Reactive and Neoplastic Oral Diseases Flashcards
Traumatic Ulcers
Removable, yellow membrane with a rolled white border and surrounding erythema
Cause of Traumatic Ulcers
Mechanical damage
Accidental biting, sharp teeth, sharp foods, etc
Tx of Traumatic Ulcers:
Remove irritating source
Palliative
Salt-water rinses
Local anesthetic rinse (Dyclonine HCl )
Morsicatio Buccarum
AKA chronic cheek chewing
Thickened, shredded, white areas found on anterior buccal mucosa at midline
Possible zones of erythema or ulceration
Cause of Morsicatio Buccarum:
Chronic biting
Common in people under high stress
Tx of Morsicatio Buccarum:
Cessation of habit
Reduce stress
No long-term difficulties
Mucocele:
small dome-shaped swelling
Often tranlucent or bluish
Can wax & wane
Cause of Mucocele:
Rupture of a salivary duct (usually by trauma) & spillage of mucin into tissue
Most often on lower lip
Tx of Mucocele:
Removal of lesion and offending minor salivary gland
May recur
Epulis Fissuratum:
Poorly fitting denture
Usually 2 folds of tissue where denture fits
Tx of Epulis Fissuratum:
Surgical removal of tissue
Adjust or remake denture
Pyogenic Granuloma
Reactive, tumor-like growth
Erythematous mass, usually ulcerated
Painless & bleeds easily
May grow rapidly
Cause of Pyogenic Granuloma:
Local irritation or trauma
Female predilection, especially during pregnancy– “Pregnancy granuloma”
Tx of Pyogenic Granuloma:
Excision
Defer tx during pregnancy, higher recurrence if removed during pregnancy
Nicotine Stomatitis:
Hard palate is gray or white
Numerous elevated papules with red centers
Papules are inflamed minor salivary glands
Cause of Nicotine Stomatitis:
Reaction to heat in cigarettes or cigars
Tx of Nicotine Stomatitis:
Cessation of habit, completely reversible after 2 weeks of smoking cessation
Fibroma:
Most common ‘tumor’ of oral cavity
Reactive hyperplasia of fibrous connective tissue
small painless, sessile, smooth pink nodule
Most are found on cheek along bite line
Cause of Fibromas:
Local irritation or trauma
Tx of Fibromas:
Surgical excision
Papillomas:
Up to 5 mm (pencil eraser is 6 mm)
Painless, raised growth with numerous finger-like surface projections
White, slightly red, or normal in color
Grow rapidly to full size
Cause of Papillomas:
(HPV), usually strains 6 and 11
Extremely low virulence & infectivity rate
Tx of Papillomas:
Surgical excision, recurrence unlikely
Common Benign Oral Neoplasms
Pleomorphic adenoma
Lipoma
Hemangioma
Pleomorphic Adenoma:
Benign salivary tumor
Most common salivary neoplasm
Most common locations: palate & parotid gland
Painless, slowly growing firm mass
Often smooth surfaced, may be ulcerated from trauma
Tx of Pleomorphic Adenoma:
Excision
Lipoma:
Benign tumor of fat
Appear to be more common in obese patients
Soft, painless, yellow or pink nodular masses
Tx of Lipomas:
Excision
Recurrence rare
Hemangiomas:
Benign vascular tumor
Most common tumor of infancy
Head and neck is most common location
Rapid growth during first few weeks of life
Superficial skin lesions are raised with a bright-red color
Feels firm & rubbery, blood does not move when pressure is applied
Deeper tumors are slightly raised and blue
Tx of Hemangiomas:
“Watchful neglect”
90% spontaneously resolve before age 10
Complications of Hemangiomas:
Ulceration, possible infection
Vision problems, airway obstruction
Pre-malignant lesions
Leukoplakia
Erythroplakia
Leukoplakia:
“White patch” Strictly a clinical diagnosis Most are due to thickened surface keratin Considered precancerous lesion Most common oral pre-cancer
Risk Factors for Leukoplakia:
Tobacco
80% of pts are smokers
Alcohol
Ultraviolet radiation
High risk sites for malignant transformation of Leukoplakia:
Tongue (ventral/lateral)
Lip vermillion
Floor of mouth
90% with dysplasia or carcinoma found in these locations
Presentation of Leukoplakia:
Early lesions are grayish plaques
Lesions then extend, become thicker, & white
The mucosa feels leathery & may have fissures
Next, increased surface irregularities & scattered red patches develop
Erythroleukoplakia
Tx of Leukoplakia:
Biopsy!
Complications of Leukplakia:
Recurrence likely, especially for thick lesions
Erythroplakia:
“Red patch”
Strictly a clinical diagnosis
Almost all are dysplasia or carcinoma
Most common sites of Erythroplakia:
Floor of mouth
Tongue (ventral/lateral)
Soft palate
Presentation of Erythroplakia:
Well-demarcated, asymptomatic, erythematous plaque with soft texture
Tx of Erythroplakia:
Biopsy is mandatory and guides tx
Complications of Erythroplakia:
Recurrence is common
Long-term follow-up is necessary
Most Common Malignant Neoplasms:
Squamous cell carcinoma
Non-Hodgkin’s lymphoma
Mucoepidermoid carcinoma
SCCA:
95% of all oral malignancies Cause is multifactorial Tobacco smoke Alcohol Syphilis Sunlight (lip) Human papilloma virus (HPV 16, 18, 31, 33) Iron-deficiency anemia Immune suppression Radiation
Causes of SCCA:
Heredity is NOT a cause
Most are preceded by a precancerous lesion,
There is minimal pain during early stages!!
Delayed detection, delayed treatment
Most common sites of SCCA:
Most common sites
#1. Tongue (ventral/lateral)
2. Floor of mouth
3. Soft palate
Tx of SCCA:
Wedge resection if on lower lip
Wide excision
Radiation
Chemotherapy
Non-Hodgkin’s Lymphoma:
2nd most common malignancy of head & neck after SCCA
More common in older patients
Painless, diffuse “boggy” swelling, may be red or purple
Tx of Non-Hodgkin’s Lymphoma:
Depends on grade and type of lymphoma “Watch and wait” Rituximab Radiation Chemotherapy ........ Prognosis; If high-grade, 60% 5-year survival rate
Complications of Non-Hodgkin’s Lymphoma:
Complications:
Infection, effects of treatment
Mucoepidermoid Carcinoma:
Most common salivary gland malignancy
Found parotid or palate in all ages
Asymptomatic swelling
In palate, may be fluctuant & have a bluish color
Tx of Mucoepidermoid Carcinoma:
Surgical resection, sometimes radiation
