Oral Cavity Conditions Flashcards
Leukoplakia
- 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%
Variants of leukoplakia
- Erythroplakia
- Red patches in mouth
- Greater malignant potential - Oral hairy leukoplakia
- EBV related
- White patches (exophytic-looking) on lateral border of tongue
- A/w HIV and immunosuppression
Investigations for leukoplakia
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
Management for leukoplakia
- Regular review even if initial biopsy benign
- Laser ablation*
Lichen planus
T cell mediated inflammation (autoimmune) that can affect skin and oral cavity
Clinical features of lichen planus
- 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’
Management of lichen planus
- Topical/systemic steroids
- Immunosuppressants
Black hairy tongue
- Overgrowth of filiform papillae
- A/w smoking, poor oral hygiene, Abx use, C. albicans infx, xerostomia, LPR
Management of black hairy tongue
- Vigorous brushing of tongue to scrape these away or use a special tongue cleaner
- Resolves usually
Risk factors for squamous cell carcinoma of the mouth
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)
Most common oral cavity cancer
Squamous cell carcinoma
Most common site for oral cancer
Lateral border of tongue
Clinical features of SqCC
- 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)
Investigations for SqCC
Management for SqCC
- Surgery +/- adjuvant chemo/RT
- Mandible split (mandibulotomy) or mandibulectomy
- Neck dissection
Aphthous Ulcers
Common ‘mouth ulcers’
- Can be a/w Behcet syndrome, IBD
RFs for aphthous ulcers
Stress
Poor diet
Trauma
Poor oral hygiene
Hormonal changes
Risk factors for candida albicans
Heavy smoking
Foreign bodies
Immunocompromised
Abx use
Inhaled steroids use
Clinical features of candida
- White specks coalesce to form patches or a membrane
- When membrane is lifted, reveals a red, raw, bleeding mucosal surface
Investigations for candida
Clinical Dx
Scrapings of lesion
- Microbiological examination
- Biopsy
Management for candida
Topical antifungals
1st-line:
- Clotrimazole troches
- Miconazole mucoadhesive buccal tablets
- Nystatin swish and swallow
2nd-line:
- PO fluconazole
Benign oral cavity lesions
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)
Ranula
- Mucus retention cyst that forms in the floor of mouth under tongue
- Develops from sublingual gland ducts
“mucocele that arises from sublingual gland”
Clinical features of ranula
- 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
Management of ranula
Complete excision of cyst and ipsilateral sublingual gland
Marsupialization of cyst
Mucus retention cyst/Mucocele
- 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
Torus palatinus
Benign osteoma (exostoses) of hard palate
Clinical features of torus palatinus
- 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
Management of torus palatinus
Conservative
Removal only if symptomatic or interferes with dentures
Oral cavity cancer examination
Palpate mass
1. Induration
2. Tongue mobility
3. Cervical lymph nodes
Mucocele
Arises from minor salivary glands
Extravasation of saliva usually due to minor trauma
Tx: excision
Papilloma
Firm, pedunculated mass with no deep extension
A/w HPV, most commonly 6 and 11
Tx: excision
Pyogenic granuloma
- Due to trauma or dental extraction
- Commonly located on gingiva, lips, buccal mucosa, tongue
- Seen commonly during pregnancy and may resolve after
- Tx: excision
Types of oral candidiasis
Pseudomembranous thrush vs erythematous
What condition is associated with oral candida?
Median rhomboid glossitis
- Papillary atrophy of midline tongue (appears smooth)
- Likely due to candida infection
- Treat with anti-fungals
