DISORDERS OF MOUTH AND OROPHARYNX Flashcards
Whats the prevalence of cleft lip and palate?
1 in 1000 babies
Whats the most common congenital deformity affecting the orofacial structures?
Cleft lip and cleft palate
What are the commonest variants of Cleft lip and palate?
isolated cleft lip (15%)
isolated cleft palate (40%)
combined cleft lip and palate (45%)
What is cleft lip?
a congenital condition where there is a split or open section of the upper lip. This opening can occur at any point along the top lip, and can extend as high as the nose.
What is cleft palate?
Cleft palate is where a defect exists in the hard or soft palate at the roof of the mouth. This leaves an opening between the mouth and the nasal cavity. Cleft lip and cleft palate can occur together or on their own.
What proportion of cases of cleft lip/palate are associated with an underlying syndrome?
3 in 10
What are complications of cleft palate/lip?
Significant feeding, swallowing and speech
It can have significant psycho-social implications - e.g. affecting bonding between mother ans child
More prone to otitis media
What are the aetiological factors of cleft lip/palate?
Genes - if one parent has it, the risk of a child getting it is 4-6%
Teratogenic drugs - e.g. antiepilpetics, corticosteroids
Maternal smoking and alcohol use
How does cleft lip present?
Small gap in lift with the split running from the philtrum to thw nostril
They may just be an indentation in partial or incomplete cleft
It may be unilateral or bilarteral
Whats the pathophysiology of cleft lip?
It is due to a failure of fusion of the maxillary and medial nasal processes in the developing fetus.
Whats the pathophysiology of cleft palate?
occurs when the two plates in the base of the skull which form the hard palate fail to fuse.
The cleft is therefore central in the plate and the soft palate is usually cleft as well
What disease are associated with cleft palate/lip?
Females have an increased risk of breast cancer and primary brain maliganncy
Males have increased risk of primarily lung cancer
Anxiety and depression
How is cleft lip/palate managed?
Speech therapy - 75% of children will develop normal speech
Orthodontic devices to help with feeding
Cleft lip is repaired earlier than cleft palate, with practices varying from repair in the first week of life to three months
cleft palates are typically repaired between 6-12 months of age
What can cause mouth ulcers?
Viral infections - herpes simplex virus, chickenpox, hand, foot& mouth disease
Vitamin B12 and iron deficiency
Crohn’s disease
Coeliac disease
Reactive arthritis
Weakened immune system
NSAIDs
Nicorandil
Beta blockers
Chemo/radiotherapy (mucositis)
Others - stress, hormone changes, certain foods, toothpaste donating sodium lauryl sulphate, stopping smoking, hard food, poor fitting dentures, defective filling, biting your cheek
What causes glossitis
Allergic reactions to oral care products, foods, or medicine
Dry mouth due to Sjögren syndrome
Infection from bacteria, yeast or viruses (including oral herpes)
Injury (such as from burns, rough teeth, or bad-fitting dentures)
Skin conditions that affect the mouth
Irritants such as tobacco, alcohol, hot foods, spices, or other irritants
Hormonal factors
Certain vitamin deficiencies - riboflavin, niacin, pyridoxine, B12, Folic acid, iron zinc, vit E
What is Sialadenitis?
Salivary gland infection
In which salivary glands do tumours most commonly occur?
Parotid - 80% occur here
In which salivary glands to stones typically form in?
Submandibular
What proportion of parotid gland tumours are benign?
Up to 80%
Whats the epidemiology of benign parotid gland tumours?
Occur in 5th decade of life typically
More common in women than men (except warthins tumour)
What are the most common types of benign parotid gland tumours?
Benign pleomorphic adenoma or benign mixed tumour
Warthin tumour
Monomorphic adenoma
Haemangioma
Whats the most common parotid neoplasm?
Benign pleomorphic adenoma or benign mixed tumour
What is a warthin tumour?
papillary cystadenoma lymphoma or adenolymphoma
What is warthin tumour most commonly associated with?s
Smoking
Who do haemangiomas typically affect?
children - Accounts for 90% of parotid tumours in children less than 1 year of age
What are the types of maligannt parotid gland tumours?
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Mixed tumours
Acinic cell carcinoma
Adenocarcinoma
Lymphoma
What is sjogrens syndrome?
Autoimmune disorder characterised by parotid enlargement, xerostomia and keratoconjunctivitis sicca
90% of cases occur in females
Second most common connective tissue disorder
Bilateral, non tender enlargement of the parotid gland is usual
There is an increased risk of subsequent lymphoma
How much saliva do submandibular glands secrete a day?
800-1000ml
What is sialolithiasis?
Stones in salivary gland
What are salivary gland stones usually consist of?
calcium phosphate or calcium carbonate (radio-opaque)
How does sialolithiasis present?
colicky pain and post prandial swelling of the gland
What usually causes sialadenitis?
Staph aureus infection
How does sialadenitis present?
Increasingly painful swelling of salivary gland
Purulent discharge
Systemic manifestations
What is leukoplakia?
Leukoplakia is a premalignant condition which presents as white, hard spots on the mucous membranes of the mouth
Increased risk of mouth cancer
Who is Leukoplakia common in?
Smokers
Why is leukoplakia said to be a diagnosis of exclusion?
As candidiasis and lichen planus should be ruled out first, especially if the lesion can be rubbed off
Biopsies also must be performed to exclude alternative diagnoses e.g. squamous cell carcinoma
How does leukoplakia present?
Thick white patches on the inside surfa e of the mouth
Usually painless
Whats the referral criteria for oral cancer?
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for oral cancer in people with either:
unexplained ulceration in the oral cavity lasting for more than 3 weeks or
a persistent and unexplained lump in the neck.
Consider an urgent referral (for an appointment within 2 weeks) for assessment for possible oral cancer by a dentist in people who have either:
a lump on the lip or in the oral cavity or
a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia.
What is erythroplakia?
Abnormal red lesions on mucous membrane sin mouth
Can’t be scraped off
Precancerous lesions for oral cancer
What is erythroleukoplakia?
An abnormal patch of red and white tissue that forms on mucous membranes in the mouth and may become cancer
What are the potential areas for head and neck cancer?
Nasal cavity
Paranasal sinuses
Mouth
Salivary glands
Pharynx (throat)
Larynx (epiglottis, supraglottis, vocal cords, glottis and subglottis)
Where do head anc neck cancers typically spread to first?
Lymph nodes
What are risk factors for head anc neck cancers?
Smoking
Chewing tobacco
Chewing betel quid (a habit in south-east Asia)
Alcohol
Human papillomavirus (HPV), particularly strain 16
Epstein–Barr virus (EBV) infection
What are red flags for head and neck cancers?
Lump in the mouth or on the lip
Unexplained ulceration in the mouth lasting more than 3 weeks
Erythroplakia or erythroleukoplakia
Persistent neck lump
Unexplained hoarseness of voice
Unexplained thyroid lump
unexplained loose teeth or sockets that do not heal after extractions
unexplained, persistent numbness or an odd feeling on the lip or tongue
What are the different types of mouth cancers?
Squamous cell carcinoma - most common (9/10 cases)
Adenocarcinoma (inside salivary gland)
Sarcoma (bone, cartilage, muscle etc)
Oral maligannt melanoma
Lymphoma
How does oral maligannt melanoma present?
These appear as very dark, mottled swellings that often bleed
What monoclonal antibody is used to treat squamous cell carcinomas of the head and neck?
Cetuximab - targets epidermal growth factor receptor, blocking the activation of this receptor and inhibiting the growth and metastasis of the tumour
