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Oral cavity ppt- college seminar

  2.  The oral cavity represents the first part of the digestive tube.  Its primary function is to serve as the entrance of the alimentary tract and to initiate the digestive process by salivation and propulsion of the alimentary bolus into the pharynx.  It's lined by mucous membrane which is pink in color non-keratinizing stratified squamous epithelia contain taste buds and minor salivary glands.
  3.  Posteriorly: Separated from the oropharynx by anterior Pillar of the tonsil laterally The junction of the hard and soft palate above. And the line of the circumvallate papillae bellow.  Anteriorly: the junction of the mucosa & vermillion border with the skin of the lips.  Inferiorly: the junction of the ant. 2/3 and the posterior 1/3 of the tongue.  Superiorly: the junction of the hard palate and soft palate. Anatomy of the oral cavity ANATOMY
  4. 1. Sensory nerve supply • Anterior 2/3 tongue: • General sensation: lingual nerve from mandibular branch of trigeminal nerve. • Special sensation (Taste): facial nerve via chorda tympani • Posterior 1/3: general sensation + taste by Hypoglossal nerve . • Roof: general sensation via the maxillary branch of trigeminal nerve. 2. Motor nerve supply: • The hard and soft palates are innervated by the greater palatine and nasopalatine nerves.They are both derived from the maxillary branch (V2) of the trigeminal nerve. • Muscle in the cheek and the lip are supplied by the branches of the facial nerve • The muscles of the tongue supplied by Hypoglossal nerve
  5. A. Cleft lip and palate. B. Congenital abnormalities of the jaws such as Pierre Robin syndrome which is a congenital condition of facial abnormalities in humans it is a chain of certain developmental malformations. The three main features are cleft palate, retrognathia and glossoptosis.
  6. 1. Dyskeratosis congenita: (DKC), also known as Zinsser- Engman-Cole syndrome it's a rare congenital abnormality resulting in dyskeratotic white patches in the mouth also associated with abnormalities of the skin pigmentation, leukoplakia, cornea. 2. Fordyce’s spots: are small raised, pale red, yellowish or skin- colored spots that appear on the the labia, scrotum, or the vermilion border of the lips of a person's face these lesions are of no significance.
  7. 3. White sponge naevus: • Is an autosomal dominant condition of the oral mucosa. • It is caused by a defect in the normal process of keratinization of the mucosa. • This results in lesions which are thick, white on the inside of the cheeks within the mouth. • Usually, these lesions are present from birth or develop during childhood. • The condition is entirely harmless, and no treatment is required 4. Hereditary hemorrhagic telangiectasia ( osler-Weber disease): • Is a rare autosomal dominant genetic disorder that leads to abnormal blood vessel formation in the skin, mucous membranes, and often in organs such as the lungs, liver, and brain.
  8. 1. Macroglossia: • Is the medical term for an unusually large tongue • Occurs in congenital diseases e.g. /Down syndrome, cretinism • Or NON- congenital like lymphangioma, acromegaly 2. Ankyloglossia: • Also known as tongue-tie. • Is a congenital oral anomaly that decrease mobility of the tongue tip • Caused by an unusually short, thick lingual frenulum. • It is rarely severe enough to affect suckling or later speech. • Treated by horizontal incision and vertical repair.
  9. 3. Median rhomboid glossitis: • It's of no significance. • Flat pink area on the dorsum of the tongue anterior to the circumvallate papillae 4. Lingual thyroid: • Part or the whole the thyroid tissue will stay in the foramen cecum (in the midline of the posterior 1/3 of the tongue( as soft tissue mass. • It's important to remember that it may be the only thyroid tissue in the body and may be a site of a thyroid neoplasm.
  10. 1. Hematological diseases: A. Agranulocytosis: it is an acute condition involving a severe and dangerous leukopenia. It causes acute ulcers and sloughing in the oral cavity. B. Acute leukemia: leukemia depend on the general status of patients include gingival swelling, oral ulceration, spontaneous gingival bleeding, petechiae, mucosal pallor, herpetic infections and candidiasis. C. AIDs: causes hairy leukoplakia, oral candidiasis, herpetic stomatitis, and Kaposi sarcoma.
  11. C. Measles ➡ Kopliks spots. A. Chicken pox ➡ Vesicles B. Acute streptococcal tonsillitis ➡ strawberry tongue. D. Glandular fever ➡ petechial rash on the hard palate 2. Acute exanthematous manifestation of viral infection
  12. 3. Drugs side effects: A. Penicillin, sulphonamides, and barbiturates ➡ oral thrush and erythema multiform. B. Phenytoin, nifidipine, cyclosporine ➡ Gingival hyperplasia . C. Gold salts ➡ ulcerations of the mouth
  13. 4.Vitamin deficiency: A. Vitamin c ➡ gingivitis. B. Iron, folate, B12 ➡ glossitis C. B2 (riboflavin) and nicotinic acid ➡ angular cheilitis and glossitis.
  14. 5. Auto-immune diseases: A. Chronic lupus and SLE causes vesicular and ulcerative lesions. B. Scleroderma. D. Sjögren syndrome: • Xerostomia, dry, red, wrinkled mucosa • Dysphagia • Disturbance in taste. • Increase risk of infections. C. behcet's disease
  15. • Black people have darker color of gums. • Hemochromatosis. McCune-Albright syndrome Mercury chronic lead-poisoning (plumbism)
  16. Peutz- Jegher syndromeMelanoma Addison's diseaseBismuth
  17. A.Viral: 1. Primary herpetic gingivostomatitis: • Caused by herpes simplex virus 1 • Frequently affecting children and adults not exposed to the virus before. • Clinically the patient have fever, malaise vesicular lesions 2-4 mm in size which breaks forming ulcers with yellowish base. • Last's 1-2 weeks. • Recurrent oral herpes is unusual while herpes labials (cold sore) is very common.
  18. 2. Herpes zoster : • Affects the trigeminal nerve causing painful unilateral lesions may be associated with cervical lymph node and facial nerve palsy. 3. Hand foot mouth disease: • Mild, contagious viral infection caused by Group A coxsacki virus. • Mostly in children. • The incubation period is 1 week and it last about 1 week. • The patient has fever, malaise, with vesicles on the hand, feet, buttocks, and mouth and later ulcers 4. Herpangina: Occurs mainly in children and caused by different viruses (Coxsackie, echovirus) It's similar to herpes simplex but the lesions are more in the oropharynx than the oral cavity.
  19. B. Bacterial infections: 1. Acute necrotizing gingivitis: • Caused by borrelia vincentii and anaerobic bacillus fusiformis. • Affect the inter dental papillae in debilitated adults with poor dental hygiene. • The patient had pain, fever, enlarged lymph nodes, ulceration, and necrotic membrane which may spread to the tonsil and nasopharynx. • Treatment is by local mouth wash and systemic penicillin and flagyl (IV).
  20. 2. Gangrenous stomatitis (cancrum oris) • Severe disfiguring infection of the mouth and face that starts as a gingival ulcer and spreads rapidly through the tissues of the mouth and face. • The exact cause is unknown, but may be due to bacteria called Fusobacterium necrophorum. • Often following other illness such as measles or tuberculosis. • This disorder most often occurs in young, severely malnourished children between the ages of 2 and 5 and is mostly found in African children. • Treatment: antibiotics and proper nutrition helps stop the disease from getting worse. • Plastic surgery may be necessary to remove destroyed tissues.
  21. C. Fungal infections: 1. Candidiasis:  Fungal infection due to any type of candida . when it affects the mouth, it is commonly called thrush  Acute type: • Multiple small white patches when wiped off leaving painful erythematous patch • Treated by local nystatin or amphotericin.  Chronic type: • White lesion cannot be rubbed off (candidal leukoplakia) mainly inside the corner of the mouth. • Treated by ketoconazole.
  22. 2. Histoplasmosis • Systemic fungal disease caused by histoplasma capsulatum that takes various clinical forms among which oral lesions are rare. • The disseminated form of the disease that usually occurs in association with HIV. • Histoplasmosis causing granular looking ulcers usually in wide spread. • Treatment is by ketoconazole.
  23.  Traumatic injuries to oral mucosa are quite common.  Traumatic ulcers are most commonly affecting the tongue, lips, and buccal mucosa .  These lesions may persist for a few days or even several weeks .
  24. Traumatic injury can occur by one of the following means :  Mechanical .  Thermal .  Chemical.  Factitious injury .  Radiation .  Eosinophilic ulcer s (Traumatic Granuloma ) .
  25.  They are clinically diverse, but usually appear as a single , painful ulcer with a smooth red or whitish- yellow surface and a thin erythematous halo.  They are usually soft on palpation, and heal without scarring within 6–10 days, spontaneously or after removal of the cause.
  26. 1. Removing factors, caused trauma. 2. Good hygiene of oral cavity. 3. Antiseptic for 7-10 days. 4. Analgetics if it is necessary. 5. Topical steroids may be used for a short time. 6. Biopsy.
  27. 1- Aphthous ulceration  It is very common ulcers with unknown etiology (hypersestivity reaction ,hormonal , vit defeciency, stress). There are basically 3 types of aphthous ulcers:  Recurrent minor aphthous ulcers, which occur in up to 80% of aphthous ulcer cases.They are usually less than 5mm in diameter and heal within 1-2 weeks.  Major aphthous ulcers, which are large ulcers (more than 10mm) that take weeks or months to heal and do so with scarring.  Herpetiform ulcers, which are multiple pinpoint ulcers that heal within a month.These are most commonly on the tongue.
  28.  It is of unknown eitology clinicaly the patient had relapsing oral and genital ulceration associted with uvitis , vasculitis of the skin ,synovitis and meningoencephalitis .  treatment by oral steroid .
  29. Is a rare chronic blistering skin disease. It classfied as type 2 hypersensitivity reaction.  it affect late middle age and elderly patients.  Pemphigus vulgaris most commonly presents with oral blisters (buccal and palatine mucosa, especially), but also includes cutaneous blisters.
  30.  Blisters commonly erode and leave ulcerated lesions and erosions.A positive Nikolsky sign (induction of blistering in normal skin or at the edge of a blister) is indicative of the disease.  Severe pain with chewing can lead to weight loss and malnutrition.
  31. Is a group of rare chronic autoimmune disorders characterized by blistering lesions that primarily affect the various mucous membranes of the body.The mucous membranes of the mouth and eyes are most often affected. usually results in permanent scarring of the affected area, particularly the conjunctiva .
  32.  Gum involvement is common, and as with lichen planus the gums are bright red  Compared to other conditions affecting the mouth, vesicles or small bullae may remain intact for some time. When erosions form they are slow to heal
  33.  Affecting young patient 10-13y  Secondary to herps and mycoplasma infection , or caused by drugs like pencillian. Most commonly lips, inside the cheeks, tongue Less commonly floor of the mouth, palate, gums.  Treatment is supporative and Systemic steroid .
  34. Uncommon benign ulaceration of the hard palate or oropharynx. It is thought to be caused by ischemic necrosis of minor salivary glands in response to trauma.  painless, self-limiting, heals within several weeks and most frequently develops in the palates ( unilateral ,bilateral or midline in location ) .
  35.  It’s an autoimmune disease .  In most cases the cause is idiopathic , other causes include drugs , mechanical trauma and viral infection.  It is uncommon disease with 2 types : 1. Reticular : slightly raised lesion with white bluish tinge and reticular striae . 2. Erosive: erythematous painful ulcerated lesion.
  36. Is defined as a predominantly white lesion on the mucous membrane with an increased risk of cancer with histological changes like : Keratosis, Hyperkeratosis, Parakeratosis ,Acanthosis .  Diagnosis is by biopsy .  Treatment is not needed in asymptomatic patient .  Antiviral (aciclovir/ valacyclovir).
  37. Mucosal abnormality which cause erythematous due to dysplasia without keratosis .The dysplasia is sever with high malignant potential.  These may appear as a bright red, smooth, velvety, granular or nodular lesions often with a well-defined margins adjacent to normal looking mucosa and are usually asymptomatic.  The soft palate, the floor of mouth, the ventral surface of tongue and the retro-molar area are the most common sites of involvement.
  38.  Called migratory glossitis or erythema migrans .  It’s bengin condition of unknown eaitology .  Clinically the patient is asymptomatic with map like appearance tongue due to loss of filiform papillae. No treatment is required .
  39.  Coated tongue due to elongation and accumulation of keratin assocaited with filiform paplliae it usually appear white in color and become black in smoker .  It’s of unknown eitology .  Treatment by scraping off the keratin with a brush.
  40. A. cyst of the mouth 1- Developmental cyst : the may be midline or lateral where the maxillary and premaxillary fuse. 2-Cyst associatd with the teeth . 3-Nasopalatine cyst 4-Cyst and tumors of the jaws. 5-Dermoid cyst : it may be submental or in the floor of the mouth and tongue.
  41. 6- Retention cyst or ranula : it is uni or multilocular mucous filled cyst in the floor of the mouth and classified into :- A.Simple ranula which an epithelial lining and confined to the floor of the mouth . B.Plunging ranula which is lined by connective tissue confined to the floor of the mouth or extend through mylohyoid muscle into the neck .
  42. Associted with the teeth ,dental caries , and gingivitis are predisposing factors .  These cyst may lead to destuction of the enamel and dentine and dental abscess formation leading to chronic inflammatory disease of the gum .  Traetment is by removal of swelling and treatment of causative infection .
  44. squamous papilloma arise from the stratified squamous epithelia of the oral cavity. It has little malignant transformation appears as :- 1- exophytic growth made up of numerous small finger like projections. 2- either single or multiple growth. 3- cauliflower or wart like appearance in the mucosa of the oral cavity, most frequently on the tongue.
  45. Papilloma of the tongue, appears as small, cauliflower elevations.
  46. Most common oral benign soft tissue tumor. Most of these lesions are infact hyperplasis or reactive poliferation of the fibrouse tissue due to irritation of trauma Appears as • round-to-ovoid, asymptomatic, smooth-surfaced, pedunculated mass. • The surface is usually similar in color to the surrounding mucosa but may be ulcerated, owing to repeated trauma. • Most often in the buccal mucosa where it is frequently bitten by the patient.
  47. Fibroma of the buccal mucosa Treatment is simple excision
  48. Most common benign salivary gland tumor in the oral cavity and it’s the most common tumor of the parotid gland. Appears as 1. soft, irregular, bluish or purple in color. 2. The tumor is usually solitary and presents as a slow growing, painless, firm single nodular mass. 3. Majority in the hard palate, also the tongue, floor of the mouth. 4. complete excision which should be as conservative as possible.
  49. Neurilemmoma is rarely seen. Neurofibroma is sometimes seen as part of Von- Recklinghausen’s disease. Neurofibromaneurilemmoma
  50. rarely seen as leiomyoma, rhabdomyoma and lipoma. Rhabdomyomaleiomyomalipoma
  51.  pseudoepitheliomatous hyperplasia  firm non ulcerated nodule  mass of large cells with granular eosinophilic cytoplasm.
  52. High risk lesions • Erythroplakia • Chronic hyperplasitic candidiasis Medium risk lesion • Oral submucous fibrosis • Syphlitic glossitis Low risk lesion • Oral lichen planus • Discoid lupus erthromatosus Conditions associated with malignant transformation
  53. 90 % of oral cancers are primary squamous cell carcinoma arising from the oral mucous membrane The incidence In India and parts of Asia western countries Highest rated 3 % of all 40% of all cancers cancers Tumors who tend to have a good prognosis are 1. Small , slow growing lesions. 2. Detected early. 3. Present in the front of the mouth. Tumors who tend to have the worst prognosis are 1. Rapid growing lesions. 2. Invade the bone. 3. Posteriorly sited.
  54. Mutagenic agents • Tobacco • alcohol Previous cancer • Oral • Esophagus • Lung • Throat Immuncompromized patients • AIDS • Post transplant patients Postulated agents • Chronic Candida infections • Vitamin deficiencies
  55. 1) area of ulceration, often Surrounded by leukoplakic or erythroplakic patches. 2) commonest sites involved are floor of the mouth, ventro- lateral tongue and the soft palate. Ulcerated lesionof an oral squamous cell carcinoma arising on the lateral border of the tongue
  56. 3) Symptoms of early lesions: Asymptomatic, Irritation, Discomfort 4) Symptoms of late lesions: non-specific symptoms Pain , swelling, Parasthesia , Dysarthia , Dysphagia . 5) Signs of oral cancer: Non-healing ulcer Induration and fixation of tissues Exophytic growth White/red mucosal patches Unexplained localized tooth mobility Non-healing tooth socket SQUAMOUS CELL CARCINOMA
  57. Oral cancer has the Ability to invade and destroy local structures Spread via lymphatic into the neck. Pattern of spread is essential for effective treatment . Local invasion Can infiltrate widely into adjacent connective tissue within (muscle bundles, perineural spaces) local blood vessels. Direct extension via odontal membrane or cortical deficiencies in edentulous ridges allows invasion of alveolar bone.
  58. •More frequent in the later stages •May not be clinically apparent • but metastatic deposits have been found in the lungs, liver and bones in approximately 50% of post-mortem examinations carried out in patients dying with oral cancer.
  59. o Effective exposure and complete removal of oral tumors. o Surgical approach should be easy to repair and produce minimal scarring and deformity. o Splitting of the lip, division of the mandible(mandibulotomy) .
  60. o Fully displays the posterior tongue, retromolar and soft palate regions and facilitates tumour excision .
  61. o Facial cheek flaps and maxillary osteotomies allow similar access to the posterior palate and retro maxillary regions.
  62. Resection of the primary tumor o The principal objective of surgical treatment is to excise the entire primary tumor with a margin (ideally about 1cm) of adjacent normal tissue in anticipation of microscopic spread, and to remove channels of metastasis such as nerves, vessels and lymphatics. o Anterior tongue tumors may require partial, hemi or subtotal glossectomy depending on the size and position.
  63. o Lower lip cancers may be treated by wedge excision alone or combined with a lip shave procedure (removal of the entire vermilion).
  64. o small buccal mucosal cancers can be excised intraorally, more advanced lesions may require excision of buccinator muscle and overlying skin. o Tumors of the floor of mouth, retromolar region and lower alveolus usually involve the underlying mandible and require mandibular resection. The inferior dental nerve canal, should be included in mandibular body resections due to the likelihood of perineural spread. o Mucosal excision, alveolar resection, palatal fenestration or maxillectomy may be required for tumours arising from the palatal mucosa and maxillary alveolus depending on their size and position.
  65. Management of the neck o Neck dissection o It is indicated after clinical examination or imaging techniques confirm enlarged lymph nodes. FNA may be carried out to confirm cytologically the presence of carcinoma deposits within enlarged nodes. o In oral cancer management. Levels I to III or IV are the most often dissected
  66. o post-operative radiotherapy advised if multiple nodes prove positive or there is extra capsular tumor spread. o Neck dissection contraindicated in extensive disease where involved lymph nodes may be fixed by tumour extension into vital structures such as the carotid artery or skull base. A complete surgical excision is either not possible or may produce significant morbidity or even mortality.
  67. Reconstruction o Important aims of reconstruction is :-  prevent facial deformity.  Maintain bone continuity. and facilitate masticatory, swallowing and speech functions.  Reduction of psychological morbidity.  Acceptable quality of life outcome. o By tissue transfer and micro vascular surgery, in which free flaps (often comprising skin, muscle and bone) are transferred from distant sites and their dependent arteries and veins connected to vessels in the neck.
  68. o The radial forearm osseofasciocutaneous flap, a groin flap, or the fibula flap, may be used to reconstruct the mandible. o Maxillary defects result in direct communications between oral and nasal cavities or the paranasal sinuses, with the inevitable production of nasal speech and swallowing difficulties.
  69. Radiotherapy o Radiotherapy is the treatment of tumors with ionizing radiation and is potentially curative in oral cancer treatment. o X-ray, gamma ray and less commonly particulate radiation is delivered either as external beams from outside the patient (teletherapy)
  70. o or radioactive materials such as iridium wires can be implanted within or in close proximity to the tumor (brachytherapy).
  71. o Chemotherapy has provided a major advance in the management of certain malignancies. chemotherapeutic agents have markedly improved the long-term survival rates of patients. In general, chemotherapy is less effective in treating solid tumours in adults and is rarely of curative value in oral cancer treatment, but may have a role in trying to prevent secondary tumours developing from metastatic deposits.
  72. o Chemotherapy Drugs like Cisplatin , 5-fluorouracil o Targets of Chemotherapy actively dividing cells to eliminate tumours . o Side effects of chemotherapy are nausea and vomiting, bone marrow suppression, alopecia and oral mucositis. To reduce the severity of mucositis, a high standard of oral hygiene and careful attention to preventive and restorative dental care is essential .

Editor's Notes

  1. retrognathia (abnormal positioning of the jaw or maxilla) and glossoptosis (airway obstruction caused by backwards displacement of the tongue base)
  2. Acquired forms of agranulocytosis can be caused by: drugs, such as clozapine and antithyroid medication. exposure to chemicals, such as the insecticide DDT. diseases that affect bone marrow, such as cancer. serious infections. exposure to radiation. autoimmune diseases, such as systemic lupus erythematosus.
  3. An exanthem is any eruptive skin rash that may be associated with fever or other systemic symptoms.
  4. erythema multiform presents a localized eruption of the skin with minimal or no mucosal involvement.
  5. red, swollen patches in the corners of your mouth 
  6. Scleroderma – diffuse sclerosis of the skin, GIT, heart muscle, lungs, kidney Oral signs – pursed lips – dificult to open the mouth , decreased mobility of tongue – salivary hypofunction Connective-tissue diseases Limited mouth opening and decreased tongue mobility Gingival retraction
  7. 1. accumulation of iron in the body from any cause. The most important causes are hereditary haemochromatosis (HHC), McCune-Albright syndrome is a disorder that affects the bones, skin swelling of both jaws
  8. BISMUTH LINE”: a thin blue black line in the marginal gingiva sometimes confined to gingival papillae. Also seen in buccal mucosa and ventral surface of tongue • Pigmentation shows precipitated granules of bismuth sulfide produced by action of hydrogen sulfide on bismuth. • Hydrogen sulfide is produced by bacterial degradation of organic material or food debris. • Burning sensation • Metallic taste
  9. Ramsey hunt syndrome