Chapter 76 Biology and Pathology of the Oral Cavity Flashcards
1
Q
oral ulcer appears as a yellow–white papule or plaque of ____ (often referred to as a “pseudomembrane”), usually with a surrounding red rim
A
fibrin
2
Q
Recurrent aphthous ulcer (RAU) is a ____-mediated disorder and _____ plays an important role in its occurrence
A
T-cell-
tumor necrosis factor (TNF)-α
3
Q
____, ____, _____ predisposes to their occurrence in susceptible individuals
A
Stress, systemic illness, and local trauma
4
Q
Aphtheiform ulcers are aphthous-like in their appearance and history but they may occur sometimes on the ______ if they are a result of ____ or _____
A
dorsum of the tongue
hematinic deficiency or IBD
5
Q
RAU are seen in all patients with _____ disease and may precede other findings by years.
a vasculitic disorder, has a predilection for ____ and ____ populations and is associated with an increase in ____
A
Behçet disease
Turkish and Japanese
HLA-B51
6
Q
Approximately 3% of patients with RAU have ______ and some show sensitivity to foods and _______
A
gluten-sensitive enteropathy
sodium lauryl sulfate
7
Q
Idiopathic RAU occurs in 15–20% of the population beginning in the _____ of life and the disease generally becomes less severe over the age of ___
A
second decade
50
8
Q
Minor ulcers ______; the most common form.
Major ulcers _______
Herpetiform ulcers_______
Severe aphthous ulcers where patients have minor ulcers but with _______
A
<1 cm, 1–10 at each episode lasting 1–2 weeks
> 1 cm lasting several weeks and healing with scarring
<1 cm, usually 0.1–0.5 cm each, >10 clustered ulcers at each episode, lasting 1–2 weeks
continuous ulcerations with minimum or no ulcer-free days for months
9
Q
Idiopathic RAU are almost always con ned to the ______ mucosa
A
nonkeratinized
10
Q
Differential Dx of RAU
A
Traumatic lesions
chemotherapy- and neutropenia-associated
Herpetic ulcers
11
Q
Biopsy of RAU
A
nonspecific and shows only a fibrin membrane with acute and chronic inflammation and granulation tissue, but may exclude an infectious etiology
12
Q
treatment for minor RAU is ____ or ____ if the ulcers are large and persistent, especially those of aphthous major or in patients with HIV disease
A
topical steroids or intralesional steroid injection
13
Q
Systemic therapy with ____ for a few weeks and maintenance with _______ may reduce the number, duration and size of ulcers, and reduce the number of episodes
A
prednisone
pentoxifylline
14
Q
most common bowel diseases associated with oral ulcers are ____, _____, _____ leading to hematinic deficiency, and celiac disease
A
Crohn disease, ulcerative colitis, malabsorption syndromes
15
Q
Ulcers of Crohn disease typically present as ___ lesions along the ___________
reliable finding is a dusky-red firm area of the _____ skin that has a slight pitted, “orange peel” appearance
A
linear
maxillary and mandibular vestibule/sulcus
perivermilion
patients often also present with papulous folds of tissues, swelling of the lips (indistinguishable from cheilitis granulomatosa), and cobblestoning of the mucosa
16
Q
______ (oral analog of pyoderma gangrenosum) associated with inflammatory bowel disease presents as ______ ulcers of the oral mucosa
A
Pyostomatitis vegetans
“snail-track”
17
Q
Elevated _____ and the presence of ____ support the diagnosis of celiac disease
A
tissue transglutaminase
endomysial antibodies
18
Q
biopsy of oral lesions of Crohn disease shows ______ or while pyostomatitis vegetans shows ______
A
granulomatous inflammation
acantholysis
19
Q
Chemotherapy Agents often associated with chemo associated ulcerative mucositis include ____ and _____, especially when combined with ______
A
cytarabine and cisplatin
radiation
20
Q
ulcers (chemo associated ulcerative mucositis) are generally located on the _____ sites and in particular the _____ and _____
A
nonkeratinized
buccal mucosa and ventral tongue
They begin within 3–5 days of the start of chemotherapy and generally resolve when absolute neutrophil counts recover, usually a course of 7–10 days.
Lesions are extremely painful and may measure several centimeters in size
21
Q
Patients (chemo associated ulcerative mucositis) are often treated with ________ to reduce the period of neutropenia and this has reduced the frequency of such ulcers
A
granulocyte-colony-stimulating factor
22
Q
Topical analgesia such as viscous _____ and systemic analgesia (especially _____) is the mainstay of pain control
A
lidocaine
narcotics
23
Q
_______ seen usually in patients who have diabetes mellitus (usually ketoacidotic) or are immunocompromised, and are often life threatening
A
Mucor and Rhizopus infections
24
Q
Organisms are inhaled and spread into the adjacent sinuses, eroding through the bone, sometimes presenting on the palate as a necrotic ulcer, a condition also referred to as _______
A
rhinocerebral zygomycosis
25
_______ are seen in neutropenic patients, especially those with leukemia and tend to present as necrotic soft tissue and bony lesions of the gingiva, while histoplasmosis, coccidioidomycosis, blastomycosis, and paracoccidioidomycosis are seen in areas where such infections are endemic such as in South America and in patients with _______
Aspergillus infections
| HIV/AIDS
26
deep fungal infections usually present as ____ because they are _____ organisms that cause vascular _______
necrotic ulcers
angioinvasive
thrombosis and ischemia
27
most common location for rhinocerebral zygomycosis is the ______
palate
28
Treatment (zygomycosis) is with systemic antifungal agents such as ______ and triazole antifungal agents such as _____, _____, _____ often with surgical debridement
liposomal amphotericin
| fluconazole, itraconazole, and posaconazole,
29
Oral ulcers in infectious mononucleosis in young adults; nasopharyngeal carcinoma in older adults, hairy leukoplakia in patients with HIV/AIDS
HHV-4 (Epstein Barr)
30
Oral ulcers; may be seen associated with HSV ulcers; usually in immunocompromised patients
HHV-5 (cytomegalovirus)
31
Kaposi sarcoma; usually seen in patients with HIV/AIDS
HHV-8
32
_______ tend to be well demarcated at least around part of the lesion, are frequently dysplastic at rst biopsy, and carry a significant potential for developing into SCC over time
True leukoplakias
33
________ is an extremely rare condition, inherited in an autosomal _______ fashion. It affects the ____ and ____ mucosa, usually in a symmetric and often multifocal pattern, due to mutation in keratin _____ that results in keratin instability and abnormal keratin aggregation
Biopsy or exfoliative cytology is always indicated and shows_______________ (representing abnormal keratin aggregation)
```
White sponge nevus
dominant
oral and genital
K4 or K13
perinuclear eosinophilic condensations
```
poorly demarcated, diffuse, painless white plaques on the oral mucosa, usually the buccal mucosa and tongue, usually within the first two decades of life
34
Tx of white sponge nevus
tetracycline
| postulated to affect the keratinization process and inhibits epithelial proliferation
35
______ occurs in 20%–70% with habits such as using tobacco, coca, or marijuana to >90% of dark- skinned individuals mainly because the whiteness of the lesion shows up more clearly on pigmented mucosa
Stretching the mucosa completely eliminates these fine lines since this is not a keratotic lesion, but rather caused by__________
Leukoedema
intracellular edema of damaged superficial keratinocytes
usually bilateral on the buccal mucosa or ventral tongue and consist of painless, fine grayish white, opalescent reticulations
no Tx
smoking cessation
36
________ common oral condition, where the injury to the tissue is slightly more severe than in leukoedema causing actual degeneration and detachment of the superficial keratinocytes
offending agents are mouthwashes and toothpastes that are caustic [in particular Listerine (Pfizer Pharmaceutical, NY) mouthwash that contains ___, ____, ____
Contact desquamation
27% alcohol, eucalyptol and menthol
often report that their mouth is “peeling.” Lesions present as painless sloughs of desquamated tissue that lie in thin ribbons on the mucosa and can be removed without pain or discomfort to the patient, with normal-appearing, pink underlying tissue
37
_______
white papules and plaques on either side of the linea alba on the buccal mucosa, lower labial mucosa, or the lateral tongue, usually caused by raking of the teeth over the mucosa
A biopsy shows varying degrees of ____ with _____ and benign epithelial hyperplasia.
Morsicatio Mucosae Oris
parakeratosis with impetiginization
more intense local factitial injury to the oral mucosa, caused by a chewing habit, leading to reactive keratosis and benign epithelial hyperplasia. It occurs in 3% of the population
38
_____ poorly demarcated, painless white papules and plaques, often with a rough surface, usually less than 1 cm in greatest dimension
The most common location is the _______ (at the site of previously extracted wisdom teeth) and other areas where teeth have been extracted
Benign Alveolar Ridge Keratosis
retromolar pad
occurs primarily on the keratinized mucosa of the gingiva and hard palate as a reaction to frictional trauma
39
_____
palate of adult patients is the site most often affected. It is diffusely white with red, punctuate areas representing the openings of salivary ducts
development of ______ areas should raise suspicion for malignant transformation
Nicotinic stomatitis
raised, indurated
not caused by nicotine as its name suggests but rather by heat, usually from pipe smoking
40
______ results from a combination of direct contact toxicity of the smokeless tobacco on the mucosa (early lesions), and from effects of carcinogens within the snuff, namely tobacco-associated ______ (late lesions that represent true leukoplakias)
Biopsy reveals thin parakeratosis, intracellular edema, and devitalization of _________
Smokeless tobacco keratosis
nitrosamines
superficial keratinocytes
lesions are located where the snuff is placed, usually the mandibular sulcus/vestibule, between the teeth and the buccal mucosa. The area looks grayish white, opalescent, and wrinkled, often with fissures
41
______, snuff from Ethiopia, has the highest levels of nitrosamines of all
Toombak
42
In many Asian countries, snuff and smokeless tobacco is mixed with other substances such as spices and importantly ______, which contains another potent carcinogen, the _______
areca nut
| alkaloid arecoline
43
Although C. albicans is the most common pathogen in denture-associated candidiasis, _______ is found in 30% of cases
C. glabrata
44
1. Erythematous areas under a denture
| 2. Linear gingival erythema in HIV/AIDS
Erythematous/Atrophic candidiasis
45
Primarily white papules and plaques with minimal erythema; associated with mucocutaneous disease or hairy leukoplakia
Hyperplastic candidiasis
46
Rhomboidal area in posterior midline of tongue, anterior to circumvallate
papillae; maybe slightly depressed and erythematous, or raised
Median rhomboid glossitis
47
use of cholinergic agents such as____ or _____ helps to restore some secretory function of salivary glands and may reduce the frequency of candidiasis
pilocarpine or cevimeline
48
_______ painless, white plaque usually located on the lateral border of the tongue in immunocompromised patients, and in particular, those with HIV/AIDS and after organ transplantation.
Typically, these present as white linear lesions running ________ but when more advanced, may extend onto the dorsum and present as a plaque
Lesions are usually asymptomatic and usually superinfected with ______
Hairy Leukoplakia
perpendicular to the long axis of the tongue
Candida
Lesions are usually asymptomatic and usually superinfected with Candida
49
Oral LP is an immune-mediated disorder and an interface stomatitis characterized by _____ destruction of the _____ cells of the epithelium, possibly as a result of altered antigen presentation on these cells, mediated by ______
______ production is thought to mediate lesions involving the oral cavity only while ____ may mediate systemic disease
```
T-cell
basal
TH1 cytokines
Interferon-α
TNF-α
```
50
Oral Lichen planus
Local lichenoid reactions may develop as a result of contact injury to ____ or _____ from chewing gum
Medications implicated in the development of oral LP include antihypertensive agents (especially _____), some hypoglycemic agents, ____, _____, _____ and the new biological agents
amalgam restorations or cinnamic aldehyde
hydrochlorthiazide
allopurinol, sulfasalazine, carbamazepine
51
oral LP
| Other conditions associated with oral lichenoid lesions include _____; ____, and _____
hepatitis C in Mediterranean races and this is associated with HLA-DR6; chronic graft- versus-host disease, and lupus erythematosus
52
oral LP
The most recognizable is the ______ (Wickham striae) that is usually not painful. This is ____ in distribution and reticulations almost always occur on the ____ and ____ although any oral mucosal site may be affected
_____ form is usually painful and this is particularly common as a primary presentation on the ____ (clinically desquamative gingivitis). LP on the gingiva is also noted in the _______
keratotic/reticular form
symmetric
buccal mucosa and tongue
erythematous or erosive
gingival–genital syndrome
gingiva
Ulcerative LP usually occurs in association with the other two forms
Concomitant skin involvement is noted only in 10%–15% of patients
53
Oral LP
the most important DDx is _____. It can be differentiated from oral LP in that it is ____________ (although it may have subtle linear areas), is usually asymmetrically distributed, and often presents at a high-risk site for cancer such as the _________
erythroleukoplakia
not usually definitively reticulated
ventral tongue unilaterally
54
__________ is an entity that resembles erythematous/erosive LP but is associated with antibodies directed against ______
Chronic ulcerative stomatitis
| δNp63α
55
Diagnostic histopathologic findings for oral LP, are_________ and a _______ at the interface. DIF studies show_______ and often ______ and________
```
squamatization of basal cells
lymphocytic band
shaggy fibrinogen
IgM at the interface
IgM staining of colloid bodies
```
56
Oral LP
Gingival lesions are effectively treated with _________
Systemic therapy with ______ or ______ should be instituted in severe cases and topical therapy started concomitantly
topical steroids held in a stent
prednisone (at 1 mg/ kg for 1 week with a fairly rapid taper)
hydroxychloroquine
57
____________ LP has a very low malignant potential
Classic, bilaterally symmetric, reticulated LP
58
________
white plaque of questionable risk having excluded other (known) diseases or disorders that carry no increased risk for cancer
Leukoplakia
59
Frictional keratosis is NOT a leukoplakia and the only two histologically well-defined frictional keratoses are ____ and ____
(1) MMO and (2) BARK
60
Leukoplakia is strongly associated with ______ and/or _______
smoking and/or alcohol ingestion
61
_______ leukoplakia may show areas of fissuring.
_______ leukoplakia have areas of erythema (erythroleukoplakia), rough, warty areas (verrucous leukoplakia), or nodular areas; they have a higher association with dysplasia and carcinoma, as do lesions on the ____, _____, _____
Homogenous
Nonhomogenous
floor of mouth, ventral tongue, and soft palate
62
_________ tends to occur in middle-aged females and, as its name suggests, tends to spread or proliferate over the mucosa over time, and is usually multifocal
Approximately 70%–100% of cases develop ____ over time
Proliferative verrucous leukoplakia (PVL)
| SCC
63
_______, an uncommon lesion and in its pure form presents as a painless, red, sometimes velvety plaque of the oral mucosa
___% of lesions diagnosed as “benign hyperkeratosis,” when followed over time, transform to carcinoma
______ are intraepithelial neoplasias that have not yet become invasive. If such lesions can be removed without excessive morbidity, this seems prudent
erythroplakia
5%–18%
True dysplasias
64
Leukoplakia & erythroplakia
Options for the ____% of cases diagnosed as “benign hyperkeratosis,” include ____or ____
50%–80%
| periodic rebiopsy or excision
65
Oral SCC
Excluding the lip, the most common sites are the ___, ____, ____
Metastases to the____ and _____ are common, and nodes should be palpated in patients with suspicious lesions.
ventral tongue, gingiva, and foor of mouth
| submandibular and upper cervical lymph nodes
66
Oral SCC
Most _____ lesions are treated with surgical excision (usually en bloc resection) with an objective of obtaining clear margins
Stage I and II
67
oral SCC
______ tumors may be treated with surgery, radiation or chemoradiation (the chemotherapy being a radiation sensitizer) for organ-sparing purposes
Stage III and IV
68
oral SCC
The use of ______, a monoclonal antibody against the ________ receptor, which is highly expressed in many oral cancer, has resulted in improved disease control
cetuximab
| epidermal growth factor
69
The most common presentation for mucous membrane pemphigoid is ______.
This presents as a band of bright red, painful gingiva, often ________, with areas that are ____ or _____ epithelium lying on the surface
desquamative gingivitis
denuded of epithelium
ulcerated or with necrotic
70
mucous membrane pemphigoid
____ is the most common disease (____%) presenting as desquamative gingivitis, with mucous membrane pemphigoid representing ____% of cases
____ and ____ always present with concomitant skin lesions.
_______ produces a granular, erythematous gingivitis
LP
70-75%
9%–14
Linear IgA disease and epidermolysis bullosa acquisita
Granulomatosis with polyangiitis (Wegener disease)
71
The most effective way to treat mucous membrane pemphigoid presenting as desquamative gingivitis is with a ______ (similar to a bleaching or fluoride tray extended over the gingiva) for ____ min ____ a day
___ and ___ may be used if lesions are recalcitrant
topical steroid gel held in a soft stent
30 minutes twice a day
Prednisone and dapsone
72
oral pemphigus
predilection for this condition among Ashkenazi Jews and those living around the ____ and ____ and a strong association with ____, ____, ____
Mediterranean and South Asia
| HLA-DR4, Drw14, and DQB1*503
73
________
Lesions may present as desquamative gingivitis, but almost invariably, other mucosae are involved, in particular the ____ and ______.
Oral lesions are denuded and erythematous, painful, and slightly depressed.
Remnants of the bullae or necrotic debris may overlie the erosion, or be heaped up at the edges
oral pemphigus
| hard and soft palate
74
patients with paraneoplastic pemphigus (also known as paraneoplastic autoimmune multiorgan syndrome) present with ______. It is usually associated with a ________
hemorrhagic crusting of the lips
| lymphoid malignancy
75
Patients with____ and ____ lupus erythematosus present with oral ndings in up to ___% of cases
may present with erythematous and eroded mucosa, especially on the____ and _____ with _____
systemic and discoid LE
25%
buccal mucosa and palate with a hint of white reticulations
76
two most common pigments of exogenous origin are ____ and ____ from pencil lead
endogenous origin are usually caused by ___ or ____
amalgam and graphite
| melanin or hemosiderin
77
amalgam tattoo
The silver particles stain the ____ leading to the tattoo
This presents in adults usually, as a discrete, nontender, slate-gray, or black macule of the oral mucosa that is usually less than 1 cm
DDx
________ and ______ usually have less uniform pigmentation and irregular borders. A vascular lesion such as a___ or ____ may look similar, although those intend to appear as blebs or papules and blanch with pressure
reticulin fibers
Dysplastic melanocytic lesions and melanom
varix or venous lake
78
Physiologic pigmentation
Postinflammatory hypermelanosis from diffuse and symmetric involvement but _______ may also have a similar appearance. However, the pigmented areas tend to be located where the obvious ______ are present
oral LP
| white reticulations
79
_________
most common sites of involvement are the lower lip vermilion, gingiva, and hard palate.
They are asymptomatic, discrete, tan, brown, or black macules, usually less than 1 cm with even pigmentation
DDX
sudden onset of melanotic macules should raise the possibility of _____ and _____ levels should be measured
Biopsy reveals increased melanin pigment in the _____ in the absence of______ , and many melanophages in the ______
oral melanotic macule
Addison disease and ACTH
basal cells
melanocytic hyperplasia
lamina propria
80
postinflammatory hypermelanosis
____ is often associated with and the pigmentation underlies the reticulations of the disease
DDx
Oral melanotic macules may resemble _________, another likely inflammatory reactive disorder in which there is proliferation of______ throughout acanthotic epithelium
LP
melanoacanthosis
dendritic melanocytes
81
Medication induced
Minocycline and tetracycline chelate to ________ in bones and teeth and their metabolic products chelate _______ in the soft tissues
_________ may stimulate melanin production by stimulating production of α-melanocyte stimulating factor.
apatite crystals
iron and melanin
Pegylated interferon used with ribavirin
82
Medication induced
Heavy metals such as ____ is secreted into the gingival fluids and likely chelate with _____ (usually black) produced by plaque bacteria
______ ingestion is also associated with pigmentation of the tongue either from systemic ingestion and tissue deposition, or direct conversion of the compound to bismuth sulfide from oral bacteria
lead
sulfides
Bismuth subsalicylate
83
Medication induced
most common site of pigmentation caused by minocycline and antimalarial medications is the _______, which assumes a slate-gray to blue diffuse macular discoloration that is generally bilateral and symmetric
Tongue pigmentation caused by ______ accentuates the papillae in a _____ configuration
palatal mucosa
pegylated interferon
punctate
84
________
starts as a brown macule, usu- ally on the buccal mucosa, that over days and weeks spreads rapidly, but still in a macular fashion
Melanoacanthosis
85
Nevomelanocytic nevi
most common is the ______ that accounts for two-thirds of cases, followed by the _____ and ______ (17%) each; _______ constitute only 3% of lesions
intramucosal nevus
compound nevus and the blue nevus
junctional nevus
The most common location is the palate (40%) followed by the buccal mucosa (19%)
86
_______
more frequent in black and Japanese patients and the most common site is the
palate or maxillary gingiva
DDx
______ tends to be purple or bluish-red, while tend to be brown-to-black
Five-year survival is approximately __%
________ is the treatment of choice
______ greatly reduces local relapse and metastasis to lymph nodes, although it may not improve survival
melanoma
Kaposi sarcoma
melanomas
20%–30%
Excision with clear margin
Surgery with radiotherapy
87
There is usually a background of chronic actinic damage and ________ with blurring of junction of the _______, predominantly involving the ______.
_______ presents as single or multiple crusted or scabbing, slightly scaly lesions and plaques on the ________, usually several millimeters in size, that heal and then break down
the use of _____________________ has shown complete clinical response in two-thirds of cases and partial response in one-third; follow-up revealed recurrence in approximately one-third of cases
```
atrophy of the lip
vermilion and the skin
lower lip
Actinic cheilitis
vermilion of the lip
```
photodynamic therapy with 5-aminolevulinic acid
88
___________ refers to the triad of fissured tongue, facial palsy, and cheilitis granulomatosa, but it is rare to see the triad fully expressed clinically
Melkersson–Rosenthal syndrome
89
________________
Some present with unilateral, soft (early lesions), or firm-rubbery (more established lesions) painless swelling of the lip, and others present with symmetric swelling of the upper or lower lips or, less frequently, both
swelling is originally relapsing–recurring and then becomes persistent, often with_______. There may also be a history of ________, _______, _______
cheilitis granulomatosa
fissuring of the lips
facial swelling, VII nerve palsy (uncommon), and gingival involvement
90
cheilitis granulomatosa
_________ are the mainstay of treatment. The dose depends on the severity of swelling and usually patients are treated __________
Topical and intralesional steroid injections
| every week for 2–3 weeks
91
_____________
There is painful, usually bilateral maceration of the corners of the mouth with ulceration, crusting, cracking, and, in severe cases, ssuring.
Lesions may heal and recur within days or weeks. Some patients develop a diffuse ________
The usual anticandidal regimens employing ____, ____, ____ are also effective.
If lesions only partially resolve, S. aureus infection should be suspected and treatment with __________ usually resolves the residual lesion
angular cheilitis
cheilitis due to candidiasis
nystatin, clotrimazole, and chlorhexidine
topical erythromycin
92
_______________
The lip is covered by fine or thick scales and crusts that can be peeled away, leaving an erythematous, raw area
Patients will report that within a few hours, a new scale or crust forms
exfoliative cheilitis
93
On the lower lip nodules usually result from trauma and include _____ and _______
```
Upper lip is traumatized much less frequently and mucosal nodules at this site usually represent one of the following:
______
______
______
______
______
```
bite or irritation fibromas and mucoceles
1. Benign salivary gland neoplasm (pleomorphic adenoma or canalicular adenoma)
2. Malignant salivary gland neoplasm (mucoepidermoid carcinoma)
3. Benign nerve sheath tumor (solitary circumscribed neuroma)
4. Benign vascular tumor (pyogenic granuloma)
5. Nasolabial cyst, a developmental malformation
94
atrophic glossitis
Atrophy of the ____ and ____ papillae of the tongue leads to a bald shiny, erythematous ______. Such atrophy is often seen in _______ and in patients with prolonged hyposalivation such as those with ______ or ______
often complain of a burning sensation and experience sensitivity when eating acidic, salty, or crunchy foods.
They may have associated ________ if there is a _________. Patients who develop _________________ are prone to developing atrophic glossitis
filiform and fungiform
tongue dorsum
hematinic deficiencies
Sjögren syndrome or after head and neck radiation therapy
angular cheilitis
hematinic deficiency
malabsorption after intestinal surgery
95
_________ is caused by retention of keratinaceous debris on the tongue dorsum resulting from two factors acting alone or in combination:
(1) _________ (leading to more sticky and mucous rather than serous saliva) and
(2) ________ (eating a soft diet or one low in fresh fruits and vegetables)
The thickened matte of keratin on the tongue leads to increased ______ and their metabolic products (______) may lead to a foul or stale breath
Hairy tongue
dehydration
poor oral intake
bacterial colonization
often sulfides
96
__________
There are two main patterns. The first consists of a ______, either alone or with smaller fissures radiating from it at right angles
The second pattern is one of ______ distributed evenly throughout the tongue without the central fissure
Fissured tongue
central fissure
short fissures
97
___________________
This occurs in ____% of the population and is associated with a fissured tongue in about 30% of cases.
There is an area of ________ leading to loss of _____ and a slightly depressed erythematous area that is usually sensitive or painful, especially when acidic foods come in contact with it
Such demarcated areas rimmed by a ___________ are diagnostic
biopsy showing a _____ with _______ in the absence of candidal hyphae is diagnostic
______ used as a swish and spit preparation or _______ may reduce symptoms. If severe, topical steroids (especially ______) are helpful
BENIGN MIGRATORY GLOSSITIS/ STOMATITIS (GEOGRAPHIC TONGUE)
1%–2%
atrophy of the tongue dorsum
filiform papillae
raised white border that is circinate or serpiginous
psoriasiform pattern with many spongiotic pustules
Diphenhydramine
2% viscous lidocaine
dexamethasone
98
______ refers to the diffuse enlargement of the tongue that may be symmetric or asymmetric
Mild symmetric enlargement is usually caused by ______ such as in _____ or with some systemic conditions such as ______
Asymmetric enlargement is usually caused by in particular a ____ or _____ that tends to insinuate between the muscle fibers
For patients with amyloidosis, a ________ is indicated. For patients with other tumors, ___________ in the case of vascular tumors is the treatment of choice
Macroglossia
loss of muscle tone
aging
amyloidosis
vascular malformation of either lymphatic (lymphangioma) or blood vascular origin (venous malformation)
work-up for plasma cell dyscrasia
excision with/out the use of embolization
99
______ is located on the posterolateral aspects of the tongue bilaterally and is part of ______. In its healthy form, it lies below the _____
_______, when inflamed, protrudes as a fleshy, soft area with a slightly irregular surface
lingual tonsil
Waldeyer ring
foliate papillae
hyperplastic lingual tonsil
100
_______ that presents as multiple enlarged white papillae scattered over the surface of the tongue that tends to be relapsing–recurring.
Another form presents as ______ on the dorsum of the tongue.
A rare form is _____ with intrafamilial transmission
____ reduces inflammation
transient lingual papillitis
reddened and enlarged fungiform papillae
eruptive papillitis
Dexameth- asone mouth rinse
101
nodules on the lateral tongue tend to have a traumatic etiology and include _____ and _____
fibromas (and its variant giant cell fibroma) and traumatic neuroma
