journal presentation

1. JOURNAL PRESENTATION
HOD – DR.SAMAR CHATTERJEE
GUIDE – DR. ANJALI MANAYIL
PRESENTER – DR. PINDI SOWMYA
PG PART – 1 ( JNR)

2. IDENTIFY ???

3. ORAL LEUKOPLAKIA
• DEFINITION:
It may be clinically defined as a white patch or plaque on the oral mucosa, exceeding
5 mm in diameter, which cannot be rubbed off nor can be classified into any other
diagnosable disease.
It is a premalginant lesion,now considered as potentially malignant disorder by WHO
• INCIDENCE:
More in male than females
Common in middle aged and elderly
The prevalence increases with age.

4. ETIOLOGY
• Multifactorial and many causes are idiopathic.
• Main cause among those are smoking and tobacco in all forms, betal
nut, paan.
• Alcohol consumption, chronic irritation Infections like chronic
candidiasis, bacterial infections
• Sexually transmitted diseases like syphilis

5. TYPES OF LEUKOPLAKIA
1.Homogeneous leukoplakia: smooth, white
2. Nodular leukoplakia: nodular, white
3. Verrucous leukoplakia: warty, white
4. Speckled (erythro) leukoplakia:
white&red

6. PATHOPHYSIOLOGY
1. Tissue cell is exposed to any type of carcinogen.
2. Tissue cell tries to adapt by increase in cell proliferation, shrinking the cytosolic
capacity, and the allied organelle loadoral epithelium, a hastened growth phase
represented by augmentation of the progenitor compartment (hyperplasia)
3. When the irritant persists further, the epithelium shows features of cellular
degeneration, a well-characterized feature of adaptation (atrophy).
4. When the stage of adaptation and revocable cell damage ends, the cells gradually
reach a stage of irrevocable cell damage, manifesting as either apoptosis or
malignant transformation.

7. PATHOLOGICAL STAGE
1.Hyperkeratosis: thickening of stratum corneum
2. Parakeratosis: keratinization with retention of nuclei in stratum
corneum (homogeneous leukoplakia)
3. Acanthosis: thickening of stratum spinosum(verrucous & nodular
leukoplakia)
4. Dyskeratosis: abnormal keratinization presentCow stratum
granulosum (speckled leukoplakia)

8. STAGES OF LEUKOPLAKIA
• L – SIZE OF OL P – HISTOPATHOLOGICAL
• L1 - Lesion ≤ 2 cm P0 – No dysplasia
• L2 - Lesion of 2-4 cm P1 – Dysplasia
• L3 - Lesion ≥ 4 cm PX – Presence of dysplasia not specified
• Lx - Size of lesion not specified
• C – CLINICAL PRESENTATION
• C1 - Homogenous leukoplakia
• C2 - Non homogenous leukoplakia

9. EVALUATION
• Gold standard for diagnosis of leukoplakia = BIOPSY from the site of the lesion,
but this procedure needs a qualified health-care provider and is considered as an
invasive, painful, expensive, and time-consuming procedure.
• In the case of small lesions = excisional biopsy is indicated,
• large lesion = incisional biopsy, including the adjacent healthy tissue, is removed
for histopathological examination.
• conventional clinical diagnostic tools for timely detection of leukoplakia include
toluidine blue dye, oral brush biopsy kits, and salivary diagnostics and optical
imaging systems.

10. CONVENTIONAL TREATMENTS
• Surgical execision
• Laser therapy
• Photodynamic therapy
• Topical agents and drugs

11. DIFFERENTIAL
DIAGNOSIS
1. ORAL LICHEN PLANUS
2. ORAL CANDIASIS
3. ORAL CANCER
4. WHITE SPONGE NEVUS

12. Homoeopathic treatment of oral leucoplakia: A
case report
• Authors:
• Suraia Parveen
• Dr. Anjali Chatterji Regional Research Institute for Homoeopathy, Kolkata,
West Bengal, India, drsuraia@gmail.com Zeeshan Ahmed
• Regional Research Institute (H), Guwahati, Assam, India

13. ABSTRACT
• Introduction: Oral leucoplakia (OL), a premalignant lesion which is more
frequently encountered in elderly people, is defined as a white lesion of the
oral mucosa. Smoking is one of the most common risk factors.
Conventionally, surgical excision is the most recommended treatment option
for OL.

14. CASE SUMMARY
• A 55-year-old male presented with the complaint of a whitish lesion inside
the left angle of the mouth(buccal mucosa) for the past 1½ years. The case
was clinically diagnosed as OL. He was advised for surgical excision, but he
preferred to go for homoeopathic treatment. Based on characteristic
symptoms, repertorial analysis and individualisation, homoeopathic medicine
Kali iodatum (200C and 1M) followed by Syphilinum 200C was prescribed.
Over 14 months of treatment, the patient initially improved with Kali
iodatum followed by total remission of the lesion by Syphilinum.

15. • Modified Naranjo Criteria for Homoeopathy (MONARCH) was used to the
attribution of recovery to homoeopathic treatment. The MONARCH score
was (+8 on a ‘−6 to +13’ scale), which is indicative of the possibility of
patient’s improvement resulting from the homoeopathic treatment. This
clinical case report demonstrates the beneficial effects of individualized
homoeopathic treatment for the management of premalignant lesions like
OL.

16. CASE REPORT
• AGE: 55 Years
• SEX: Male
• DATE OF REPORTING: 27 October 2018
• PRESENTING COMPLAINT:
Complaint of whitish lesion inside the left angle of the mouth(buccal mucosa)for the
past 1 ½ years. There was pain and burning sensation over the lesion along with
excessive salivation,which aggravated in a warm room and after eating rich and spicy
food. The case was already diagnosed as OL by an allopathic physician.

17. BEFORE TREATMENT

18. HISTORY OF PRESENTING COMPLAINT
• The patient’s complaints started 1½ years back when he observed the
gradually increasing size of a white patchy lesion inside the left angle
of the mouth. There was no discomfort earlier, but for the past 2–3
months, he had started feeling pain and burning sensation after eating
anything spicy, along with excessive salivation. He was also suffering
from low back pain, which aggravated during walking. He reported to
have taken allopathic treatment for OL without much improvement
and was then advised surgery.

19. PAST HISTORY AND FAMILY HISTORY
• He had suffered from chicken pox at the age of 16 years and typhoid
at the age of 23 years and recovered well from both after taking
conventional treatment. His father was hypertensive, and mother
suffered from osteoarthritis.

20. PERSONAL HISTORY
• he patient used to work in a jute mill and belonged to a low
socioeconomic background. He had a habit of smoking tobacco in the
form of cigarettes/bidi (15–16/day) since 20 years of age. After
developing the white patch, he was advised to stop smoking by his
allopathic physician. Although he could not stop it altogether, he
reduced the quantity of smoking to 7–8 times/day. However, for the
past 6–7 months, following the appearance of this lesion, the patient
reported to have stopped smoking completely. He also consumed
alcohol occasionally for 10–15 years.

21. CLINICAL EXAMINATION
• Weight: 70 kg
• Height: 5ft 5 inches
• BMI: 25.7 kg/m2
• Oral examination : White patches inside the left angle of the mouth
and no other significant changes.

22. GENERALITIES
• The patient was very talkative, anxious and reported to have a marked
fear of death. His thermal reaction was hot, with an increased appetite
and profuse thirst. He had a craving for milk and preferred spicy and
rich food. His bowel movement was regular, but the urge for urination
was increased and he described his urine to be offensive. The patient
also occasionally complained of disturbed and unrefreshing sleep.

23. DIAGNOSTIC ASSESSMENT
• This was a diagnosed case of OL inside the left angle of the mouth (buccal
mucosa) [Figure 1] verified clinically in the OPD. For further confirmation, a
biopsy could not be done as the patient refused to undergo any invasive
investigation, despite counselling him for the same.

24. • Fear of death
• Very talkative
• Hot; aggravated in a warm room
• Appetite increased
• profuse thirst, drinks 3–4 litres of water/day
• Craving for milk
• Whitish lesion inside the left angle of the mouth (buccal mucosa)
• Pain and burning sensation over the lesion; aggravated from warm food and after eating rich
and spicy food
• .Soreness on the affected buccal mucosa
• •Excessive salivation
• •Low back pain aggravated by walking
• Frequent urination with offensive odour.

25. REPERTORISATION CHART

26. • After repertorisation, Kali iodatum covered the maximum number of
symptoms (14), with a total score of 26. Sulphur covered 13 symptoms,
while Calcarea carbonica and Natrum muriaticum covered 12 symptoms
each. The characteristic symptoms were assessed for the miasmatic
background and the case was found to be psoro-syphilitic.

27. • FIRST PRESCRIPTION:KALI IODATUM 200C FOUR GLOBULES OF
MEDICINE TWICE DAILY ON EMPTY STOMACH FOR TWO
CONSCUTIVE DAYS

33. MY WORK OUT

38. DEMERITS
• Size of lesion not mentioned
• They have only clinically diagnosed, and gold standard
diagnostic assessment is not done due to patient’s
unwillingness, but they could’ve provided negative
history
• Fear of death – common in these cases
• No proper justification on mental generals
• No adequate information on back pain and offensive
history
• In repertorisation too many unwanted symptoms.
• In the patient information there was no mention of
soreness of affected buccal mucosa but taken in
repertorisation.
MERITS
• This case report shows the
potential of homoeopthy to treat
pre malignant disorders and
prevent the further progress of
the condition into carcinoma.
• Homecare guidelines and
MONARCH Criteria have used.

39. THANK YOU