Chapter 8: Physical and chemical injuries Flashcards
Morsicatio buccarum
-‐ Similar lesions seen in glassblowers
-‐ Histologically, may resemble OHL, uremic stomatitis and betel chewer’s mucosa
Traumatic ulcerations
-‐ TUGSE: due to trauma. Deep pseudoenvasive, slow to resolve, may involute after biopsy. Can present similarly to a pyogenic granuloma
-‐ TUGSE-‐like lesion sseen in pts with familial dysautonomia (Riley-‐Day syndrome, indiff to pain)
-‐ Riga-‐Fede disease: TUGSE in infants. Ant ventral tongue, from ant teeth trauma
-‐ Some cases of TUGSE are unrelated to trauma. Shows sheets of large atypical cells, of unknown origin. Histiocytes (atypical histiocytic granuloma) or T lymphocytes (Oral CD30+ lymphoproliferative disorder)
-‐ Riga-‐Fede seen in Riley-‐Day syndrome (dystonia), congenital indifference to pain, Lesch-‐Nyhan syndrome, Gaucher disease, cerebral palsy and Tourette syndrome
Electrical and thermal burns
-‐ Contact: current passes through the body, fro source to ground
-‐ Arc: most common. Current flows between source and mouth, with saliva acting as medium
-‐ Thermal burns: food and beverage
-‐ Major complication in electrical burn: contracture of mouth opening during healing
Chemical injuries of the oral mucosa
-‐ Aspirin, hydrogen peroxide, silver nitrate, phenol and endo materials
-‐ Cotton roll stomatitis: cotton roll strips epithelium on removal
-‐ Histo: coagulative necrosis (only outline of cells and nuclei remain)
Non-‐infectious oral complications of antineoplastic therapy
-‐ Phase of the cell cycle most susceptible to radiation is “M” phase; least “S” phase
-‐ Cytoreductive therapy: therapy to debulk, or reduce the size of, a cancerous tumor
-‐ CT: mucositis and hemorrhage (from thrombocytopenia due to bone marrow suppresion)
-‐ RT: mucositis and dermatitis. Also, xerostomia, hypogeusia, ORN, trismus and tooth anomalies
-‐ Radiation-‐caries: often affects cervical part of tooth
Bisphosphonate-‐associated osteonecrosis (BON)
-‐ Associated with aminobisphosphonates (2nd generation; 12y half-‐life)
-‐ Used for tx of Paget’s, osteoporosis, and bone cancers
-‐ Pamidronate and zoledronic acid (zometa) (IV formulation) for cancer (MM): 95% cases
-‐ Oral: alendronate (fosamax), risedronate and ibandronate (boniva)
-‐ Serum C-‐telopeptide (CTX): possible marker for development of BON
-‐ ARONJ (antiresportive agent-‐induced ONJ): due to use of denosumab and cathepsin K inhibitors (for osteoporosis), following sx.
Orofacial complications of methamphetamine abuse
-‐ Parasitosis (formication): sensation of snakes or insects crawling on or under skin
-‐ Speed bumps (meth sores, crank bugs): trauma from trying to remove “insects”
-‐ Rampant caries ~ to milk-‐bottle caries (due to xerostomia and heavy intake of sugary drinks)
Anesthetic necrosis
-‐ Ulceration/necrosis at site of anesthesia injection, due to ischemia. Most on hard palate.
Exfoliative cheilitis
-‐ Persisten scaling/flaking of the vermillion border of both lips.
-‐ Causes: contact dermatitis, allergic contact stomatitis and atopic eczema
-‐ R/O atopy, candida, actinic cheilitis, chelitis glandularis, hypervitaminosis A and photosensitivity
-‐ Factitious cheilitis: when due to from chronic injury (lip licking, biting, picking or sucking)
-‐ Cheilocandidiasis: diffuse candidasis of lips in areas of low-‐grade trauma
-‐ Circumoral dermatitis: crusting and erythema of skin surface adjacent to lips due to trauma
Submucosal hemorrhage
-‐ Petecchiae (minute), purpura (larger), ecchymosis (> 2cm) and hematoma (mass; blut trauma)
-‐ Can arise from intrathoracic pressure from coughing, vomiting, etc
-‐ Non-‐traumatic: blood dyscrasias, infections (measles, mono), medications
-‐ FOM hemorrhage: implant placement, severe HT, coagulopathy
-‐ Anthral hematoma: from intranasal hemorrhage
Oral trauma from sexual practices
-‐ Palatal hemorrhage due to felatio most common change
-‐ Cunnilingus: ulceration/fibrosis of lingual frenum
Amalgam tattoo and other localized exogenous pigmentations
-‐ Tissue reaction related to size of particles
-‐ Graphite implantation: birefringent after tx with ammonium sulfide, doesn’t stain reticulin fibers
Oral piercings and other body modifications
-‐ Forked tongue: anterior 1/3 of tongue is split
-‐ Susuk: charm needles or charm pins (form of talisman) (seen in xray)
-‐ Barbell: metal rod with a ball that screws onto each end (tongue piercing)
-‐ Labret: ring with flat end attached to mucosal side and ball for cutaneous part (lip piercing)
-‐ Most common complications: gingival recession and tooth fracture
Systemic metallic intoxication
Lead
Lead (plumbism): very common source of intoxication in children (water, paint)
-‐ Generalized argyria (chronic silver intox) may result from long term tx of aphthous ulcers, denture sores and gingival hemorrhage with topical silver nitrate
-‐ Lead: ulcerative stomatitis, Burton’s line, tongue tremor, perio disease, sialorrhea, discoloration and metallic taste
-‐ Burton’s line: gingival blue line. Due to action of bacterial HS on lead
Systemic metallic intoxication
Mercury
-‐ Mercury: metallic taste, ulcerative stomatitis, discoloration, tooth exfoliation, enlargement of SG, gingival and tongue.
-‐ Acrodynia (Swift disease; pink disease): chronic mercury intoxication. Cold hands, feet, nose, ears, irritability. Pruritic rash, severe sweating, and excessive salivation.
Systemic metallic intoxication
Bismuth
-‐ Bismuth: black hairy tongue, w/o elongated papilla
-‐ Silver and bismuth: blue-‐gray discoloration of skin; Burton’s line
Systemic metallic intoxication
Arsenic
-‐ Arsenic: palmar-‐plantar keratosis
-‐ Arsenical keratosis: premalignant skin lesions
Systemic metallic intoxication
Gold
Gold: dermatitis (preceded by pruritus) and oral mucositis (allergic reaction)
Chryasis: blue discoloration of sun exposed skin when therapy with gold is used
Smoker’s melanosis
Melanin exerts a protective effect against smoke substance. Most in anterior gingiva
Drug-‐related discolorations of the oral mucosa
-‐ Due to melanocyte induction or deposition of drug metabolites
-‐ Phenolphthalein (laxative): numerous small, well-‐demarcated skin lesions (also oral)
-‐ Minocycline: bone (band above attached gingiva and hard palate) and teeth
-‐ Tranquilizers, anti-‐malarials: blue-‐black discoloration limited to hard palate
-‐ Etrogen, CT, and AIDS drugs: diffuse brown melanosis, most gingiva and buccal mucosa
Reactive osseus and chondromatous metaplasia (Cutright lesion)
-‐ If in anterior maxilla, probably remnants (not metaplasia)
-‐ True Cutright found in post mand alveolar ridge. Rarely in MX or ant MD
-‐ Metaplasia due to trauma from denture. Pts usually have knife edge-‐like crest
Oral ulceration with bone sequestration
-‐ No systemic disease, infection or major trauma.
-‐ Possibly due to previous trauma or apthae that causes osteitis and necrosis
-‐ Usually lingual surface of post mandible or exostosis
Pseudocysts and cysts of the maxillary sinus
-‐ Antral pseudocyst: dome-‐shaped radiopacity of sinus floor. Accumulation of serum below sinus lining. Due to odontogenic infection or possibly allergy. Dome shaped mass (no bone erosion)
-‐ Sinus mucocele: accumulation of mucin. Portion of sinus is separated from main body. Two types: surgical ciliated cyst (after sx, usually Caldwell-‐Luc or 3rd molar) or sinus ostium blockage
-‐ Retention cyst: partial blockage of a gland duct or invagination of respiratory epithelium. Mucin surrounded by epithelium, w/o extravasation. Most assoc w/ polyps and not evident clinically
-‐ Mucocele and retention cyst are true, epithelial-‐lined cysts
Cervicofacial emphysema
-‐ Introduction of air into subcutaneous or facial spaces.
-‐ Causes: compressed air, difficult extractions, intra-‐oral pressure and idiopathic
-‐ Crepitus (cracking) on palpation help differentiation from angioedema
-‐ Pneumoparotid: air inside parotid. Saliva is frothy and air-‐filled, instead of waterlike
-‐ 90% develop during sx or within 1h. Delayed onset-‐ induced by patient
-‐ Hamman’s crunch: crepitus synchronous with heartbeat; emphysema with mediastinal involvement (pneumomediastinum)
Myospherulosis
-‐ Form of lipogranuloma, placement of antibiotic (tetracycline) in a petrolatum base into sx site
-‐ Oral: usually extraction site to prevent alveolar osteitis, mostly MD
-‐ Histo: cyst-‐like spaces with numerous brown to black spherules (RBCs altered by medication)
-‐ Bag of marbles: spherules surrounded by outer membrane (parent body)
-‐ If in sinus, can become contaminated by fungus (zygomycetes and aspergillus)
