derma

1. Diseases of the oral cavity and
salivary gland
TEKLEWEINI ABRHA (MD)

2. Mouth = Oral Cavity
• Opening of alimentary canal
• Lined with mucosa
• Thick, stratified epithelium (slightly
keratinized in some parts)
• Boundaries
– Anterior = lips
– Lateral = cheeks
– Posterior = oropharynx
– Superior = palate-hard & soft
– Inferior = tongue
• Vestibule & oral cavity proper
• Consists of the lips, bucal mucosa
,tongue ,maxillary & mandibular
bones, alveolar ridges & teeth
Pg 617

3. Function of oral cavity
• Serve as the entrance of alimentary tract & to
initiate the digestive process
• As a secondary respiratory conduit
• A site of sound modification for the
production of speech & chemosensory organ
• Is well endowed with sensory & reflex
activities to facilitate ingestion & digestion &
promote the expulsion of noxious material

4. TONGUE
• A muscular structure
 Anterior 2/3-is in the oral cavity & triangular in
shape
• Posterior 1/3-is part of oropharynxCreates floor of
mouth
• Attachments: hyoid, mandible, soft palate
• Innervation
– Motor = Hypoglossal (CN XII)
– Sensory (Taste) = Mandibular (CN V), Facial (CN VII),
Glossopharyngeal (CN IX)

7. TONGUE…
• Functions
– Grips and moves food between teeth during
chewing
– Mixes food with saliva = BOLUS
– Moves bolus down pharynx
– Speech production
– Has taste buds for taste sensation

8. Diseases of the oral cavity
• Congenital-
– cleft lip ,cleft palate
– microglossia, macroglossia
• Inflammatory-
– Viral –herpangina ,HSV ,HZ ,HIV ,EBV …
– Bacterial – TB ,syphilis ,actinomycosis
– Fungal -candidiasis
• Neoplasms-
– Benign- solid –papiloma ,fibroma ,hemangioma
-cystic –mucocele ,ranula ,dermoid
– Premalignant –leucoplakia ,erytroplakia ,melanosis
– malignant

9. • SCC constitute 95% of cases
• SCC
– Average age at diagnosis is 60 years
– Incidence increases with age
Etiology
• Well established causes
- Tobacco(80-90% of cases)
- Alcohol
- Tobacco & alcohol ----Synergistic effect
- Pipe smoking & sun exposure
- Poor oral hygiene
- Dietary deficiency –VA ,VC ,Iron ,
- Recent studies suggest HSV 1,HPV 2, 11, 16
Malignant tumors of the oral cavity

10. Fig.
Incidence of SCC in the oral cavity by site

11. • Clinically early lesions appear
- Indurated nodules or shallow ulcer with poorly defined margins
- Exophytic, infiltrative resulting in functional abnormalities
Pathogenesis

12. • Majority present as ulcer
• Lump in the lip/oral cavity
• White/red patches in the oral cavity
• Palpation yield more information than inspection alone
• Others suggesting malignant growth
- Unusual pain or bleeding
- Difficulty/pain with chewing/swallowing
- Change in fit of dentures
- Referred otalgia, change in voice
Clinical features

13. • Biopsy mandatory before any surgical intervention
• Surgery & radiotherapy primary mode of treatment
• Radiation for high risk of regional recurrences
Treatment

14. Salivary Glands
• Exocrine, tubuloalveolar glands
• Produce Saliva
• MINOR salivary glands are small
– In mucosa of tongue, lips, palate, cheeks
– Keep areas wet
• MAJOR salivary glands are large, have ducts
– External to mouth
– Provide saliva when necessary or anticipated
– 2 Submandibular, 2 Sublingual, 2 Parotid glands

15. Salivary Glands…
Function of saliva
• Moisten mouth, wet food
• Dissolve food to taste
• Bind food together
• Begin to break down starch
• Neutralize mouth acid
• Kill harmful microorganisms
• Promote beneficial bacteria

16. Diseases of the salivary gland
• Congenital -agenesis
• Inflammatory –viral ,bacterial, granulomatous
• Trauma
• Neoplasm
– Benign
– malignant

17. Sialadenitis
• inflammation of salivary glands
Etiology
• viral most common (mumps)
• bacterial causes: S. aureus, S. pneumoniae, H. influenzae
• obstructive vs. non-obstructive
Predisposing Factors
• HIV
• anorexia/bulimia
• Sjogren’s syndrome
• Cushing’s, hypothyroidism, DM
• hepatic/renal failure
• medicatios that increase stasis: diuretics, TCAs, beta-blockers,
anticholinergics, antibiotics

18. Clinical Features
• acute onset of pain and edema of parotid or submandibular gland
that may lead to marked swelling
• ± fever
• ± leukocytosis
• ± suppurative drainage from punctum of the gland
Investigations
• U/S imaging to differentiate obstructive vs. non-obstructive
sialadenitis
Treatment
• bacterial: treat with cloxacillin ± abscess drainage
• viral: no treatment
N.B. Mumps usually presents with bilateral parotid enlargement, ±
sensorineural hearing loss, ± orchitis.

19. Sialolithiasis
• stone in the parenchyma or the duct
• 80% in submandibular gland, <20% in parotid gland, ~1% in
sublingual gland
Risk Factors
• any condition causing duct stenosis or a change in salivary
secretions (e.g. dehydration, diabetes, hypercalcemia)
Clinical Features
• pain and tenderness over involved gland
• intermittent swelling related to meals
• digital palpation reveals presence of calculi

20. Investigations
• X-ray
• u/s
Treatment
• may resolve spontaneously if small
• encourage salivation to clear calculus
• remove calculi by dilating duct and orifice or excision through
floor of mouth
• if calculus is within the gland parenchyma then the whole gland
must be excised.

21. Salivary Gland Neoplasms
• 75% are benign
– 80% of them arise from parotid gland
• Malignant –common in the minor salivary glands
Epidemiology
• 3 to 6% of all head and neck neoplasms in adults
• mean age at presentation: 55 to 65
Clinical presentation
• Benign - painless slow-growing mass
• Malignant –rapid growth ,pain ,Facial nerve involvement
P/E – restricted mobility ,fixity to the overlying skin

22. Salivary Gland Neoplasms…
Investigations
• fine needle aspiration
• Large bore needle biopsy
• Excisional biopsy
• CT or MRI to determine extent of tumour
Treatment
• surgery for all salivary gland neoplasms