03 02 06 Benign Mucosal Lesions of the Oral Cavity

Benign Mucosal Lesions of the Oral Cavity : 

Benign Mucosal Lesions of the Oral Cavity DR.KCSUDEEP

Causes of ulcers of the oral cavity : 

INFECTION VIRAL : HERPANGINA , HERPES SIMPLEX, PRIMARY & SECONDARY , HAND FOOT AND MOUTH DISEASE. BACTERIAL: VINCENT’S INFECTION , TB, SYPHILIS FUNGAL: CANDIDIASIS IMMUNE DISORDERS APTHOUS ULCER, BEHCET’S SYNDORME TRAUMA PHYSICAL CHEMICAL THERMAL Causes of ulcers of the oral cavity

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NEOPLASM SKIN DISORDERS BLOOD DISORDERS DRUG ALLERGY VITAMIN DEFICIENCIES MISCELLANEOUS : RADIATION MUCOSITIS CANCER

HERPANGINA : 

HERPANGINA

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It is a coxsackie viral infection mostly affecting children . Multiple small vesicles appear on the faucial pillars, tonsils, soft palate and uvula. Rupture to form ulcers which are usually 2-4 mm in size, have a yellow base and red areola around them. They disappear within 1 week.

HERPETIC GINGIVOSTOMATITIS : 

Caused by herpes simplex virus and is of two types : 1. Primary 2. Secondary 1.PRIMARY: affects children and is characterised by clusters of multiple vesicles which soon rupture to form ulcers Any part of the oral cavity may be affected. Constitutional symptoms like fever, malaise and headache may accompany sore throat and lymphadenopathy. HERPETIC GINGIVOSTOMATITIS

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SECONDARY: affects adults Commonly occurs at vermilion border of the lip but less often lesion appear intraorally on the hard palate and gingiva. It is presumed that virus lies dormant in the trigeminal ganglion and when reactivated, travels along peripheral sensory nerves to involve oropharyngeal mucosa. Tretment: acyclovir 200 mg 5 times for 7 days

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Hand-foot-and-mouth disease (HFMD) is a systemic infection caused by coxsackievirus A16, characterizedby ulcerative oral lesions and a vesicular exanthem on the distal extremities in associationwith mild constitutional symptoms.

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EPIDEMIOLOGY Age of Onset Most commonly children younger than 10 years of age, but also young and middle-aged adults. Etiology Coxsackievirus A16. Sporadic cases have been reported with coxsackievirusesA4–7, A9, A10, B2, and B5 and enterovirus 71. Season Epidemic outbreaks every 3 years. Intemperate climates, outbreaks during warmer months. Transmission Highly contagious, spread from person to person by oral-oral and fecal-oral routes.

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MANAGEMENT Symptomatic treatment, including topical application of dyclonine HCl solution or lidocaine gel, may reduce oral discomfort.

Oropharyngeal Candidiasis : 

Candidiasis of the oropharyngeal mucosa (OPC) occurs with minor variations of host factors such as antibiotic therapy, glucocorticoid therapy (topical or systemic), age (very young, very old) aswell as with significant immunocompromise. Esophageal and/or tracheobronchial candidiasis may be associated with oropharyngeal candidiasis and always occurs in the setting of advanced immunocompromise. Candida can invade through eroded mucosa, with resultant fungemia and invasive candidiasis. Synonyms: Thrush, mycotic stomatitis, Candida leukoplakia. Oropharyngeal Candidiasis

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DIAGNOSIS Clinical suspicion confirmed by KOH preparationof scraping from mucosal surface.

MANAGEMENT : 

Topical Therapy These preparations are effective in the immunocompetent individual but relatively ineffective with decreasing cellmediated immunity. Nystatin Oral tablets, 100,000 units qid dissolved slowly in the mouth, are the most effective preparation. The oral suspension, 1 to 2 teaspoons, held in mouth for 5 min and then swallowed may be effective. Clotrimazole Oral tablets (troche), 10 mg, onetablet 5 times daily may be effective. MANAGEMENT

Aphthous Ulcer : 

Aphthous ulcers (AU) are painful mucosal ulcerations of idiopathic etiology occurring commonly in the oropharynx and less commonly in the esophagus, upper and lower GI tract, and anogenital epithelium, characterized clinically by pain and sharply marginated gray-based, red-rimmed ulcer(s). Synonyms: Aphthous (ancient Greek word for “ulcer”) stomatitis, “canker sore.” Minor AU: recurrentaphthae of Mikulicz. Major AU: Sutton’s disease, periadenitis mucosa necrotica recurrens. Aphthous Ulcer

Fig- Aphthous ulcers Multiple, very painful, graybased ulcers with erythematous halos on the labial mucosa. : 

Fig- Aphthous ulcers Multiple, very painful, graybased ulcers with erythematous halos on the labial mucosa.

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EPIDEMIOLOGY Age of Onset Any age; often during second decade, persisting into adulthood, and becoming less frequent with advancing age. Sex Females > males. Etiology Unknown. Incidence Extremely common; most adults experience AU at some time during their lives. Risk Factors Local trauma, heredity. Associated Disorders Behçet’s disease, cyclicneutropenia, HIV disease.

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DIAGNOSIS : Clinically MANAGEMENT Topical Modalities Topical glucocorticoids in a base suited for mucous membranes. Topical anesthetics (diphenhydramine, viscous lidocaine). Intralesional triamcinolone Injection 3 to10 mg/mL. Systemic Therapy In persons with large, persistent, painful AU interfering with nutrition, a brief course of oral glucocorticoids is effective. Thalidomide particularly has been used successfully in persons with HIV disease, Behçet’s disease, and large painful AU.

Mucocele : 

Mucocele is a painless, translucent, blister-like swelling of the mucous membrane that is easily ruptured,drains a clear fluid, and then refills. It develops at sites where minor salivary glands are easily traumatized: mucous membranes of the lip and floor of the mouth. May be chronic, recurrent,and then it presents as a firm, inflamed nodule. Synonym: Ranula. Mucocele

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PHYSICAL EXAMINATION: Mucus-filled cavity, with a thick roof ; chronic lesions are firm, inflamed, poorly circumscribed nodules; bluish, translucent; fluctuant. Occur in areas in the mouth wheresalivary glands are exposed to trauma, i.e., floor of the mouth, lower lip. Dermatopathology Cavity in the connective tissue that is filled with mucoid material and contained in a capsule of granulation tissue; polymorphonuclear leukocytes and “foamy”macrophages are present in the mucoid material.

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SUBMUCOUS FIBROSIS : 

SUBMUCOUS FIBROSIS It is a chronic insidious process characterised by juxta epithelial deposition of fibrous tissue in the oral cavity and sometimes in the pharynx. The condition was first described in India by Joshi in 1953.

Showing clinical picture (blanching and fibrosis) in oral submucous fibrosis : 

Showing clinical picture (blanching and fibrosis) in oral submucous fibrosis

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AETIOLOGY: PROLONGED LOCAL IRRITATION DIETARY DEFICIENCY LOCALISED COLLAGEN DISEASE RACIAL

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PATHOLOGY Basic change is fibroelastotic transformation of connective tissues in lamina propria associated with epithelial atrophy, sometimes preceded by vesicle formation . When fibrosis is marked, there is progressive trismus and difficulty to protrude the tongue.

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CLINICAL FEATURE AGE AND SEX: 20-40 Soreness of mouth with constant burning sensation ; worsened during meals particularly of pungent spicy type Repeated vesicular eruption on the palate and pillars. Difficulty to open the mouth fully Difficulty to protrude the tongue

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FINDING :- changes of submucous fibrosis are most marked over Soft palate Faucial pillars and buccal mucosa In iniitial stages, there is patchy redness of mucous membrane with formation of vesicles which rupture to form superficial ulcers. In later stages, when fibrosis develops in the submucosal layers, there is blanching of mucosa with loss of suppleness. Fibrosis and scarring has also been demonstrated in the underlying muscle leading to further restrictive mobility of soft palate, tongue and jaw. Trismus is progressive.

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Tretment Medical Topical injection of steroids into the affected area is more effective than their systemic use as it also has the advantage of fewer side effects. It may be combined with hylase Avoid irritant factors Treat existent anaemia or vit deficiencies

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Surgical attempts to force open the mouth or cutting bands under anaesthesia to relieve trismus have resulted in more fibrosis and disability. Recently, lasers have been used to cut the fibrous bands.