Chapter 9 Flashcards by Jessica Ash

Transient Lingual Papilliits - Localized

1+ enlarged papilla - red/yellow

Painful

Anterior doral tongue

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Transient Lingual Papillitis - Generalized

Large percent of fungiform papilla involved

Tip and lateral dorsal tongue

Painful and sensitive

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Recurrent Apthous Ulcerations - Minor

Most common form

Occurs in childhood

3-10 mm lesions

1-5 lesions

7-14 days healing time

No Scarring

Fewest recurrences

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Recurrent Aphthous Ulcerations - Major

“Sutton’s Disease”

Occurs in adolescents

1-3 cm lesions

1-10 lesions

Healing time 2-6 weeks

Scarring is possilbe

More recurrences than minor, less than herpetiform

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Recurrent Aphthous Ulcerations - Herpetic Form

Occurs in adults

1-3 mm lesions

Up to 100 lesions

Healing time 2-4 weeks

Scarring

Most recurrences

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Treatment of Recurrent Aphthous Ulcerations

Minor cases = no treatment

Major cases, multiple recurrences = clobetasol proprionate (.05% steroid for pain)

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Transient Lingual Papillitis

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Diffuse papulokeratotic variant

Large number of affected papilla –> transient papillitis

All papilla affected - all over the otngue

Apearance: elevated, white or yellow

Asymptomatic

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Treatment for Transient Lingual Papillitis

Resolve w/o therapy

Topical steroids reduce pain

Magic mouthwash - malox, benadryl, lidocaine viscous

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Recurrent Aphthous Ulcerations

AKA Recurrent aphthous stomatitiis

Very Common - 30%

Occur exclusively on MOVABLE MUCOSA

Clinical variations: minor, major, herpetiform

Younger patients

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Behcet’s syndrome

Chronic, recurrent immune disease

Includes:

Oral aphthous-like ulcerations

Ocular inflammation

Genital ulcers

Skin lesions

Arthralgia

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Sarcoidosis

Multisystem granulomatous disorder

Afican Americans >>>> Caucasions

90% Abnormal x-ray

25% skin lesions on head and neck and lower legs

Syndromes:

Lofgren’s syndrome

Heerfordt’s syndrome

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Syndromes of Sarcoidosis

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Lofgren’s Syndrome

Erythema nodosum

Bilateral hilar lymphadeopathy

Arthralgia

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Heerfordt’s Syndrome

Parotid Enlargment

Inflammation of the eye

Facial paralysis

Fever

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Organs involved in Sarcoidosis

Lungs

Lymph nodes

Skin

Eyes

Salivary glands

Lupus pernio

Chronic, purple, indurated lesion on head and neck

Erythema nodosum

Scattered, nonspecific, tender, red nodules on lower legs

Sarcoidosis - Histology

Non caseating granulomatous inflammation

Schaumann bodies (degenerated lysosomes)

Asteroid Bodies (entrapped collagen fragments)

Hamazaki-Weseberg bodies (large lysosomes)

Sarcoidosis - Diagnosis

Elevated serum angiotensin-converting enzyme levels

Chest x-ray

Kveim test - no longer used

Orofacial Granulomatosis

Variable presentation

Lips are most commonly involved

If only lips are invovled = cheilitis granulomatosa

Syndrome - Melkersson-Rosenthal syndrome

Histology - granulomatous inflammation

Melkersson-Rosenthal Syndrome

Cheilitis granulomatosa

Facial paralysis

Fissured tongue

clobetasol proprionate

Used for treatment of major or recurring apthough ulcers

Skin lesion of Sarcoidosis

Lupus Pernio

Erythema Nodosum

Wegener's Granulomatosis

Necrotizing granulomatous lesions of _Respiratory tract, glomerulonephritis,_ systemic vascluitis If untreated --rapid renal involement --\> DEATH Oral lesions

**STRAWBERRY GINGIVITIS** Oral lesions of _Wegner's Granulomatosis_ Early manifestation Appearance: Florid, erythematous, granular hyperplasia

Diagnosis of Wegner's Granulomatosis

Indirect inmmunofluorescence detects presence of antineutrophil cytoplasm antibodies Perinuclear (p-ANCA) Cytoplasmic (c-ANCA) -- most useful

Treatment of Wegner's Granulamostosis

STERIODS -- first line tx (75% survival) Untreated -- 10% two year survival (necrotixing glomerulonephritis)

Contact Stomatitis from Cinnamon

Reactions associated with pronlonged or frequent contact (candy, chewing gum, toothpaste) Gingiva can appear large and red --\> plasma cell gingivitis Superficial slough of tissue (similar to sodiun laryl-sulfate containing toothpaste) Localized lesions --\> ulcerated, white, red Signs --\> disappear within 1 week discontinued use

Angioedema

**Quincke's Disease** DIffuse edematous swelling of the soft tissue No pain Itching and erythema Quick onset **common cause --\> mast cell degranulation leads to histamine release** \*\* IgE mediated hypersensitivity \*\* Diffuse involvement of the head and neck --\> **caused by angiotensin-converting enzyme (ACE) inhibitors**

Treatment for allergic angioedema

Oral antihistamine therapy IM epinephrine and IV corticosteriods for SEVERE cases

What are some angiotensin-converting enzyme inhibitors?

-prils (lisinopril) Medication used for HTN or chronic heart failure Swelling associated with these drugs do not respond well to antihistamines

Treatmen tof ACE inhbitor associated angioedema

Avoid all ACE inhbitor medications monitor until swelling subsides C1-INH concentrate

Anigioedema vs Orofacial granulomatosis

Angioedema -\> quick onset Orofacial (chelitis) granulomatosis --\> slow onset

Recurrent apthough ulcers vs HSV

Recurrent apthous ulcers --\> MOVABLE mucosa HSV --\> MOVABLE and ATTACHED mucosa

Where do Major RAU generally occur?

Labial mucosa Soft pallate Tonsillar faucets