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m4 ENT > Oral Cavity Conditions > Flashcards

Oral Cavity Conditions Flashcards

1
Q

Leukoplakia

A
  • White patch in mouth that CANNOT be scraped off
  • Hyperkeratosis of oral mucosa a/w local irritation
    -> Ill-fitting dentures
    -> Smoking
    -> Alcohol
    -> Eating strong spices
    -> Bad dentition
  • Overall risk of malignancy: 6%
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2
Q

Variants of leukoplakia

A
  1. Erythroplakia
    - Red patches in mouth
    - Greater malignant potential
  2. Oral hairy leukoplakia
    - EBV related
    - White patches (exophytic-looking) on lateral border of tongue
    - A/w HIV and immunosuppression
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3
Q

Investigations for leukoplakia

A

Biopsy*
- May choose to tx with trial of antifungals for 2 weeks first
- 1-20% risk of malignancy
- 3% undergo malignant change in 5 years, more so in erythroplakia

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4
Q

Management for leukoplakia

A
  • Regular review even if initial biopsy benign
  • Laser ablation*
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5
Q

Lichen planus

A

T cell mediated inflammation (autoimmune) that can affect skin and oral cavity

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6
Q

Clinical features of lichen planus

A
  • Variable lesions but may mimic hyperkeratosis
  • White lace-like appearance
  • Waxing or waning nature
  • Painless
  • Benign but has pre-malignant risk of 1-5%*

‘Lacy, reticulated pattern’

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7
Q

Management of lichen planus

A
  • Topical/systemic steroids
  • Immunosuppressants
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8
Q

Black hairy tongue

A
  • Overgrowth of filiform papillae
  • A/w smoking, poor oral hygiene, Abx use, C. albicans infx, xerostomia, LPR
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9
Q

Management of black hairy tongue

A
  • Vigorous brushing of tongue to scrape these away or use a special tongue cleaner
  • Resolves usually
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10
Q

Risk factors for squamous cell carcinoma of the mouth

A

6S factors
1. Smoking
2. Spirits
3. Sunlight
4. Sharp teeth (Chronic injury)
5. Sexually-acquired diseases (HPV, syphilis)
6. Spices
+ 7. Known leukoplakia/ erythroplakia (Premalignant conditions)

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11
Q

Most common oral cavity cancer

A

Squamous cell carcinoma

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12
Q

Most common site for oral cancer

A

Lateral border of tongue

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13
Q

Clinical features of SqCC

A
  • Non-healing ulcer (>2 weeks, enlarging)
  • Oral cavity mass
  • Bleeding
  • Otalgia (referred pain from pharyngeal plexus - posterior oropharynx)
  • Dysarthria
  • Difficulty chewing
  • Trismus
  • Change in denture fit (due to enlargement)
  • Neck lump (nodal spread)
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14
Q

Investigations for SqCC

A
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15
Q

Management for SqCC

A
  • Surgery +/- adjuvant chemo/RT
  • Mandible split (mandibulotomy) or mandibulectomy
  • Neck dissection
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16
Q

Aphthous Ulcers

A

Common ‘mouth ulcers’
- Can be a/w Behcet syndrome, IBD

17
Q

RFs for aphthous ulcers

A

Stress
Poor diet
Trauma
Poor oral hygiene
Hormonal changes

18
Q

Risk factors for candida albicans

A

Heavy smoking
Foreign bodies
Immunocompromised
Abx use
Inhaled steroids use

19
Q

Clinical features of candida

A
  • White specks coalesce to form patches or a membrane
  • When membrane is lifted, reveals a red, raw, bleeding mucosal surface
20
Q

Investigations for candida

A

Clinical Dx
Scrapings of lesion
- Microbiological examination
- Biopsy

21
Q

Management for candida

A

Topical antifungals
1st-line:
- Clotrimazole troches
- Miconazole mucoadhesive buccal tablets
- Nystatin swish and swallow
2nd-line:
- PO fluconazole

22
Q

Benign oral cavity lesions

A

Congenital
1. Vascular malformation (venous, lymphatic, hemangioma, AVM)

Acquired
1. Ranula
2. Mucus retention cyst/mucocele
3. Torus palatinus

Infective/Inflammatory
1. Apthous ulcer
2. Pyogenic granuloma
3. Fibroma
4. Lichen planus

Neoplastic
Benign
- Salivary tumours (Pleomorphic adenoma)
- Papilloma

(Malignant
- SCC
- Salivary tumours (Adenoid cystic CA)
- Sarcoma
- Lymphoma)

23
Q

Ranula

A
  • Mucus retention cyst that forms in the floor of mouth under tongue
  • Develops from sublingual gland ducts

“mucocele that arises from sublingual gland”

24
Q

Clinical features of ranula

A
  • Swelling may enlarge and reduce intermittently as contents discharge and then reaccumulate
  • Simple ranula is confined to oral cavity
  • May cause tongue to be lifted up and deviated frenulum
  • May develop into a plunging ranula which enlarges beyond floor of the mouth and usually along posterior border of mylohyoid
25
Q

Management of ranula

A

Complete excision of cyst and ipsilateral sublingual gland
Marsupialization of cyst

26
Q

Mucus retention cyst/Mucocele

A
  • Blockage of mucus glands
  • Precipitated by local trauma

Clinical features
- Smooth, plate, round swellings that fluctuate in size

Mx
- Excise if symptomatic or uncertain Dx

27
Q

Torus palatinus

A

Benign osteoma (exostoses) of hard palate

28
Q

Clinical features of torus palatinus

A
  • Bony hard growth in midline of hard palate
  • Overlying mucosa is normal, bony hard on palpation
  • Can also present in inner alveolar surface (‘Torus mandibularis’)
  • Surface may become ulcerated as a result of trauma from dentures –> May appear malignant
29
Q

Management of torus palatinus

A

Conservative
Removal only if symptomatic or interferes with dentures

30
Q

Oral cavity cancer examination

A

Palpate mass
1. Induration
2. Tongue mobility
3. Cervical lymph nodes

31
Q

Mucocele

A

Arises from minor salivary glands
Extravasation of saliva usually due to minor trauma
Tx: excision

32
Q

Papilloma

A

Firm, pedunculated mass with no deep extension
A/w HPV, most commonly 6 and 11
Tx: excision

33
Q

Pyogenic granuloma

A
  • Due to trauma or dental extraction
  • Commonly located on gingiva, lips, buccal mucosa, tongue
  • Seen commonly during pregnancy and may resolve after
  • Tx: excision
34
Q

Types of oral candidiasis

A

Pseudomembranous thrush vs erythematous

35
Q

What condition is associated with oral candida?

A

Median rhomboid glossitis
- Papillary atrophy of midline tongue (appears smooth)
- Likely due to candida infection
- Treat with anti-fungals

m4 ENT (25 decks)

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