Lecture 7- Lumps and swellings of the oral cavity and lips

Question 1

What is this? What causes it?

Answer 1

Angiodema- commonly caused by ace inhibitors

Question 2

WHAT IS THIS?

Answer 2

Alergic cheltitis

Question 3

What is this condition?

Answer 3

Erythema multiforme

Question 4

What is OROFACIAL GRANULOMATOSIS? (OFG)

Answer 4

Chronic or recurrent swelling of the orofacial tissues with no evidence of gastrointestinal involvement. Can get mucosal tags Lip swelling Fissuring PERIVERMILLION ERYTHEMA Histopath shows non caseating granulomateous infammation Exclude the presence of fungi and mycobacteria swell as foreign material.

Question 5

what are the differential diagnoses of OFG?

Answer 5

Oral Crohn’s MelkerssonRosenthalSyndrome(Orofacialswelling, fissured tongue, facial palsy) Sarcoidosis •Allergic causes eg. angioedema

Question 6

Investigations of OFG?

Answer 6

orofacial signs may precede intestinal disease in 60% of cases exclude other diagnosis e.g sarcoidosis Biopsy and microscopic investigation OFG can be caused by allergy so may do allergy testing

Question 7

How to manage OFG?

Answer 7

Topical and systemically.

Topical -intralesional steroids-(Triamcinolone Acetonide) - Topical steroids(Adcortyl in Orabase)

• Topical immunosuppresants (Protopic)

Systemic-

Steroids

• Antimicrobials (Dapsone)
• immunosuppressants (Azathiaprine)

Question 8

How do you distinguish between crohns and OFG

Answer 8

Chrones has gut involvement but otherwise the facial symptoms are the same,

Question 9

What oral symptoms are their of crohn’s?

Answer 9

Staghorning,

recurrent apthous ulcerations,

PYOSTOMATOTIS VEGETANS( specific marker for IBD)

Question 10

What features does crohn’s show down the microscope?

Answer 10

Ulceration

Submucosal oedema and lymphangiectasia

Focal and diffuse lymphoid infiltration

Non-caseating epithelioid granulomas

Granulomatous lymphangiitis

Question 11

How do you manage Crohn’s?

Answer 11

Management should be holistic.

Same topical and systemic considerations as OFG Anti TNF-alpha (infliximab)

Question 12

what is sarcoidosis?

Answer 12

it is a Chronic multisystem disorder of unknown origin non caseating epithelioid granulomas.

It effects Lungs, liver, spleen, lymph nodes, skin, eyes and bone

Question 13

What are the oral manifestations of sarcoidosis?

Answer 13

Lip swelling,

granular gingivitis tongue isn’t usually involved

Often involved the labial glands

Question 14

What are the investigations for sarcoidosis?

Answer 14

• Biopsy
• Chest radiograph - bilateral hilar lymphadenopathy - pulmonary fibrosis
• Blood and urinary calcium
• Serum angiotensin converting enzyme

Question 15

what can be the causes of localised intraoral swellings?

Answer 15

• Cystic • Neoplastic • Reactive • Inflammatory • Vascular • Developmental • Infective

Question 16

What is this?

Answer 16

Fibrous overgrowth it is reactive! Sessile or pedunculated • Chronic irritation - calculus, broken tooth, restoration, prosthesis • Denture granuloma, leaf fibroma • Gingiva (epulis)

Question 17

how does fibrous overgrowths look under the microscope?

Answer 17

• Bundles of interlacing fibrous tissue of variable cellularity
• Hyperplastic epithelium
• +/- ulceration (INSERT PICURE)

Question 18

What is an epulis

Answer 18

isolated swelling of the gingiva

Question 19

What types of Epulis are there?

Answer 19

• Fibrous
• Vascular - pyogenic granuloma - pregnancy epulis
• Giant cell - peripheral giant cell reparative granuloma
• Congenital
• Others

Question 20

What are the microscopic features of an Epulis

Answer 20

Bundles of interlacing fibrous tissue of variable cellularity

• Hyperplastic epithelium
• +/- ulceration
• Osseous metaplasia
• Dystrophic calcification

Question 21

What are the infective causes of lumps and swellings?

Answer 21

Periodontal abscess

Viral squamous cell papilloma (see photo)

Question 22

What are the cystic causes of swellings

Answer 22

Radicular cysts(most common, dervived from the epithlial rest of mallazes in PDL usually after pulp death)

Ranula

Question 23

Immunological causes of the swellings

Answer 23

OFG (Oral facial Granuloma)

Wegeners

Question 24

Congenital and heridetary causes?

Answer 24

Torus palitinus( non neoplastic growth, presents before 30, more common in females. Normal lammela bone, no treatment necessary)

Fibrous dysplasia (Fibro-osseous lesion. Replacement of normal bone by cellular fibrous tissue and islands of woven bone,Activating mutation GNAS I )

Question 25

Vascular causes of lumps and swellings?

Answer 25

• HEREDITARY HAEMORRHAGIC TELANGIECTASIA