midterm path Flashcards
1-fibroma
2-inflammatory fibrous hyperplasia—epulis fissuratum
3-gingival fibromatosis
1-tumor of oral cavity
reactive hyperplasia of CT
in buccal mucosa along bite line, in areas near trauma
surgical excision—recurrence not expected
2-tumor-like hyperplasia of fibrous CT bc of ill-fitting denture
- 75% in women
- in maxilla & mandible—in anterior region
- single/multiple fold of hyperplastic tissue on alveolus
- tx= surgical excision
3-enlargement begins before age 20 & correlates w/ teeth eruption
- growth more frequent in maxilla—localized or generalized
- gingivectomy & oral hygiene
1-drug related gingival hyperplasia
2-nasopharyngeal angiofibroma
3-fibrosarcoma
1-abnormal growth of tissue secondary to meds
- 1-3 mo enlargement orginate in dental papilla
- growth covers a portion of the crowns of several teeth
- degree of enlargement related to suceptibility & hygiene
- tx=discontinue drug/change hygiene
2-in adolescent males
nasal obstruction & epistaxis
locally destructive & aggressive
anterior bowing of posterior wall of max sinus
tx= surgical excision
3-cats & dogs!!!
- 10% occur in head/neck
- surgical excision 40-70% survival
1-benign fibrous histiocytoma
2-malignant fibrous histiocytoma
3-lipoma
4-liposarcoma
5-lymphangioma
1-in skin of extremities (dermatofibroma)
-oral lesions= buccal mucosa & vestibule
tx= surgical excision
2-expanding mass—painful/ulcerated
exision= 40%—survival rates worse for lesions
3-on trunk & extremities
-50% in buccal mucosa & buccal vestibule
-yellow/pink, painless sessile nodules
tx=excision
4-malig tumor of fat—20% sarcomas—neck, tongue & cheek
tx= radical surgical excision
5-50-75% in head/neck
-cystic hygroma
-oral lesions—in anterior 2/3 of tongue= macroglossia
tx= surgical excision
1-angiosarcoma
2-traumatic neuroma
3-granular cell tumor
1-50% in head & neck (scalp/forehead)
-early lesions resemble bruise
tx-surgical excision
2-in middle aged adults—more common in females
-smooth surface, non ulcerated nodule
-history of trauma
-pain in 25% of cases, in area of mental nerve
-abundant nerve tissue & collagen in haphazard arrangement
tx- surgical excision
3-2:1 female —4th-6th decades
asymptomatic pink/yellow sessile nodule
-in dorsal tongue
-large polygonal cells w/ abundant granular cytoplasm
-tx= surgical excision
1-schwannoma-neurilemmoma
2-neurofibroma
3-neurofibromatosis
4-malig. peripheral nerve sheath tumor
1-50% head/neck-tongue most common intra-oral location
- slow growing solitary encapsulated
- tx= excision
2-slow growing, soft, painless lesion varying in size
tx= excision
3-von recklinghausens
50% of cases are new mutations
multiple neurofibromas
cafe au lait macules
crowe’s sign (axillary freckling)
lisch nodules (pigmented spots on iris)
tx= prevention/management
4-50% develop in context of NF
10-15% in head neck—oral= mandible, lips, buccal mucosa
tx= chemo/radio
1-leiomyoma
2-leiomyosarcoma
3-rhabdomyoma
4-rhabdomyosarma
5-conc
1-most commonly in uterus
80% of oral leimyomas seen in palate, cheek, tongue & lips
-pink/bluish, firm, slow growing mucosal nodule
tx= excision
2-tx= excision, radio or chemo
3-adult= 70% men---middleaged: pharynx, larynx, mouth fetal= male, young kids, face & periauricular
4-60% of all kid sarcomas—in first decade of life
- head & neck most common site
- orbit is common location—sudden & rapidly progressive proptosis
- tx= excision
5-mesenchymal tissues can give rise to lesions
benign & malig
biopsy achieve final diagnosis
surgical excision required
1-traumatic ulcer
1a-riga-fede disease
2-aphthous ulcer
4-minor aphthous ulcerations—mikulicz aphthae
4- major aphthous ulcerations—suttons disease
5-herpetiform aphtous ulceration
1-lesion caused by mechanical trauma: lip, tongue, cheek
acute= painful, yellow base, red halo, hx of trauma
chronic= elevated margins, delayed healing, like oral cancer
1a-ulcer on tongue of neonates bc of trauma from erupting teeth
tx- remove source of irritation—if a single ulcer shows no signs of healing 15 days after putative cause removed= malignant
2-t-cell mediated immuno reaction, affects 20% of pop
-presence of highly antigenic reagent, dec mucosal barrier, & abnormal response to common antigen
3-80% of cases
1-5 lesions—between 3-10 mm…heals in 1-2 wks
4-10% of cases
1-10 lesions—between 1-3 cm…heals in up to 6 wks
5-10% of cases—10-100 lesions—between 1-3 mm heal in 7-10 days
tx= corticosteroids
1-erythema multiforme
1a-stevens johnson syndrome (EM major)
3-toxic epidermal necrolysis (lyells disease)
4-contact allergy—stomatitis venenata
5-drug reaction—stomatitis medicamentosa
1-blistering, ulcerative mucocutaneous disorder
- 50% cases w/ either herpes or pneumonia
- acute= wide spec of severity (oral lesions—>skin)
- target=concentric circular rings resembling target or bulls eye
- large shallow, irregular erosions & ulcerations which emerge quickly
- hemorrhagic crusting of vermillion zone of lips
2-oral, skin, ocular/genital lesions
3-diffuse sloughing of skin
tx= corticosteroids
4-wide array of substances w/ oral cavity
- presents from erythmatous to white to ulcerative
- tx= removal of agent
5-most commonly seen in skin—in oral cavity
1-crohns disease
2-wegeners granulomatosis (granulomatosis w/ polyanglitis)
3-tuberculosis
1-inflamm disease that may affect any part of digestive tract
-teenagers w/ 2nd peak at 60s
-GI issues
weight loss & malnutrition
wide range of lesions
precede GI lesions in 30%
-non caseating, chronic granulomatous inflamm
tx= crorticoids, suppressors, antibiotics
2-granulomatous lesions of upper aerodistive tract
necrotizing glomerulonephritis
systemic vasculitis of small arteries & veins
tx= cyclophosphamide
3-mycobacterium tuberculosis
HIV inc risk
poverty & crowding
alcoholism & malnutrition
from person to person via salivary air droplets
-chronic painless ulcer, bc of 2ndary infection
-tx= multiagent
1-hensens disease (leprosy)
2-tuberculoid
3-lepromatous
1-mycobacterium leprae
initial infection in asal & oropharyngeal mucosa
-brazil, india, indo, etc
2-strong immune response
localized disease
hipopigmented macules
neural involvement
-well formed granulomas w/ macrophages etc
3-weak immune response
multiple lesions
macules, papules, nodules
neural involvement
-no granulomas w/ lots of bacteria w/in macrophages
1-syphilis
2-congenital syphilis
3-gonorrhea
4-histoplasmosis
5-conc
1-treponema pallidum
-sexual relations, blood transfusion, & vertical transmission
primary= chancre at intitial site, single lesion at genitalia, upper/lower lip
secondary= maculopapular rash, mucous patches, & condyloma lata
tertiary= gumma, neurosyphilis w. cardiovascular issues
2-hutchinsons triad—teeth, keratitis & 8 nerve deafness
3-caued by neisseria gonorrhoeae
2nd most common bacterial infection
more common in females
in oropharynx
may show necrosis or hemorrhage
tx= fluroquinolones
4-dimorphic: hyphae—>yeast
-grows in humid areas w/ soil enriched by bird/bad excrement
-endemic in fertile river valley—ohio & mississippi
-solitary, variable painful ulceration= malig in tongue, palate & cheek
tx= on severity & host status
5-oral ulcers caused by various reasons
trauma, infections & immuno issues
manifestation of systemic
biopsy may be needed
1-leukoplakia
2-erythroplakia
1-white patch
-represents 85% of all premalig lesions
-33% cancers have leukoplakia
-80% are smokes—-may resolve after cessation
-alc synergistic w/ tobacco
-alc= grayish plaques not like leukoplakia
more in old males
-70% in lip vermillion, buccal mucosa & gingiva but those in tongue & floor are dysplastic/malig
-progressive growth—eventually becomes cancer
-more common—lower malig potential
2-red patch
- first in male genitalia—same risk factors as oral cancer
- less common—greater malig potential
- well demarcated macule/plaque w/ velvety texture
- in floor of mouth, tongue, & palate
1-smokeless tobacco keratosis
2-oral submucous fibrosis
3-actinic cheilitis
1-uually in vestible
- caries, gingival recession & halitossis
- thin gray white plaques w/ undefined borders
- lesions get thicker & appear leathery or nodular
- tx= habit removal in 98% of cases
2-in indian subcontinent, SE asia, taiwan etc
- associated w/ paan
- trismus= complaint
- betel chewers mucosa= brown/red incrustations (not precancerous)
- common in buccal mucosa & retromolar pad
- pallor & fibrosis of soft palate—marble like pallor
- tx= doesnt regress w/ cessation, surgery can improve fibrosis
3-long term exposure of UV
fair skin—tendency to burn
more in males—older patients
-slow development—atrophy of vermillion
-smooth surface & pale
blurring of vermillion
-rough/scale…leukoplakia
-6% malig transformation potential
-tx= changes are reversible—lip balms to prevent damage
1-squamous cell carcinoma
2-conc
1-80% patients are smokers
- inc risk
- risk of 2ndary carcinoma
- 30% patients are drinkers
- 20% cirrhosis
- 15x risk
- UV damage
- outdoor occupation
- 90& lower lip & metastases
- HPC= oropharyngeal cancer role in cancer
- –if single ulcer shows no signs of healing 15 d after putative cause is removed= malig
- –invasion of epi into underlying CT
2-cancer is often preceded by premalig lesions
- careful exam needed for diagnosis
- oral cancer mortality have remained steady
- dentists have a critical role in improving rates
