Oral cavity Flashcards

1
Q

what are the two parts of the OC

A

vestibule (region between the lips and teeth)
OC proper (bounded by the teeth anteriorly, cheeks laterally and pillar of fornices posteriorly)

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2
Q

what does the OC contain

A

ant 2/3 of tongue (moveable part): circumvallate papillae
sulcus terminalis
buccal mucosa: lining sitting infront of the pillar of fornices
floor of mouth
retromolar trigone - sitting behind molars

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3
Q

what is the sulcus terminalis

A

it is the border between the anterior and posterior part of the tongue

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4
Q

what does the roof of mouth contain

A

hard palate
palatine bones and maxilla
rigid
soft palate comprised of muscle, anchored by the palatoglossal and palatopharyngeal arches

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5
Q

what are the core muscles

A

obicularis oris
buccinator
work together to keep food between the teeth, when we chew forms the vestibule

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6
Q

what is the role of the tongue

A

helps with sound formation, manipulation of air

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7
Q

what does the intrinsic muscles of the tongue do

A

changes shape, not anchored

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8
Q

what does the extrinsic muscles do

A

alters tongue position
attachment muscles attach adjacent bony structures

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9
Q

what happens via mechanical processing

A

manipulation of food

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10
Q

sensory analysis

A

taste: papillae on surface, senses temperature, secrete lingual lipase

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11
Q

what is frenulum lingae

A

extension of tissue at the bottom, is the opening for sublingual salivary glands

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12
Q

epidemiology

A

increases with age
x2 common in males
50+
south asian and chinese population

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13
Q

aetiology

A

smoking x3
alcohol x6
betel quid chewing
leukoplakia: pre cancerous plaques which can progress to cancer
poor dental health + poorly fitted dentures
syphilis

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14
Q

what can impact teeth

A

necrosis, teeth might need to be removed before RT

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15
Q

what is the common type of cancer

A

SCC [90%] = well differentiated

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16
Q

what are the other types of cancer

A

adenocarcinomas [salivary glands]
malignant mixed [minor SG]
lymphomas

17
Q

what does HPV do to the prognosis

A

greater prognosis, linked with the OC, oropharynx, nasopharynx
better response to chemo and RT

18
Q

what is the presentation symptoms

A

persistent deep ulcers
infections = halitosis
leukoplakia
interference with swallowing, chewing, might impair on speech
pain radiating from ear
asymptomatic

19
Q

what are the investigations

A

full medical history
clinical exam
indirect laryngoscopy: check opening and closing of vocal chords
haematological = rule out infection if enlarged LN
biopsy = primary and potential leukoplasia + enlarged LN, identifies differentiation
FNA
EUA [depth of invasion and extent]
dental assessment

20
Q

nodal involvement

A

2 CTVs
+ nodes: primary dose
SIB = 54Gy in 30

21
Q

what are the types of spread

A

direct
lymphatic
haematological [late stage: liver, lung, bone]

22
Q

direct spread:

A

early
into adjacent tissues
invasion through bony structures

23
Q

lymphatic spread

A

first involvement depends on the subsite
crosses midline - bilateral involvement is common
rich blood supply

24
Q

what is the treatment given dependent on

A

location and PS

25
Q

what approach is given to T3/T4

A

multimodality

26
Q

what can cis-platin cause

A

tinnitus, peripheral neuropathy, renal toxicity

27
Q

what is brachy used for

A

small superifical lesions, which have excellent conformity

28
Q

describe the brachy process

A

implants last 4-6 days
swelling can occur during insertion, cant occlude airway, steroids and analgesia

29
Q

what implants can be given

A

hair pin implant: anterior tongue or floor of mouth tumours
single plane implant; small buccal mucosa lesions

30
Q

what does is given during brachy

A

65-70Gy

31
Q

describe one sided lesion treatment

A

primary + icm margin + 1st echleon (level I nodes + potentially II+III)
electively irradiate the whole jugular chain
wedge effect created by the movement of the jaws and MLC’s in parallel
anterior lateral wedged pair [spares parotid]
OAR: parotid, eye, cord
60Gy in 30 + 54Gy in 30
tongue = 50Gy in 25

32
Q

describe midline treatment

A

IMRT: delivers beamlets
5 equally spaced beams
CTV 1 = bilat node I,II + involved nodes
CTV 2 = all uninvolved nodes I-IV + V on ipsilateral side
risk of bilateral spread

33
Q

how is NG inserted

A

using contrast to highlight the stomach lining

34
Q

SE

A

mucositis: deep ulcers, inflammation, reduction in food [mouthwashes, good oral hygiene, pain relief, nebuliser]
loss of taste
dysphagia
oral canditasis: topical dressings
xerostomia [artificial saliva, orange sticks, increase fluid intake]

high fluoride toothpaste, avoid metal cutlery