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EAR, NOSE AND THROAT > DISORDERS OF THE ORAL CAVITY > Flashcards

DISORDERS OF THE ORAL CAVITY Flashcards

1
Q

What are the different types of jaw cysts?

A 
Odontogenic cysts - derived from dental structures - include:
Radicular cysts
Dentigerous or follicular cysts
Eruption cysts
Odontogenic keratocysts

Fissural cysts include:
Nasopalantine duct cysts
Nasolabial cyst/globulomaxillary cyst

Bone cyst

Ameloblastoma

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2
Q

What is the most common type of jaw cyst?

A

Radicular cysts

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3
Q

Where are radicular cysts of the jaw formed?

A

At the root apex of non-vital teeth

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4
Q

How do you treat radicular cysts of the jaw?

A

Often root canal surgery is needed to remove the dead necrosing pulp of the tooth. This allows the cyst to heal.

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5
Q

Where are most odontogenic keratocysts found?

A

Posterior ramus of the mandible. It may be large enough to compress the alveolar nerve causing anaesthesia of the chin.

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6
Q

How do you treat odontogenic keraotcysts?

A

Surgical removal. Important to note that recurrence is high.

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7
Q

Who do fissural cysts of the jaw tend to occur in?

A

Children. Most often presents as an infected cystic lesion.

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8
Q

What is an ameloblastoma?

A

Rare benign tumour of the ondogenic epithelium.

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9
Q

Where do ameloblastomas most commonly occur?

A

Usually a multilocular lesion at the angle of the mandible. Seen in the maxilla as well though.

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10
Q

What are the clinical features of an ameloblastoma?

A 
Painless swelling
Facial deformity if severe enough
Pain if the swelling impinges on other structures
Loose teeth
Ulcers
Periodontal (gum) disease
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11
Q

What are the radiological findings of ameloblastoma?

A

‘Soap bubble’ radiolucency

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12
Q

How do you treat an ameloblastoma?

A

Surgical removal of the tumour along with the teeth involved. Block resection of involved bone with margin of healthy tissue is advocated by some.

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13
Q

What are the infective causes of mouth ulcers?

A

Viral - herpes simplex, coxsackie virus

Bacterial - TB, syphilis

Fungal - candida

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14
Q

What are the systemic inflammatory diseases associated with mouth ulcers?

A

Behcet’s syndrome
Crohn’s disease
Coeliac disease and dermatitis herpetiformis

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15
Q

What are the vesiculobullous disorders associated with mouth ulcers?

A

Pemphigus

Pemphigoid

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16
Q

What are the two causes of mouth ulcers associated with malignancy?

A

Squamous cell carcinoma

Neutropenia

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17
Q

What is the virus most commonly associated with oral disease?

A

Herpes simplex type 1

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18
Q

What are the two main forms of oral disease associated with herpes simplex virus?

A

Herpetic gingivostomatitis - primary infection

Recurrent herpes simplex infection - virus lies dormant for several years

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19
Q

What are clinical features of herpetic gingivostomatitis?

A

Mouth ulcers affecting most of the gum and mouth

Odynophagia (pain on swallowing), which may lead to drooling

Fever

More often seen in children

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20
Q

How do you treat herpetic gingivostomatitis?

A

You tend not to need to. It is usually self-limiting within 10 days

21
Q

Where can herpes simpex type 1 lie dormant after herpetic gingivostomatitis?

A

Trigeminal root ganglion

22
Q

What can spark reactivation of herpes simplex type 1 infection in the mouth after years of dormancy, to produce vesicle formation and the familiar cold sore often found in the lips?

A

Sunlight

Stress

Intercurrent illness

23
Q

What do we call cold sores caused by reactivation of herpes simplex virus?

A

Herpes labialis

24
Q

How do we treat herpes labialis?

A

Topical aciclovir

25
Q

What are vesiculo-bullous disorders?

A

Rare conditions where there is a loss of normal cell to cell adhesion as a result of autoimmune destruction, which results in blister formation and loss of epithelium leaving ulceration of mucosal surfaces.

26
Q

What are the clinical differences between bullous pemphigoid and pemphigus vulgaris?

A

Bullous pemphigoid:
May present with itchy eczematous or urticarial rash prior to blistering.
Crops of tense blisters, filled with clear or blood-stained fluid. Lesions heal without scarring.
Localised or widespread.
Mucosal ulceration in 10- 25 per cent of cases.

Pemphigus vulgaris:
Usually first presents with ulceration of mucous membranes.
Flaccid blisters develop in the skin. These quickly rupture leaving painful erosions.

27
Q

What are the autoantibodies directed towards in pemphigus vulgaris?

A

Desmogleins, protein that sticks cells together

28
Q

What are the autoantibodies directed towards in bullous pemphigoid?

A

Mucosal basement membrane

29
Q

What technique is used to visualise autoantibodies such as at anti-desmogleins found in pemphigus vulgaris patients?

A

Immunofluorescence

30
Q

How do you manage patients with pemphigus vulgaris or bullous pemphigoid?

A

Steroids and immunosuppressants

31
Q

What is the surprisingly common cancer of the mouth?

A

Oral squamous cell carcinoma

Did you know more people die in the UK of oral squamous cell carcinoma than of cervical cancer, yet it attracts relatively little publicity.

32
Q

What are the clinical features of oral cancer?

A

Initially painless ulcer
May present as crater-like ulcer, white patch (leukoplakia) or a red area (erythroplakia)
Local invasion and destruction can lead to nerve damage

33
Q

What is the most common site for oral cancers?

A

Floor of the mouth
Tongue
Retromolar area
Tonsillar area

34
Q

How would you investigate someone who presents with an oral ulcer that has lasted more than 2 weeks?

A

Biopsy
Orthopantomogram (OPG) may reveal bony erosion or invasion
CT scan would help work out if cancer had spread to neck lymph nodes

35
Q

What is the 5 year survival rate of patients with oral cancer with lymph node metastasis?

A

40%

36
Q

What are the differential diagnoses for someone who presents with white patches in the mouth (leukoplakia)?

A

Congenital - sponge naevus

Infective - candidiasis, hairy leukoplakia

Immune - Lichen planus, discoid lupus erythematosus

Idiopathic

Squamous cell carcinoma

37
Q

Who is more likely to develop candidal infection (thrush) in the mouth?

A

Neonates
Immunocompromised
Those taking broad spectrum antibiotics

38
Q

What are the clinical features of oral candida infection?

A

Cream coloured plaques of fungi that can be wiped off the mucosa to leave an erythematous, sometimes bleeding, base.

39
Q

How do you treat oral candida infection?

A

Topical antifungals such as:

Nystatin
Miconazole

40
Q

What is hairy leukoplakia?

A

A condition that is characterised by irregular white patches on the side of the tongue and occasionally elsewhere on the tongue or in the mouth, caused by EBV. Strongly associated with HIV and can be the first sign of immunosuppression.

41
Q

What is the most commonly seen skin disease in the ora cavity?

A

Lichen planus - immune mediated chronic inflammatory disorder. Cause is however unknown.

42
Q

What are the classic clinical features of Lichen planus?

A

Reticulate or striate leukoplakia affecting the buccal mucosa
Erosive forms will produce large areas of ulceration, which are painful especially when exposed to spicy foods.
Associated skin lesions (itchy violaceous plaques) found on flexor surfaces of forearms and shins, and also on genitals can occur.

43
Q

How do you treat Lichen planus?

A

Most patients will not requires treatment. In erosive forms it is important to rule out more sinister diagnosis such as SCC and topical steroids may be used for symptomatic relief.

44
Q

What are the two forms of gingivitis based on severity?

A

Simple gingivitis

Acute necrotizing ulcerative gingivitis

45
Q

What is the main cause of gingivitis?

A

Poor oral hygiene

46
Q

What are the clinical features of simple gingivitis?

A

Painless, red swelling of the gum margin

Bleeds on contact such as brushing teeth

47
Q

What are the clinical features of necrotizing ulcerative gingivitis?

A

Painful bleeding gums

Halitosis

Punched-out ulcers on the gums

48
Q

How do we manage a patient with acute necrotizing ulcerative gingivitis?

A

Refer the patient to a dentist, meanwhile the following is recommended:

  • Oral metronidazole for 3 days
  • Chlorhexidine (0.12% or 0.2%) or hydrogen peroxide 6% mouth wash
  • Simple analgesia

EAR, NOSE AND THROAT (8 decks)

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