Oral Cavity Flashcards
What causes oral candidiasis?
Candida albicans causes an opportunistic infection
Which conditions are required for candida albicans to cause an infection?
Oral cavity flora change
Immunocompromised
How does candida albicans present?
White plaques on oral mucosa that can be rubbed off with a painless, red base underneath
How do you treat candidiasis?
Miconazole or Nystatin (anti-fungals)
How do you identify leukoplakia and erythoplakia and how do you distinguish between them?
Raised, sharply defined edges
Cannot be rubbed off
Leuko = white patches
Erythro = red patches
What is the significance of leuko- and erythroplakia?
They are pre-malignant
Which, between leukoplakia and erythroplakia, is at higher risk of malignancy?
Erythroplakia
How do you investigate leuko- and erythroplakia?
Biopsy
What is the management plan for leukoplakia and erythroplakia?
Frequent clinical exam with photographic records
> 90% of oral tumours have which histological cell type?
Squamous cell carcinomas
What are oral SCCs?
Invasive oral cancers that end to have granular or smooth texture
What is the macroscopic appearance of oral SCCs?
20% have elevation of approx. 1 mm
Majority have no ulceration/bleeding and aren’t indurated (hardened)
What are causes/risk factors of oral SCCs?
Tobacco Alcohol Diet and nutrition HPV (risk increase with number of sexual partners and age) UV-Light Candida
Where are high risk sites for oral tumours?
(soft non-keratinising site) Ventral of tongue Floor of mouth Lateral tongue Soft palate Retro-molar pad Tonsillar pillars
Where are rare sites of oral tumours?
Hard palate
Dorsum of tongue
What are potentially malignant lesions of the mouth?
Erythroplakia Erythroleukoplakia Leukoplakia Erosive lichens planus Submucous fibrosis Dyskeratosis congenita
Histopathologically, oral SCCs show considerable variation but are cytologically _________________ and all show ______?
Malignant squamous epithelium
invasion and destruction of local tissue
How do oral tumours present?
Red, white (or both) lesions
Ulcer
Numb feeling
Unexplained pain in mouth or neck (late-stage cancer or benign ulcer)
Change in voice
Dysphagia
Drooping eyelid or facial palsy, fracture of mandible, double vision, blocked or bleeding nose/fascial swelling
What are investigations for oral tumours?
Refer for biopsy
How do you treat oral tumours?
Radiotherapy
Chemotherapy
Surgical resection
The majority of salivary gland tumours are?
Pleomorphic adenomas
What are pleomorphic adenomas?
Benign tumours of glandular tissue
Is a tumour more likely to be malignant if its in a small or large salivary gland?
Small
What are the risk factors for salivary gland tumours?
Smoking
Radiation exposure
Hx of previous cancer
How do salivary gland tumours present?
Facial nerve weakness Facial lump Ulceration of overlying skin Paraesthesia or anaesthesia of the skin Pain
How do you investigate salivary gland tumours?
Refer for USS +/- FNA
FNA gives you the _____ of the tumour
cytology
Biopsy gives you the _______ of the tumour
Architecture
How do you treat salivary gland tumours?
Local ablation
Radiotherapy
Surgical resection
How do you treat salivary gland tumours?
Local ablation
Radiotherapy
Surgical resection
Where do salivary gland stones form?
Typically in the major salivary glands and block associated ducts
How do salivary gland stones present?
Colicky post-prandial pain
Swelling
How do you investigate Salivary gland stones?
USS
How do you treat salivary gland stones?
Oral analgesics Abx if infection Good hydration Massage Endoscopic or surgical removal
Where are lichen planus found?
Oral mucosa Skin Scalp Nails Genitals Oesophagus
What causes lichens planus?
Unknown - potential link to ACEI treatment
What is the danger of lichen planus?
Potentially malignant
What are macroscopic features of lichen plans?
+/- erosive
+/- ulceration
What is angular chelitis?
Cracking at the corner of the mouth
Bleeding when mouth open
What are causes of angular chelitis?
Anaemia or haematinimic deficiencies
Often related to bacteria like Staph aureus
What is aphthous stomatitis?
Mouth ulcers
Oval
Yellow base + red periphery
Aphthous stomatitis can persist up to?
4 weeks
What are herpetiform?
Yellow base + red periphery
How many herpetiform ulcers are usually found?
Hundreds
Herpetiform ulcers can be caused by?
Anaemia
Vitamin B12
Coeliac’s Disease
Folic Acid
What is hairy leukoplakia?
Shaggy white patch on the side of the tongue seen in HIV
Caused by EBV
What are causes of aphthous ulcers?
Crohns and coeliac’s disease
Infections
What are therapy options for minor aphthous ulcers?
Avoid oral trauma and acidic foods or drinks
Tetracylcine or antimicrobial mouthwashes
How do you treat severe aphthous ulcers?
Prednisolone or thalidomide
