Secondary - reactivation in trigeminal ganglion (trigger: UV, stress, immunosuppression, trauma, surgery)
CP: small painful vesicles with erythematous ulceration, gray eschar
Oral Candidiasis: opportunistic infections of candida albicans - due to long term ABx, infants/elderly/immunosuppression, local/systemic corticosteroids, radiation, chemotherapy
White plaques scrape off +/- pain, friable
Dx: culture - 90 degree septate hyphae
Tx: Topical antifungals (systemic for severe)
Squamous papilloma: most common benign lesion, well-demarcated, painless, due to HPV (assoc with malignancy), Tx: excisional biopsy
Syph: THE GREAT IMITATOR
What is Behcet’s Disease? How does it present and what is it associated with?
Autoimmune - recurrent painful apthous ulcers assoc with genital ulcers and ocular inflammation
Idiopathic vasculitis of large/small vessels
