Diseases of oral cavity and tongue

1. Oral Cavity and
Tongue
PROFESSOR DR. AHMED AL ABBASI
F.R.C.S. ORL - SKULL BASE SURGERY

2. Learning Objectives
Learning Objectives
 Inflammatory lesions
 Benign ulcers and cysts
 Pigmentary disorders
 Potentially malignant lesions
 Cancer of oral cavity
 Diseases of tongue.

3. INFLAMMATORY
 Stomatitis and Gingivitis
 facultative organisms take advantage of any weakness in the
defenses of the oral mucosa and result in infection
 Nutritional deficiencies of iron, vitamin B12, folic acid and severe
protein deficiency lead to atrophy of the epithelium.
 In immunocompromised states due to chemotherapy,
agranulocytosis, aplastic anemia and steroid intake and reduced
healing may lead to secondary infection

4. Recurrent Aphthous Stomatitis

5. Herpes Simplex Infection
 vesicles that break-down to form ulcers with fever and lymphadenitis.
 Herpes febrilis presents as vesicles in infants and children during any febrile illness.

6. Pyogenic Granuloma
 a reddish nodular mass on the gingiva, in the area between two teeth. It is painless but
may bleed to touch. It may grow rapidly.
 Women are more affected than men.
 The term itself is a misnomer as it is a mass of proliferating capillaries sometimes as a
response to chronic irritation.
 Treatment is by surgical excision.

7. Vincent’s Angina
 Borrelia vincentii and Bacteroides fusiformis,
 It produces a deep ulcer covered with grayish necrotic slough
that bleeds readily.
 fever, dysphagia, salivation and submandibular swelling.
 penicillin and metronidazole. Repeated mouthwashes should
be given with dilute povidone-iodine

8. Oral Candidiasis (Thrush)

9. Cheek Bite
buccal mucosa getting caught between the teeth, slightly raised white linear streaks
develop along the lines of occlusion on both sides
Treatment by Grinding of any sharp teeth and reassurance to the patient is needed. A
biopsy should be done if the area is ulcerated or indurated.

10. Cancrum Oris
- severe form of orofacial disease
- poorly nourished children with poor oral hygiene
- often following other infections, particularly measles.
- During toxemia, severe dehydration results in thrombosis of the facial
arteries leads to necrosis of the orofacial tissues.
- Ulceration starts from the gums (acute necrotizing gingivitis, ANG) and
spreads into the jaws, lips and cheeks producing extensive tissue loss.

11. Treatment of Cancrum Oris
 penicillin and metronidazole.
 Local irrigation, and control of infection is important.
 high-protein diet with vitamins—initially through a
nasogastric tube.

12. Angular Cheilitis
- Thumb-sucking infants.
- In the elderly due to continuous drooling of saliva,
- moist cracks at the angles of the mouth may be infected with Candida and staphylococci.
Treatment consists of addressing the primary cause which may be straight-forward, yet difficult. Infection
may be controlled with application of gentian violet paint or nystatin cream and povidone-iodine
ointment.

13. Lichen Planus
- bilateral whitish striae (Wickham striae) on the buccal mucosa
and gingiva forming a reticular pattern. Skin may involved
- It may also appear as whitish plaques, erythema or shallow
erosions.
- persists for years with periods of exacerbation and quiescence.
- If the diagnosis is not certain after clinical evaluation then a
biopsy should be performed to rule out premalignant or
malignant conditions. - --
- - Treatment is never curative. Topical steroid can be used to
manage periods of exacerbations and reduce local symptoms
like pain.

14. Solitary Oral Ulcer
 Caused by a traumatic bite on the mucosa during meals. Ill-fitting dentures with
malocclusion too, are responsible for recurrent traumatic ulcers.
 These are very painful but, but heal within a few day.
 If stay more than two weeks and no possible cause can be determined, a biopsy
must be performed to exclude a malignancy.
 Treatment : Frequent mouthwashes should be employed for traumatic ulcers.
Xylocaine viscous should be used for rinsing the mouth before meals. Ill-fitting
dentures should be changed.

15. Solitary Oral Ulcer

16. Ranula
 extravasation of secretions of the sublingual gland into the submucosal tissues of the
floor of mouth.
 It presents as a translucent bluish cystic swelling in the floor of the mouth to one side of
the midline.
 generally asymptomatic.
 It may extend into the neck and is then known as a plunging ranula
 Treatment is surgical resection, The sublingual gland should be excised as well.
Recurrences are not uncommon as excision may be incomplete.
 Marsupialization of the cyst will also ensure the safety of the submandibular duct

17. Ranula

18. Fordyce’s Granules(spots)
 Ectopic sebaceous glands present below the oral mucosa.
 They are generally numerous and appear as yellowish white papules, 1–3
mm in diameter with a slightly raised or cauliflower like top.
 Treatment Other than reassurance, no treatment is needed.

19. Pigmentation Disorders
Peutz-Jeghers Syndrome
Amalgam Tattoo
Melanotic Macules

20. Peutz-Jeghers Syndrome
It autosomal dominant condition characterized by hamartomatous intestinal polyps. In
labial and buccal mucosa pigmentation.
Investigation by barium enema or fiberoptic colonoscopy.
Treatment These patients should be kept on life long follow-up and biennial
esophagogastroduodenoscopy and colonoscopy and small bowel contrast studies to pick up
malignancies early.

21. Amalgam Tattoo
 It occurs due to implantation of amalgam into the oral
mucosa most often on the labial or alveolar region. It is a
non ulcerated, soft blue-black or gray macule generally less
than 0.5 cm in size.

22. Melanotic Macules
 Due to melanin deposition in the basal layer of the epidermis. These are
dark brown or black areas of discoloration without any ulceration and affect
any part of the oral mucosa.
 Oral nevi are rare in the mouth. These appear as brown or black elevated
papules.
 Oral melanomas are uncommon and similar to their cutaneous counterparts
in appearance .Unlike cutaneous melanomas, sun exposure is not a risk
factor.
 Treatment A biopsy or excision biopsy should be done if melanoma is
suspected.

23. NEOPLASMS
Premalignant Lesions
Oral Submucus Fibrosis
Leukoplakia and Erythroplakia
Benign Papilloma
Solar Keratosis
Plummer-Vinson Syndrome

24. Oral Submucus Fibrosis
- atrophy of mucosa and fibrosis in the submucosal layer and deeper tissues of the oral cavity.
- Commonly affect buccal mucosa, retromolar trigone, tongue and soft palate.
- present bilaterally and symmetrically.
-
- common causative agent being the areca nut which is chewed in various forms in India and tobacco
abuse, excessive use of spices and malnutrition may be contributing factors.

25. Oral Submucus Fibrosis
 Clinically : - burning sensation and pain when eating.
 - The affected mucosa looks white and blanched.
 - The mucosa loses its normal elasticity and is firm on palpation.
 - There is progressive trismus and
 - decrease in movements of the tongue.
 - Investigation : biopsy is carried out only in areas that are suspicious for malignant
change.
 - Treatment :Cessation of cofactors result in some degree of spontaneous resolution.
 - If trismus is severe, excision of buccal mucosa and replacement by a free skin graft is
required.
 - These patients should be screened lifelong by regular oral examination, and biopsy is
required if changes suspicious of cancer appear.

26. Leukoplakia and Erythroplakia

27. Benign Papilloma

28. Solar Keratosis

29. Plummer-Vinson Syndrome

30. Cancers of oral cavity
• Usually delayed presentation
• Male : female ratio = 2:1
• Increase with age
• Smoking & alcohol ;
• Poor oral hygiene
• Chewing betal nut
• Premalignant conditions

31. Spread of tumor
• Along tissue plane
• Floor of mouth
• Lymphatic drainage :
bilateral to
jugulodiagastric LN
jugulo-omohyoid LN

32. pathology
• Squamous cell cacinoma
• Verrocus carcinoma
• Spindle cell carcinoma
• Adenoid cystic carcinoma
• melanoma

33. Clinical Features
• Painful ulcers
• Dental features
• Referred otalgia
• Palpable LN
• Oral nodular lesions or mass

34. Investigations
• Radiology : X-ray
CT
MRI
Bone scan
• Biopsy :

35. T.N.M classifications
•T1 = less than 2 cm
•T2 = 2-4 cm
•T3 = 4-6 cm
•T4 = more than 6 cm or extraoral extention

36. Treatment
• T1& T2 = surgery or radiotherapy
• T3 & T4 = surgery
• T1 – T4 + any L.N = surgery + radiation

37. THANK YOU