ORAL PATHOLOGY Flashcards

Question

Name the site and common age group that dentigerous cyst appear in. What is the treatment for teeth affected?

Answer 1

Mandible WT > Mx. Canines > Md. 2nd premolar Male adults 20s-40s years 1. Removal of tooth + Enucleation of cyst (other recurrence) 2. Decompression of larger cyst (allows drainage and thickening of epithelium for easier dissection) + Future enucleation

Answer 2

20-30years Treatment: Referral for specialist management - complete radiologic examination advisable due to high recurrence Surgical tx: resection, curettage or marsupialisation Carnoy’s solution (chloroform) used → effective but carcinogenic Other options have higher recurrence Important for periodic post-treatment clinical and radiographic examination to detect recurrence → Usually within first 5 years Gorlin Goltz Syndrome (Basal cell nevus syndrome) = Two major criteria or 1 major criteria w/ 2 minor criteria for diagnosis Major Multiple OKC 3+ cutaneous palmar pits Bifid, fused or splayed ribs Minor Cleft lip/palate, frontal bossing, hypertelorism Calcification of falx cerebri

Answer 3

Development cyst that arises in lateral area of neck (deep to SCM commonly or anterior mandible). Common age group = 20-40years Treatment = Excision (low recurrence)

Answer 4

Infection from Treponema pallidum (spirochaete) Primary Chancre: Single indurated painless ulcer Upper lip → Male Lower lip → Females Nil exudate Develops 3 - 90 days after exposure Genital area (<2% oral) Spontaneous healing 4-6 weeks Highly infectious Secondary Develops 6 weeks after primary chancre Maculopapular skin rash Oral ulcers covered by membrane "Snail-track" ulcers Condyloma latum Multiple lesions typical of secondary compared to primary syphilis Highly infectious Tertiary Signs can appear years later CVS lesions, CNS lesions Atrophic glossitis Syphilitic Leukoplakia Gumma (type IV hypersensitivity response) Often affects the palate or tongue

Answer 5

Local: Salivary hypofunction Smoking Systemic alteration: Extremes of age Malnutrition - iron, folate and B12 deficiency Drugs Inhaled corticosteroids Antibiotics Severe immunodeficiency = HIV/AIDS, immunosuppressant agents, chemotherapy, malignancies

Answer 6

-Treatment relies on adequate contact time with antifungal <2 years - Nystatin 100,000 units/ML suspension 1mL topically then swallowed → 4x daily for 7-14 days and then 2-3days after - Miconazole 2% gel 1.25mL topically then swallowed → 7-14 days and at least 7 days after resolution >2 years: 4x daily for 7-14 days and at least 7 days after resolution - Nystatin 100,000 units/ML suspension 1mL topically then swallowed → 4x daily for 7-14 days and then 2-3days after - Miconazole 2% gel 2.5mL topically then swallowed - Amphotericin 10mg lozenge Angular cheilitis: 2x daily for 14 days and 14 days after resolution - Miconazole 2% topical cream - Clotrimazole 1% topical cream - Hydrocortisone 1% cream can be added to manage inflammation → 2x daily for 2-3days - Note: Combination products should only be used until inflammation subsides and antifungal used alone for 14 days after symptoms resolve

Answer 7

1. Entry into cell 2. Uncoating and release of viral genome 3. Transcription of viral genome → Viral DNA transcribed into mRNA 4. Translation of viral proteins → Early proteins aid in genome replication while late proteins aid in assembly 5. Post translation modifications → Cleavage and glycosylation 6. Assembly of virion components 7. Release → Budding or cell death

Answer 8

1. Primary infection Children Fever, malaise, headache Vesicular eruptions on skin, vermillion border and I/O Oral presentation referred to as Primary Herpetic Gingivostomatitis Lesions persist for 1-10 days and resolve with no scarring Pharyngotonsillitis = Inflammation of tonsils, fever, sore throat 2. Secondary infection → Primary infection reactivated Prodromal symptoms: burning, tingling and pain at the site Within hours vesicles appear → Rupture and coalesce to form map like ulcers Lesions heal in 1-2 weeks with no scarring Herpes Labialis = “Cold sores” on vermillion border Herpes stomatitis = Vesicles appear on lip and throughout oral mucosa (severe and extensive) - Generally in severely immunosuppressed patients Herpes-associated erythema multiforme = Extensive ulceration of oropharynx and crusting of lips Herpetic Whitlow = Vesicles on finger tips due to infection of nail bed - Uncommon today

Answer 9

Herpes labialis: at prodromal stage or at first sign of recurrence -Advise patient to use SPF lipbalm -Acyclovir 5% topical cream - 5x daily for 5 days -Famciclovir 1500mg single dose -If severe and high recurrence → Referral to GP for management to systemic antivirals and underlying risk factors Primary herpetic gingivostomatitis -Ensure patient remains hydrated -Benzydamine 1% gel for analgesia - 2-3hrs

Answer 10

a) Site - High risk areas = FoM, lateral, ventral tongue, anterior buccal mucosa, retromolar trigone, anterior fauces Size - Only useful yo consider whether it could be linked to trauma Homogeneity - Colour and texture - considerations for malignancy Wipeable - Lesions wipeable: pseudomembraneous candidiasis, traumatic keratotic slough, desquamative gingivitis (partially), white hairy tongue b) Site Size Number Duration +/- recurrences Border Systemic involvement - fever, cutaneous ulcerations/blisters c) Asymmetry Border - regular or irregular Colour - Homogeneity Diameter - Consider biopsy when >6mm Evolvement - Rapid or not

Answer 11

Lined by stratified squamous epithelium Wall composed of inflamed fibrous or granulation tissue Reactive hyperplasia Rushton’s hyaline bodies Mucous goblet cells and respiratory metaplasia Occasionally cholesterol clefts Hemosiderin Foamy Macrophages

Answer 12

Granulation tissue = Inflammatory cells, fibroblasts and new blood vessels

Answer 13

50-60yrs Females Mandible - Premolar/Molar

Answer 14

20-30yrs, female, anterior mandible DDx: - Ameloblastoma (older predilection in posterior mandible) - Odontogenic Myxoma (tennis racquet, one or two straight septae) - ABC (younger age group) - Simple bone cyst (no effect on surrounding structures)

Answer 15

Nil treatment required except reassurance (based on TGA) --> May suggest difflam for symptomatic management if required

Answer 16

Parotid = Stenson's duct --> Serous Submandibular = Wharton's duct --> Mixed Sublingual = Bartholin's duct --> Mucous

Answer 17

Minor glands associate with circumvallate papilla - they are the only minor glands that are serous (all other are mucous)

Answer 18

o Serous – thin watery secretion  Pyramid shaped cells  Spherical nucleus  Intensely stained  Highly synthetic cell  Microvilli extend into luminal surface  Complex folding of basal plasma membrane o Mucous – more viscous secretion  Pyramid shaped  Flattened  Flattened nucleus at basal end  Apical portion – weakly stained  Fewer interdigitations between cells  More secretory granules

Answer 19

Sodium and chloride pumped out and potassium and bicarbonate are pushed into saliva prior to excretion

Answer 20

Treatment = Nothing (benign) Histology = Duct like structures - central space surrounded by columnar or cuboidal epithelial cells

Answer 21

(C) (A) 20-30 years (B) Young children - 10-20 years and usually posterior mandible (D) Does not fit radiographic description

Answer 22

Peripheral autonomic neuropathy Results in disordered salivary metabolism and secretion Accumulation of secretory granules = Gland enlargement

Answer 23

Common age = 30-50years Epithelial component Duct-like and cystic structures Sheets of epithelial cells Myoepithelial cells → Spindled, epithelioid, plasmacytoid Stroma component Produced by myoepithelial cells Myxoid and chondromyxoid areas Hyalinised stroma