Test 2 Flashcards
HSV1
Perioral lesion, UV exposure causes lesion, young= gingivostomatitis, old= pharyngotonsilitis (sore throat, fever, headache). resides in trigeminal ganglion (latency). Prodrome 6-24 hours (tingling that is viral replication), 2d it crusts, 7-10 days it resolves. ALWAYS on keratinized bound mucosa. Test takes 4-8 hours. Attached gingiva
HSV2
sensory ganglion, same as HSV1
HSV3
varicella-zoster: chickenpox is primary, herpes zoster is recurrent. Latent in dorsal spinal ganglion, occurs in 20% of people (usually older), usually 1 recurrence (stress, alcohol, abuse, immune weakening). Movable or bound tissue, if tip of nose is involved send to opthomalogist, Ramsay Hunt syndrome. Respiratory or contact spread
ramsay-hunt syndrome
external auditory herpes infectio, ipsilateral face paralyisis, veritgo, hearing defect
HSV4
Epstein Barr: Mononucleosis: Fatigue, malaise, anorexia. Dx= paul-bunnel heterophile antibodies, 4-6 weeks of pain pills, and sometimes abx. Also seen in oral hairy leukoplakia (bilateral), lymphomas (Africans burkitt), nasopharyngeal carcinoma.
Hsv5
cytomegalovirus: Salivary glands, endothelium, macrophages, lymphocytes. 90% asymptomatic. Fever, arthralgia, muscle pain, and shivering. Common in AIDS, chronic mucosal ulcerations, “owl eye”
HSV8
Karposis Sarcomma: multifocal neoplasm of vascular endothelial origin, 20% of AIDS, Hard palate, gingiva, tongue. Oral cavity can be primary site of involvement
shingles
chickenpox is primary, herpes zoster is recurrent. Latent in dorsal spinal ganglion, occurs in 20% of people (usually older), usually 1 recurrence (stress, alcohol, abuse, immune weakening). Movable or bound tissue, if tip of nose is involved send to opthomalogist, Ramsay Hunt syndrome. 1-4 mm white opaque vesicles that rupture to form shallow ulcerations
infectious mononucleosis
Epstein Barr: Mononucleosis: Fatigue, malaise, anorexia. Dx= paul-bunnel heterophile antibodies, 4-6 weeks of pain pills, and sometimes abx.
herpangina
coxsackie virus. 2-6 lesions in posterior mouth (soft palate/ tonsils). red macules that rapidly ulcerate. 3 mm in diameter, resolve in 10 days. Sore throat, fever, dysphagia.
hand-foot disease
Coxsackie virus: Flu like symptoms. 30 lesions up to 1 cm in diameter. Buccal, labial, and tongue, peripheral ulcers develop after oral (foot and hand) heal without crusting
rubeola- measles
): paramyxovirus: winter, respiratory droplets. 10-12 days of incubation. 9 day course of three stages. 1 stage: cough, coryza, conjunctivitis, kopliks spots. 2 Stage: fever, kopliks fade, rash (face then down). 3rd stage: healing
rubella
Togavirus. Congenital (hearing defects, heart defects, cataracts) rash, arthritis, forchiemers sign (small, dark, red papules on palate) 2-3 wks incubation. Contagious from 1 wk before rash to 5 days after.
mumps
disease of exocrine glands (salivary glands). Edema and lymphocytic infiltration. 2-4 wk incubation. Discomfort/swelling, salivation is painful. Epididymorchitis.
HIV
Bodily fluids, targets CD4+. Candidiasis( clotrimazole or systemic fluconazole if not on HAART), hairy leukoplakia (on border of tongue), karposis sarcoma (20% of AIDS, 70% of KS have oral lesions), non hodgkins, periodontal disease (linear gingival erythema , nup, nug) haart drops down chance of exposure by 75%. .3 for puncture .09 for mucus membrane
kaposis sarcomma
multifocal neoplasm of vascular endothelial origin, 20% of AIDS, Hard palate, gingiva, tongue. Oral cavity can be primary site of involvement. 70% have oral lesion
linea alba
White Line, sucking, chewing, trauma. Bilateral. 10% of population
moriscatioa buccarum
chronic cheek chewing/trauma. Linguarum, labiorum. Stress plays a role
thermal burns
food or beverage. Usually on palate/ posterior buccal mucosa. Erythema and ulceration
bronj
inhibit osteoclast. Possibly interfere with angiogenesis. Second generation has nitrogen side chain and 10 year half life. Medication goes to highest area of remodeling (jaw) bigger deal in mandible (more dense and less blood supply) 6-8% FOR iv bisphosphonates, 1:100,000 for PO. 60% occur after dental procedure 40% is spontaneous. PO you need written consent, IV avoid manipulation.
meth
parasitosis (snakes, insect crawling around mouth). Dries out the mouth and sugary snacks cause caries. Smooth surface and root. Affect sympathetic amines for 6 hours (hypertensive crisis, CVA, MI)
amalgam tattoo
amalgam gets implanted into mucosa. Dx by radiograph. Blue, black, grey. If cant see on radiograph biopsy.
smokers melanosis
nicotine stimulates melanin production. 20% of smokers (3% of non smokers) cessation of smoking has gradual disappearance. Cut out what remains after 6 weeks. If unusual looking or in unusual place, biopsy
antral psuedocyst
Pano, dome shaped, slightly RO lesion on floor of maxillary sinus. Exudate/ serum glob of inflam cells cause sessile elevation. 2-15% of population.
recurrant apthous ulcers
RAU- much more painful than appear- canker sore- only on movable mucosa. Minor Major Herpetiform Size 3-10 mm 10-30 mm 1-3mm Healing time 1-2 weeks 2-6 weeks 7-10 days Scarring No Possible No Lesions 1-5 1-10 100 Recurrances Few Medium Most (can be continuous) Age Child Adolescent adult
behcets syndrome
chronic recurrent immune mediated disease with oral apthous –like ulcers (can be on fixed mucosa). Ocular inflammation, joint inflammation, genital ulcers, skin lesions. Tx steroids
sarcoidosis
multisystem granulomatous disease of unknown cause. Lungs, lymph (almost always), skin, eyes, salivary glands. Skin Lesions = lupis pernio (chronic, purple, indurated, leasions on H&N) and erythema nodosum (scattered, nonspecific, swollen red nodules on lower legs- swollen fat deposits). DX: elevated serum angiotensin-converting enzyme levels
lofgrens syndrome
erythema nodosum, bilateral hilar lymphadenopathy, althralgia
heerdforts syndrome
: parotid enlargement, inflammation of eye, facial paralysis, fever
orofacial granulomatosis
variable presentation, lips are commonly involved. Nontender persistent swelling. Granulomatous inflammation
cheilitis granulomatosis
orofacial granulomatosis of only the lip
melerson-rosenthall
cheilitis granulomatosa, fissured tongue, facial paralysis (2 pics fat lip, fissured tongue)
wegeners granulomatosis
necrotizing granulomatous lesions of the respiratory tract, necrotizing glomerulonephritis, and systemic vasculitis of small vessels. If untreated it leads to kidney failure. Limited means only upper respiratory tract. Superficial is just skin lesions (unspecific ulcerations). Early symptom is strawberry gingivitis. DX: indirect immunofluorescence detects presence of an antineutrophil cytoplasm antibody. (ANCA). TX: steroids
angioedema
aka quinckes disease. Diffuse edematous swelling of soft tissues. Not painful but itchy and erythema. IgE mediated. Mast cell dengranulation. Resolves in 2 days. Oral antihistamine therapy. H&N involvement caused by angiotensin converting enzyme (ACE) inhibitors
squamous papiloma
benign proliferation of stratified squamous epithelium. Caused by HPV 6, 11. Tongue, lips, soft palate. Painless, pedunculated, 5mm. tx: conservative surgical excision.
verrucous vulagaris
common wart. HPV 2, 4, 6, 40. Contagious. Skin-colored, yellow, white. Pedunculated or sessile
condyloma accuminatum
Venereal Wart. HPV 6, 11 (most common) 16, 18, 31 (high risk malignancy- SCC). STD. 1-3 months incubation. Sessile. 1-1.5 cm (twice that of squamous or verruca)
hecks disease
multifocal epithelial hyperplasia. HPV 13, 32. Appears in childhood. Painless, flattened papules that cluster, mucosal colored, tx: spontaneously regresses, surgical excision, low recurrence, no risk of malignancy.
verruciform xanthoma
hyperplastic condition caused by trauma (best guess) dx: lipid laden histiocytes (xanthoma) in epithelium. Most common on gingiva, painless, sessile, papillary or roughened surface, mucosal yellow red or white, less than 2 mm tx: surgical, low risk of malignancy/recurrance
seborrheic keratosis
common in older people, benign proliferation of the epidermal basal cells. Not in mouth. Face, trunk, extremities. Usually less than 2 cm. Leser-Trelat sign=sudden appearance of many of these and puriritis (itchy skin) (think cancer somewhere)
dermatosis papulosa nigra
seborrheic keratosis. AD, multiple small (2mm) papules, no malignant potential. Zygomatic and periorbital region. Morgan Freeman
ephelis vs actinic lentigo
increased amount of melanin (not melanocytes). Chronic UV exposure. Ephelis becomes more pronounced with sun exposure. Actnic lentigo does not.
melasma
Acquired, symmetrical, hormonally drivenhyperpigmentation of the sun exposed skin on the face. Mask of pregnancy. Bilateral. Sunscreen if its an issue. No malignancy
oral melanotic macule
oral counterpart to ephilis. focal increase in melanin. Not dependant on sun exposure. Common on vermillion border of lower lip. Not malignant but biopsy to r/o melanoma. 80% are solitary.
oral melanoacanthoma
Aquired from trauma. (tooth brush with back scraper). Dendrtitic melanocytes throughout the skin. Almost exclusively in African americans. Buccal mucosa most common. Typically asyptomatic (burning if not). Smooth dark brown macule. Biopsy to r/o melanoma. No malignant risk.
blue nevus
Uncommon benign proliferation of dermal or intramucosal melanocytes. Common ( hands, feet, palate, scalp/face. Children and Young adults, less than 1 cm) Cellular (common on buttocks. Slow growing blue/black that grows up to 2 cm). tyndall effect. Tx: surgical remove-low chance of recurrence. Biopsy to e/o melanoma. Very rare malignancy.
leukoplakia
Intraoral white plaque that does not rub off and cannot be identified as any well-known entity. White because something is blocking the redness of the underlying vasculature. Precancer (dysplastic epithelium or SCCA 20%). 80% benign hyperkeratosis. 5-50% malignancy risk. Tobacco, alcohol (w tobacco), sanguinaria (maxillary vestibule or alveolar mucosa), UV radiation (lower lip vermillion), microorganisms (treponema pallidum), trauma (not precancer). Most common on lip, buccal, gingiva. Most common for cancer is lip, tongue, FOM. BIOPSY. Mild dysplasia (lower 1/3) moderate (lower ½). Severe (above the ½) In Situ (baby cancer). Follow up important because recurrence is common. Increase risk for cancer if female, persistant, nonsmoker, oral floor or ventral tongue.
risk of cancer
Low Leukoplakia, erythroleukoplakia, erythroplakia, proliferative verrucous leukoplakia (multiple keratotic plaques w roughened surfaces. Slowly spread) High
erythroplakia
red patch that cannot be identified as a well known entity. Never benign. Well-demarcated with a soft and velvety texture. Asymptomatic. Red due to underlying vasculature. Biopsy and long term follow up.
smokeless tobacco pouch keratosis
gingival recession with destruction of facial alveolar bone, bown/black extrinsic stain, white plaque there there is direct contact. Lesions develop early, not common for new ones. Appears rippled or fissured. Cessation cures in about 2 weeks. biopsy anything that is still there after 6 weeks.
oral submuccous fibrosis
chronic, high risk, progressive, precancerous condition resulting from betel quid or paan. Palor (white) and fibrosis. Trismus and pain from spicy foods. Buccal, retromolar pad, soft palate. Will not fade with cessation. Follow up due to 10% chance of malignant transformation.
nicotine stomatitis/ reverse smoking
White/grey keratotic change on the palate. Due to heat (can get same in coffee drinkers) numerous slightly elevated red centered papules (ducts from minor salivary gland) completely reversible. REverse: red bleeding ulcerated, not reversible
actinic cheilosis
: premalignant change of the lower lip. Long term UV exposure. Older than 45. Atrophy of lower lip vermillion border, smooth surface and blotchy pale areas. Blurr the margin between vermillion and cutaneous portion. Scaly as it progresses. Transforms to SCCA (10%). Irreversible. Use lip balms with sunscreen to prevent further change.
squamous cell carcinoma
posterior/lateral tongue, FOM, soft palate, gingiva. Painless, indurated, typically FOm are from leukoplakia and are near midline, gingival and alveolar (least associated with tobacco. Look over in notes.
TNM staging
look in notes
verrucous carcinoma
low grade variant of oral SCC. Men older than 55. Mandibular vestibule and gingiva. Present 2 years before diagnosis. Diffuse, well-demarcated, painless, thick plaque with papillary or verruciform surface projections. White cauliflower looking thing. Surgical excision without neck dissection. Malignant transformation potential (most) PVL, nicotine stomatitis, erythroplakia, oral submucous fibrosis, erythroleukoplakia, granular leukoplakia, actinic cheilosis (least).
basal cell carcinoma
most common of all cancers. Locally invasive and slow spreading. Frequent sunburn and freckling as a child is a risk factor. Nodular is most common. Central depression with an umbilicated appearance. Telengiectatic blood vessels and rolled borders. Metastisis is rare. Other types are pigmented (same as nodular but clinically brown or black), sclerosing (morpheaform- mimics scar tissue and is deeply invasive). Superficial (skin of trunk, multiple red scaly patches resembles psoriasis) surgical excision (use frozen section to evaluate margins) death can occur if it invades vital structures
melanoma
melanocytic neoplasm. Arises from a benign lesion or from normal melanocytes. ACUTE sun exposure is a risk factor. Increases with a family hx, fair skin, light hair ect. 3 most common skin cancer. 1/3 with oral manifestation have a hx of a pigmented macule. In oral cavity or sinus it is bad news. Radical growth (lateral) and vertical growth. ABCDE. Depth of invasion correlates with prognosis. Surgical excision 3-5 cm margin. Radio resistant. New chemo is decent. BANS. Oral melanoma has 15-20% survival rate (distant metastasis).
mucocele
spillage of mucin into soft tissue due to rupture of a salivary gland. Lower lip, FOM (ranula), anterior ventral tongue, buccal mucosa. Upper lip is most likely salivary neoplasm retromolar area is usually mucoepidermoid carcinoma.
sialolith
salivary stone- calcifications. Most likely in submandibular gland (long twisty gland). Pain or swelling at meal time. Dx: radiograph, siolography, untrasound, CT. tx: massage, increase fluid intake, moist heat, sialogogue, surgery. Anything that inhibits salivary flow or production is a factor.
necrotizing sialometaplasia
locally destructive inflammatory condition of the salivary glands. Possibly from ischemia. Predisposing factors: trauma, dental injections, ill fitting dentures, uri, tumor, surgery. Non ulcerated swelling, pain, paresthesia-necrotic tissue sluffs- heal in 5-6 weeks. Biopsy to r/o possible malignancy.
cheilitis glandularis
swelling and eversion of the lower lip as a result of hypertrophy and inflammation of the minor salivary glands. Possible causes: sun damage, tobacco, syphilis, poor hygiene, genetic. Swelling and pain, eversion of lip, red dots (ductal orifices), weeping mucopurulent secretions, middle aged to older males.
xerostomia
dry mouth. Complications: candidiasis, cervical and root carries, taste alteration. Causes: medication, alcohol, caffeine, smoking, head and neck radiation, sjorgrens, diabetes mellitis, sarcoidosis, salivary gland surgery. Tx: remove causative agent, sugarless candy/gum, mouthwash.
sjorgrens
autoimmune attacking salivary gland (and other lacrimal glands). 85% female. Dry mouth and dry eyes (sicca). Primary ss: no other autoimmune disease. Secondary SS: associated with other autoimmune disorder. DX: (2/3) positive serum anti-SSA or SSB. Ocular staining score >=3. Presence of inflammation in labial salivary gland biopsy. Exclude: radiation, hep C, AIDS, preexisting lymphoma, sarcoidosis, GVHD, anticholinergic drugs. Same tx as xerostomia, monitor for lymphoma.
salivary gland neoplasm summary
1-6.5/100,000. Parotid> minor > submandibular > sublingual Chance of being benign. Major All (66%) Parotid (70%) Submd (60%) Subling(30%) Minor: Minor gland (50%) Upper lip (80) lower lip (40) palate (50) tongue (15) cheek (50) retromolar pad (10) More common in upper lip than lower lip. Upper lip mostly benign/lower lip usually malignant (90%). Most common is pleomorphic adenoma (benign). Most common malignant is mucoepidermoid carcinoma. palate is most common place for minor salivary gland neoplasm.
pleomorphic adenoma
benign mixed tumor. Most common neoplasm. Ductal and myoepthelial cells. Big amount of parotid gland and submd. Palate is most common for minor, upper lip, buccal mucosa. Encapsulated but grows until it’s treated.
warthins tumor
parotid cystadenoma lymphomatosum. Almost exclusively in parotid. Second most common benign parotid tumor. May occur bilaterally. Smokers have 8x the risk.
mucoepidermoid carcinoma
most common malignant in adults and children. Parotid then minor glands (palate). Prognosis on grade and stage submnd has poorer prognosis than the parotid gland.
adenoid cystic carcinoma
minor gland(50%), palate > parotid, submnd. Most common malignant neoplasm of the submnd gland. Slow growing, widely infiltrative, tendency for perineural spread. Pain facial nerve paralysis. 20% survival rate in 20 years
polymorphous low grade adenocarcinoma
exclusively in minor glands. Hard and soft palate (65%) > upper lip, buccal mucosa. More females and older adults exhibit different growth patterns histologically
