Oral Cavity/Salivary Gland Diseases Flashcards
Oral Cavity
- Disorders of the Lip
- Disorders of the Tongue
- Disorders of Buccal and Tongue
Oral Cavity - Disorders of the Lip
- Exfloiatice Cheilitis
- Angular Chelitis
- Actinic Cheilitis
Exfoliative Cheilitis
•facititious cheilitis
– Chronic superficial inflammation of vermilion borders of the lips
– Characterized by persistent scaling
– Attributed to repeated lip sucking, chewing or other manipulation of lips
Angular Cheilitis
– Environmental
– B2 (Riboflavin) deficiency
Actinic Cheilitis
– Premalignant condition due to chronic UVR exposure
– Affects lower lip, initially edematous & erythematous, later atrophic, white, scaly plaque, may obliterate vermillion border
– Ulceration or induration
- biopsy to rule out malignant transformation
Disorders of the Tongue
- Geographic Tingue
- Hairy Tongue
- Oral Chancre (Syphilis)
Geographic Tongue
- Geographic tongue- benign inflammatory condition, due to loss of filiform papillae
- Erythematous plaques with an annular or serpiginous well demarcated white border
- Etiology- psoriasis, Reiter syndrome, atopic dermatitis, diabetes mellitus, anemia, hormonal disturbances, Down syndrome, lithium therapy
Hairy Tongue
- Hairy tongue (white or black hairy tongue) - hypertrophy of filiform papillae resembling hair-like projections
- Associated with - heavy tobacco use, mouth breathing, antibiotic therapy, poor oral hygiene, general debilitation, radiation therapy, chronic use of bismuth containing antacids, lack of dietary roughage
- White, yellow green, brown, or black color is due to chromogenic bacteria or staining from exogenous sources
Oral Chancre: Trepenoma pallidum
- Painless ulceration in primary syphilis
- Highly Contagious
- Represents the site of infection
Disorders of Buccal Tisue and Tongue
- Aphthous Ulcers
- Herpes Simplex Virus
- Oral Candidiasis
Aphthous Ulcers
• Etiology unknown
- runs in the family, starts in childhood/adolescence
- typically resolves in the third decade of life.
- up to 40% affected
• Exclude systemic conditions
- may be associated with immunological disorders [Crohn’s; ulcerative colitis]
- exclude cause due HIV/AIDS, vitamin deficiency states, or drugs [e.g. NSAIDS]
Herpes Simplex Virus
•Primary infection:
- usually caused by HSV-1
- widespread gingivostomatitis
- entire oral mucos red/ blistering
- Concomitant systemic viral symptoms
•Recurrent infection after latency period
- Localized cold sore
- Localized herpetic stomatitis
Oral Candidiasis
- most common oral fungal infection
- Predisposing factors- dry mouth, antimicrobials, corticosteroids, leukemia, HIV inf, tobacco smoking, denture wearing, endocrinopathy
- caused by Candida albicans
- acute pseudomembranous, erythematous, chronic hyperplastic
Oral Candidiasis - Pseudomembranous
- Most common of the 3 forms
- Also called thrush
- Superficial gray – to – white inflammatory membrane
- Scrape off exudate
- underlying erythematous inflammatory base
Oral Candidiasis - Erythematous
- Also known as atrophic form
- Red raw-looking lesion
- Associated with inhaled steroids
- Appears on palate or dorsum of tongue
Oral Candidiasis - Hyperplastic
- Nodular or plaque-like
- White plaque persistent
- Generally involves buccal mucosa on both sides of mouth
Oral Candidiasis Treatment
•Nystatin
-topical use only
•Fluconazole
- azole drug family
- decrease sterol synthesis - inhibit cytochrome P-450 [lanosterol –. ergosterol]
- adverse effect - liver dysfunction
*caspofungin
- echinocandin drugs
- decrease cell wall synthesis - block formation of Beta glycan
- adverse effect - GI upset, flushing due to histamine release
Gingivitis and Periodontal Disease
- Inflammation of the gums
- Manifestations – Redness – Swelling – Bleeding
- Results from bacterial colonization at gum margin
- necrotizing ulcerative gingivitis
- coxsackievirus infections
- herpangina
- hand foot and mouth disease
- acute lymphonodular pharyngitis
Necrotizing Ulcerative Gingivitis
• A painful, erythematous gingivitis with necrosis of interdental papillae
– Most likely caused by both a fusiform bacillus and a spirochete (Borrelia vincentii)
– Associated with decreased resistance to infection
• Diagnosis
– Necrosis results in cratering of the interdental papillae.
– Sloughing of necrotic tissue causes a pseudomembrane over the tissue.
• Treatment
– Gentle debridement
– Antibiotics if fever is present
Coxsackievirus Infections - Herpangina
• Characterized by fever, malaise, sore throat (odynophagia), and difficult swallowing (dysphagia)
– Includes vesicles on the soft palate
– Erythematous pharyngitis
• Resolves in less than 1 week without treatment
Leukoplakia
- Definition: a whitish patch or plaque that cannot be characterized clinically or pathologically as any other disease, and is not associated with any physical or chemical causative agent, except the use of tobacco.
- Annual transformation rate to SCC of 1%
- Between 5% and 25% of these lesions are premalignant
- Cannot be scraped off
- Can occur anywhere in mouth
- Epidemiology: 40 – 70 years; 2:1 male:female
- 5-25% can progress to squamous cell carcinoma [SCC]
- Use of tobacco a risk factor
Erythroplakia
- Less common than leukoplakia but more serious
- Red velvety lesion level or slightly depressed vs mucosa
- Atypical dysplastic lesion
- Highly prone to progress to SCC
- >90% have dysplasia, carcinoma-in-situ or invasive carcinoma
Oral Hairy Leukoplakia
- Whittish corrugated thickening of mucosa on lateral tongue border
- Occurs almost exclusively in HIV-infected patients
– Probability of developing AIDS is 50% at 16 months and 80% at 30 months in patients with hairy leukoplakia
- EBV present in tissue
- Usually on lateral portion of tongue
- Associated with immuno-compromised patients
- Caused by Epstein-Barr virus [EBV]
- Lesion cannot be scraped off
- Hyperparakeratosis and acanthosis
Squamous Cell Carcinoma
- 95% of head and neck malignancies
- Etiologic factors: smoking alcohol, betel nut chewing, HPV-16/18 infection
- Usually smokers in 60s
- Oral lesion infiltrates locally before metastasizing – cervical lymph node
- 5-year survival <50%
SCC Progression
- Normal
- Hyperplasia/Hyperkeratosis
- Mild/Moderate Dysplasia
- Severe Dysplasia/CIS
- SCC
Sialadenitis
- Usually affects parotid – parotitis
- From duct obstruction
- From bacterial infection: [staphylococcus or streptococcus]
- From viral infection – mumps; parainfluenza; influenza; coxsackie; EBV; CMV; adenovirus
Submandibular Calculi
• majority of salivary calculi (80% to 95%) occur in the submandibular gland
Sjogren’s Syndrome - Clinical
- Inflammatory joint pain [RA link]
- Keratoconjunctivitis sicca [decrease tears = dry eyes]; with corneal damage
- Xerostomia [decrease saliva = dry mouth
- Symptoms outside glands: arthritis; skin rash; tubule interstitial nephritis
- Complications: tooth decay; mucosa-associated lymphoma [MALT]
- Histopathologic image of focal lymphoid infiltration in the minor salivary gland associated with Sjögren’s syndrome, lip biopsy, H & E stain.
Pleomorphic Adenoma
- Benign mixed tumor
- Most common of salivary
- Painless, slow-growing
- Radiation ↑ risk
- Excise due to risk of malignancy over time
- Histologically heterogeneous appearance
- Epithelial [E] components = cells with moderate amount of cytoplasm
- Stromal component [S] = myoepithelial cells
Warthin Tumor
- [papillary cystadenoma lymphomatosum]
- Benign cystic tumor
- Second most common
- Largely parotid location [characteristic]
- Round or oval encapsulated masses
- Mucinous or serous secretions
- Oncocytic cells: abundance of structurally abnormal mitochondria with decreased metabolic function
- Smoking may damage mitochondrial DNA –> abnormalities
A) Low power view with epithelial and lymphoid elements. A follicular germinal center lies beneath the epithelium.
B) Cystic spaces separate lobules of neoplastic epithelium containing a double layer of epithelial cells on a reactive lymphoid stroma.
Mucoepidermoid Carcinoma
- Most common salivary malignancy in adults and children
- Adults most common 35-65
- Radiation = risk factor
- Histology: mucous, epidermoid and intermediate cells [progenitors]
- Low grade:
- Predominantly mucous cells
- Rarely metastasize
- 5-yr survival 90%
•High grade:
- Predominantly epidermoid cells
- Aggressive
- High recurrence
- Metastasize to distant sites
- 5-yr survival 50%
•Translocation of MECT1-MAM2 [11q21; 19p13] >50%
