Oral Mucosal Disease Flashcards
What layers expect see normal buccal mucosa?
Non-keratinised stratified squamous epithelium
Lamina propria = superficial connective tissue
Sub-mucosa = adipose
Muscle = buccinator?
What is epithelium like normal buccal mucosa?
See non-keratinised surface
See prickle layer
Basal cell layer on top basement membrane
What expect to see in histological sample hard palate?
Keratinised stratified squamous epithelium
Reduced lamina propria/ submucosa
Minor salivary gland tissue
What would make you worried about white patch?
If non-homeogenous - mixed red/white lesion
How does hyperkeratosis differ from normal epithelium?
Keratinised tissue
Why do hyperkeratosis lesions appear raised?
Hyperplasia of epithelium
How manage frictional keratosis?
Reassure
Review - remove cause of trauma e.g sharp cusps
What histological changes do you see in lichen planus?
Atrophy epithelium
Loss basal cells = ‘sawtooth’ rate pegs
Keratinisation
Inflammation - accumulation T lymphocytes
How diff lichen planus and lichenoid reactions?
Look same histologically
Need diff clinically
What are the blue cells seen in sample of lichen planus
Lymphocytes - T (but can’t differentiate H&E)
How does histology lichen planus relate clinical features?
Rate repair exceeds damage = epithelial thickening
Keratin production = white Lacey apperance
Inflammation in area atrophy = erythema
What is associated risk of lichen planus?
1-3% risk of malignant change
Management of lichen planus?
Symptomatic relief OHI Topical analgesia Can consider: topical corticosteroids, immunosupressants Systemic immunosuppressants if severe
What is ulcer?
Full thickness loss of epithelium exposing underlying connective tissue
Granulation tissue and fibre-purulent slough
Types of recurrent apthous stomatitis?
Minor, major and herpetiform
What are predisposing factors of apthous ulcers?
Stress, nutritional deficiency, familial tendency, allergies e/g cinnamon
Differential diagnosis when see erosive lesion on lower lip?
Bullous disorder - pemphigus/ pemphigoid
Erosive lichen planus
What see histology of pemphigus?
Intra-epithelial split
Thank cells in split
What causes change in epithelium in pemphigus?
Autoantibodies against binding proteins desmosomes which hold epithelium together
What investigation can be carried out to confirm pemphigus?
Immunofluroesence of fresh biopsy
What see immunoflurosence on pemphigus?
Fish net pattern
When would see sub-epithelial separation?
Pemphigoid
What happens if sub-epithelium separation is breached?
Ulcer as exposed underlying connective tissue and full thickness loss of epithelium
What is pempigoid
Type II hypersensitivity - autooantibodies to hemidesmosomes
What see on immunofluorsence of pemphigoid?
Linear pattern along basement membrane
What other lesions may pt have if they have pemphigoid?
Ocular lesions
Desquamative gingivitis
Oseophagel/ upper GI lesions
