Oral Cavity, Throat, and Neck

Question 1

Halitosis

Answer 1

breath odor

Question 2

Xerostomia

Answer 2

dry mouth

Question 3

Recurrent Herpes Labialis

• what happens?
• what are some reactivation triggers?

LIPS

Answer 3

hsv-1
prodromal itching/burning/tingling -> eruption of clustered vesicles on vermillion border -> rupture, ulceration, crusting

reactivation: UV light, trauma, fatigue, stress, menstruation

Question 4

Carcinoma of the lips

• possible etiology
• sxs
• dx

LIPS

Answer 4

often SCC

etiology: tobacco, alcohol, sunlight, pott hygiene
sxs: lesion is PANLESS, demarcated, elevated,. slow growing, fails to heal, may bleed

biopsy to dx

Question 5

Mucocele
Ranula

etiology, sxs

LIPS

Answer 5

soft cyst, mucin-filled cavity with mucus glands lining epithelium. common on lips or under tongue (ranula)

etiology: minor injury to ductal system
sxs: thick saliva creates bluish bubble, movable, may rupture.

Question 6

Cheilitis
-etiology

LIPS

Answer 6

chapped lips (erythema and scaling)
etiology-use of retinoids, windburn, allergis, lip licking

Question 7

angular cheilitis
sxs, etiology, labs

LIPS

Answer 7

etiology => elderly, poor oral hygiene, nutritional deficit

sxs= deep cracks at labial commisure, may bleed or form shallow ulcers. mauybecome infected with c. albicans

lab= KOH to assess for candida

Question 8

Oral lichen planus

• erosive?
• etiology

MUCOSAL LESION

Answer 8

nonerosive, usu PAINLESS, vary from white patches on buccal mucosa to erosions on gingiva. not contag

• • erosive form can erupt into violet papules
• • chronic –> oral cancer

etiology unknown, possible drug rxn, hep C, stress

Question 9

Leukoplakia
What is it? MvF? Age?
Etiology? SxS? PE?
Dx? DDX?

MUCOSAL LESION

Answer 9

white patches on oral mucosa that CANNOT be rubbed off

• precancerous 20%
• seen in nonmalig inflammatory conditions
• M>F, 90% >40

etiology; trauma from habitual biting, dentures, tobacco..
ssx; on tongue, mandibular alveolar ridge, and buccal mucosa in most.
lesion intensity varies, surface often shriveled and rough.
may have red specks
color varies white-brown/gray

pe: lesions CANNOT be wiped away with gauze

dx: biopsy
ddx: candidiasis and aspirin burn (can be wiped)

Question 10

Which white lesions can be wiped away with gauze? Which cannot?

Answer 10

Can: candidiasis, aspirin burn
Cannot: leukoplakia, keratosis, leukoedema, lichen planus, SLE, SCC

Question 11

Erythroplakia
etiology

MOUTH LESION

Answer 11

• red plaques with well demarcated edges
• often on floor of mouth, tongue, palate

etiology unknown
- precancer 40%

Question 12

Oral Squamous Cell Carcinoma
epidemiology
ssx
dx

MOUTH LESION

Answer 12

30,000/yr in US, 90% smokers
subset associated with HPV-16
most on floor of mouth or ventral/lateral surface of tongue

ss: looks like leuko/erthryoplakia
exophytic or ulcerated, indurated with a roller border
may be asymp at first, ulceration lesions often painful
metastatic mass in neck may be 1st symp (nontender)

biopsyy

Question 13

Melanoma
ssx, ddx

MUCOSAL LESION

Answer 13

pigmented lesions with concerning signs:

asymmetry, irregular borders, variable coloration, increasing diameter, lesion wont blanch

DDX: melanosis- symmetric, ppl w dark skin
oral melanotic macules- symmetric, stable sharply delimited dark macules on lips.oral muc

Question 14

Fordyce’s Spots

Answer 14

benign neoplams from sebaceous glands
20-30, M=F

ssx: asymptomatic, multiple yellow-white 1-2mm, in cluster. most common on vermillion/buccal border. DONT WIPE OFF
ddx: C.albicans- wipe off.

Question 15

stomatitis, etiology

Answer 15

inflammation of the oral tissue from infection, deficiency, trauma, hypersensitivity

Question 16

Oral Candidiasis
risks, ssx, dx

STOMATITIS

Answer 16

“Thrush”
fungal yeast C. albicans, glabrata, tropicalis

risks= immunodeficiency
ssx= lesion that is slightly raised and white, CAN BE WIPED. xerostomia, bleeding
dx= KOH prep

Question 17

Reccurent Aphthous Stomatitis
etiology
ssx
ddx

STOMATITIS

Answer 17

“Cancer Sore”

• acute, painful, reccuring, necrotizing ulcerations on oral mucosa
• t cell ediated localized destruction of oral mucosa

etiology= provocations, trauma most common trigger (physical, chemical, etc.)

ssx= painful lesions, prodromal burn/tingle
ulcers shallow, round-oval, red border on non-keratin, MOVABLE mucosa
continuous- 2-4outbreaks/yr

ddx= 2’ herpatic ulcerations, trauma, systemic disorders

Question 18

Hereptic Gingivostomatitis

ssx
lab
ddx

STOMATITIS

Answer 18

“cold sore”

primary HSV-1 infection, painful eruptions of the UNMOVABLE mucosa and verilion border.
triggered by trauma and emotional stress

ssx: prodromal pain, burning, tingling, fver, malaise, LA
eruprion of multiple interoral vesicular lesions and erosions, erthematousbase, crusting
self limited in 1-2wks
kids- fever, drool, decreased oral intake due to pain

Lab: Tzank smear, direct immunofluroescence smear, or viral culture

DDX: apthous stomatitis, erythema multiforme, drug eruptions, pemphigus