GI Goljan oral cavity, salivary disorders Flashcards by Hunter Garrett

What is the most common congenital disorder of oral cavity?

cleft lip and palate (50%);
cleft lip alone (25%)
cleft palate alone (25%)

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Who is cleft lip and palate most common in?

whites > blacks;
lip alone- male > female
palate alone- female > male

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Genetics involved in cleft lip and palate?

recurrence in subsequent siblings (3%)

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complications of cleft lip and palate?

malocclusion;
eustachian tube dysfunction => chronic otits media
speech problems

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pathogenesis of cleft lip and palate?

failure of fusion of facial processes

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Tx for cleft lip and palate?

surgery

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What 4 oral manifestations of HIV are found?

candidiasis;
apthous ulcers (stomatitis, canker sores);
hairy leukoplakia;
kaposi’s sarcoma

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what is the most common oral infection associated w/ HIV?

candidiasis

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what is the origin of apthous ulcers?

unknown but virus vs immunologic and often

STRESS INDUCED

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define apthous ulcers

painful ulcers covered by shaggy gray membrane

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define hairy leukoplakia

glossitis due to EBV

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What is kaposi’s sarcoma caused by? where is the most common location?

HHV-8;

location: hard palate

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what is the causative agent of dental caries? how does it lead to dental caries?

streptococcus mutans produces sucrose fermentation => acid erodes enamel to expose underlying dentine

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What aids in prevention of dental caries? what happens if there is too much of this substance?

fluoride;

chalky discoloration of teeth

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what are 4 noninfectious ulcerations in oral cavity?

pemphigus vulgaris & mucus membrane pemphigoid => immunologic
erythema multiforme;
apthous ulcers
Behcets syndrome

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What will cause erythema multiforme?

HSR against Mycoplasma or drugs (sulfonamides);

Stevens-Johnson syndrome when it involves the mouth

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Epidemiology of Behcet’s syndrome

environmental and genetic factors;
HLA-B51, HLA-B27;
precipitated by HSV or parvovirus;
high incidence in Turkey and east mediterranean

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pathophys of Behcet’s syndrome

immune complex small vessel vasculitis

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clinical findings of Behcet’s syndrome

recurrent apthous ulcers, genital ulcerations;
uveitis, erythema nodosum;
attacks last 1-4 wks

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Tx of Behcet’s syndrome

anti-inflam Rx;
corticosteroids;
colchicine;
thalidomide

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3 oral pigmentation abnormalities

Peutz-Jeghers syndrome;
Addison’s disease;
Lead poisoning

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How does Peutz Jeghers syndrome present?

Melanin pigmentation of lips and oral mucosa

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Where does addison’s disease present in the mouth? What causes it?

melanin pigmentation of buccal mucosa => increased ACTH stimulates melanocytes

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A person suffering from lead poisoning will present where?

lead deposits along gingival margins in adults w/ gingivitis

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What can cause tooth discoloration?

tetracycline; excess fluoride congenital erythropoietic porphyria

Who is tetracycline not recommended for? why?

children under 12 due to coloring of newly formed teeth

How does congenital erythropoietic porphyria present?

porphyrins deposit in teeth => reddish brown discoloration

What are 5 possible causes of macroglossia (enlarged tongue)?

``` myxedema (severe 1' hypothyroidism); down syndrome; acromegaly; amyloidosis; mucosal neuromas in MEN IIb ```

define glossitis (inflammation of tongue)

sore, beefy red tongue w/ or w/o papillary atrophy

What are the 6 causes of glossitis?

``` long standing Fe deficiency; Vit B12 or folate deficiency; scurvy (vit C deficiency); pellagra (niacin deficiency); scarlet fever; EBV assoc hairy leukoplakia ```

What is leukoplakia? rate to oral cancer?

white patch; | 30% rate of progression to oral cancer

what is erythroplakia? rate of oral cancer?

red patch; | 60% rate of progression to oral cancer

Leukoplakia and erythroplakia are due to what? risk for cancer?

lesions due to squamous hyperplasia of epidermis; | increased risk for squamous dysplasia or invasive squamous cancer

What are 4 causes of leukoplakia and erythroplakia?

chronic irritation (dentures); all forms of tobacco use; alcohol abuse; HPV

what are the 4 locations of leukoplakia and erythroplakia? give most common

vermilion border lower lip (most common site); buccal mucosa; hard and soft palates; floor of mouth

what should be done if leukoplakia and/or erythroplakia is suspected?

always biopsy bc of high risk for progression to oral cancer

Define lichen planus of oral cavity and what it is associated w/

fine, white, lacy lesions assoc w/ Wickham's stria on buccal mucosa; may be assoc w/ squamous cell carcinoma

what does dentigerous cyst derive from?

epithelial elements of dental origin => odontogenic origin

What 2 associations are found in dentigerous cyst?

crown of an unerupted or impacted 3rd molar tooth ameloblastomas in 15-30% of cases

What are 2 benign tumors of oral cavity excluding salivary gland?

squamous papillomas; | ameloblastoma

What are 2 benign tumors of oral cavity excluding salivary gland?

squamous papillomas; | ameloblastoma

What is the most common benign tumor of oral cavity?

squamous papillomas

What is the most common benign tumor of oral cavity?

squamous papillomas

what is an exophytic tumor w/ fibrovascular core?

squamous papillomas

what is an exophytic tumor w/ fibrovascular core?

squamous papillomas

Where does squamous papillomas occur?

tongue, gingiva, palate or lips

Where does squamous papillomas occur?

tongue, gingiva, palate or lips

where does ameloblastoma arise from?

enamel organ epithelium or dentigerous cyst

where does ameloblastoma arise from?

enamel organ epithelium or dentigerous cyst

Where is the ameloblastoma located? how does it present?

mandible; radiolucency in bone w/ "soap bubble" appearance; locally invasive but do NOT metastasize

Where is the ameloblastoma located? how does it present?

mandible; radiolucency in bone w/ "soap bubble" appearance; locally invasive but do NOT metastasize

What are the 6 risk factors for malignant tumors of oral cavity? most common factor

smoking (most common-pipe, cigarettes, chew); alcohol abuse (synergistic w/ smoking); synergism bw smoke & alcohol excess increase 30x; HPV; chronic irritation from dentures; lichen planus

What are 4 salivary gland disorders?

Sjogren's syndrome; pleomorphic adenoma; Warthin's tumor; Mucoepidermoid carcinoma

who is malignant tumor of oral cavity most common?

well-differentiated squamous cell carcinoma; | men > women

who is malignant tumor of oral cavity most common?

well-differentiated squamous cell carcinoma; | men > women

What are the 3 most common malignant tumor sites of oral cavity?

1) lower lip (vermilion border) 2) floor of mouth 3) lateral border of tongue

Where do malignant tumors of oral cavity metastasize?

tonsillar node => superior jugular node

What is a specific malignant tumor of oral cavity associated w/ smokeless tobacco?

verrucous carcinoma

what is most common cancer of upper lip? what is associated with?

basal cell carcinoma; | UVB exposure

Tx for squamous cancer of oral cavity?

surgery / radiation; | CTX in advanced cases

What are 4 salivary gland disorders?

Sjogren's syndrome; pleomorphic adenoma; Warthin's tumor; Mucoepidermoid carcinoma

define sjogren's syndrome

female dominant AI destruction of minor salivary and lacrimal glands

What AI disease is associated with Sjogren's syndrome?

rheumatoid arthritis

what is most common site of salivary gland tumor?

parotid gland

which salivary glands tumors are benign? malignant?

major salivary gland tumors => benign | minor salivary gland tumors => malignant

What is most common benign tumor of major and minor salivary glands? most common site?

pleomorphic adenoma; | parotid gland

define pleomorphic adenoma

female dominant; painless, moveable mass at angle of jaw

How does pleomorphic adenoma present on histology? what causes increase risk of recurrence?

epithelial cells intermixed w/ myxomatous & cartilaginous stroma; projections through capsule increase recurrence

What is a sign of malignancy of pleomorphic adenoma?

facial nerve involvement

What is a male dominant benign tumor of parotid gland?

Warthin's tumor => papillary cystadenoma lymphomatosum

define warthin's tumor

heterotopic salivary gland tissue trapped in lymph node => cystic glandular structures

Define mucoepidermoid carcinoma (location, epidemiology)

most common malignant salivary gland tumor; parotid gland; mixture of neoplastic squamous and mucus-secreting cells