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57 Cards in this Set
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Related to chronic trauma
Found on mucosa Dome-shaped, smooth surfaced nodule fibrous connective tissue |
Fibroma
conservative excision little recurrence |
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dense, firm, smooth surfaced nodule, ulcerated in premolar region
proliferation of fibroblastic cells, mineralized component |
peripheral ossifying fibroma
complete excision, remove local irritants 15% recurrence |
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smooth surfaced, dome shaped nodule, ulcerated mucosa, red
adult females cupping out of bone granulation-like,giant cells, erythrocytes and hemosiderin |
peripheral giant cell granuloma
complete surgical excision remove local irritants recurrence 15% |
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more common in pregnant females
smooth surfaced, ulcerated, lobular red to purple. found on gingiva, tongue, lips, b mucosa painless simulates malignancy granulation tissue, acute and chronic inflammatory cells |
pyogenic granuloma
excisional biopsy, remove local factors for gingival lesions delay if pregnant recurrence 15% |
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sinus tract opening, non-vital tooth and PA abscess
painless eryth nodule on gingiva, alveolar mucosa foul taste |
parulis
endo or extraction |
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painless, red mass of granulation tissue from pulp chamber of carious tooth
younger children |
chronic hyperplastic pulpitis (pulp polyp)
endo or extraction |
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chronic trauma secondary to denture not fitting
buccal vestibule dense fibrous CT, chronic inflammation |
inflammatory fibrous hyperplasia
(denture epulis, epulis fissuratum, denture induced fibrous hyperplasia excision remake denture |
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asymptomatic red papules usually on center of hard palate
constant use of (poor fitting) denture poor hygiene papillary epithelial and fibrous hyperplasia |
inflammatory papillary hyperplasia (denture papillomatosis)
benign process, may not require tx. removal is option |
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diffuse fibrotic gingival enlargement. correlated with oral hygiene
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Drug-related fibrous CT hyperplasia
dilantin 50% cyclosporine 25% Ca-channel blockers 25% |
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history of trauma occuring on tongue, lips, b mucosa, palate
erythematous ulcer with white to yellowish fibrin membrane periphery--ragged to smooth margins may be rolled and firm due to fibrosis loss of surface epithelium with fibrin |
traumatic ulceration
symptomatic--treat with Zilactin Topical corticosteroids--contraindicated several weeks--biopsy |
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same presentation as traumatic ulceration, but inflammation includes abundant eosini=ophils, but no true granuloma formation
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traumatic granuloma
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tender, done-shaped papule/nodule
found in mental foramen area, tongue, lower lip, may be intraosseous tangled mass of nerve bundles and fibers within dense fibrous CT |
traumatic neuroma
excisional biopsy |
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occurence on lower lip, b mucosa, ventral tongue
soft, nontender swelling may rupture, drain, and refill extravasated mucin, inflammatory cells and granulation tissue |
mucocele/ranula
excision of mucous deposit as well as involved salivary gland duct |
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black, blue or grey macule
gingiva, alveolar/b mucosa radiograph may detect metal particles |
amalgam/foreign body tattoo
no tx if evidence of foreign body. if no evidence, biopsy to rule out melanocytic lesion |
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white wrinkled appearance to mucosa
sloughing of epithelium adjacent to carious tooth coagulative necrosis of epithelium |
Aspirin burn
discontinue application of aspirin to mucosa |
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superficial sloughing usually with l/b mucosa
may increase sensitivity to acidic/spicy foods |
dentifrice-associated slough
replace dentifrice with bland formulation |
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single or multiple areas of white, sloughing mucosa
varying degrees of peripheral erythema coagulative necrosis of epithelium history of food burn |
electrical or thermal burns
analgesics if needed |
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extremely painful ulcerations with erythema
history of 2,500-3000 cGy during radiation |
radiation mucositis
topical anesthetic and systemic analgesics heals within 2-4 weeks after treatment |
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autoAb to desmoglein 3,1
oral lesions first, then skin progressive erosions and ulcerations fragile bullae and erosions positive nikolsky sign intraepithelial clefting with acantholysis tzanck cells positive direct and indirect IF |
pemphigus vulgaris
systemic corticosteroids |
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mortality rate of 5-10% with pemphigus vulgaris caused by
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complications of immunosuppressive therapy
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autoAbs against BMZ components
older females found on any mucosal surface, skin is uncommon positive nikolsky desquamative gingivitis ocular involvement--fibrosis-->blindness subepithelial cleft Direct IF positive, indirect is NEG |
mucous membrane pemphigoid
topical steroids for oral systemic steroids diffuse involvement eye lesions--aggressive systemic immunosuppressive therapy |
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immunologically mediated--similar to type IV, increased CD8 and CD4
skin--purple pruritic papules oral- reticular-white lines wickham's striae bilateral posterior erosive-epithelial ulceration, desquamative gingivitis |
lichen planus
treatment--reticular no treatment erosive--topical corticosteroids, good OH and mouthrinse |
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lichen planus histology
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civatte likes to plane and band saw
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chronic inflammatory disorder
affects CT, skin, joints, cardiopulmonary, kidney ANAs, females much more likely FUO, arthritis, butterfly rash weight loss proteinuria |
systemic lupus erythematosus
avoid excessive sunlight systemic corticosteroids anti-malarial |
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Systemic Lupus histology
lab cause of death prognosis |
lichenoid mucositis or dermatitis with vasculitis
ANAs anti dsDNA Abs. IF--shaggy BMZ IgG, M and C3 renal failure poorer for men even though they get it less |
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restricted to skin of head and neck
well demarcated, scaly, erythematous patches. central scarring oral lesions resemble erosive LP lichenoid mucositis or dermatitis with vasculitis almost no ANAs |
chronic cutaneous LE
avoid sunlight topical corticosteroids or anti malarials 5% conversion to SLE |
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Acute, self limiting ulcerative
triggered by drug or viral infection (HSV) young adult males sudden onset, mild mucosal, but can be severe mucocutaneous oral--hemmorhagic lesions of lips, l/b mucosa and tongue large, widespread ulcers w/ irregular margins "target lesions" annular w/ central purpura IF not helpful subepithelial vesiculation, necrotic keratinocytes, but not diagnostic |
erythema multiforme
supportive care (topical analgesics) for mild severe--systemic corticosteroids or management in burn unit antiviral to reduce recurrence severe (TEN)--34% mortality |
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oral lesions, ocular and genital conditions also present
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Stevens-Johnson syndrome (EM major)
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Systemic CT disease--abnormal deposition of collagen
diffuse, progressive induration of subQ CT sclerodactyly, dysphagia, pneumonia and dyspnea, kidney failure and hypertension Oral--purse string perioral skin diffuse symmetrical widening of the PDL resorption of ramus, coronoid process or condyle, xerostomia diffuse deposition of dense collagen while destroying and displacing normal ANAs (anti Scl 70 Abs) |
Systemic Sclerosis
scleroderma no tx that works well. poor prognosis |
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CREST syndrome
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mild scleroderma
Calcinosis cutis, Raynaud's phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasia better prognosis, affects skin |
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Chronic disease-rapid epithelial turnover
Cytokine dysregulation well-defined erythematous plaques with silvery scale oral is rare-white or red plaques |
Psoriasis
teens - 20s sun exposure coal tar derivatives topical steroids for mild PUVA or cyclosporine for severe |
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Koebner phenomenon
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incidence of psoriasis following local trauma
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chronic affects eyes, mouth, genital
immunologically mediated common in japan and middle east males more than females, 20-30 males are more severe oral-apthous ulcerations, multiple, soft palate, oropharynx. genital-75% ocular, recurrent uveitis, conjunctivitis positive pathergy test--skin prick--inflammatory pustule |
behcet's syndrome
treat with colchicine corticosteroids and immunosuppressive agents with CNS involvement, prognosis is guarded |
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abnormal intraepithelial attachments (desmosomal)
onset in childhood, multiple erythematous, confluent papules. smell in summer oral-asymptomatic white flat papules cobblestone central keratin plug overlying acantholytic epidermis grains and corps ronds-dyskeratotic cells |
keratosis follicularis (darier's disease)
genetic counseling keratolytic agents or retinoids for skin none for oral |
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etiology of epidermolysis bullosa
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abnormal production or molecular structures which bind epithelial cells to one another or to underlying basement membrane and CT
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3 types of EB
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simplex, junctional, dystrophic
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autosomal dominant inheritance
blisters on skin exposed to trauma, extremities heal with scarring, loss of nails oral-mild gingival erythema, recession, tenderness sub-epithelial clefting |
dominant dystrophic Epidermolysis bullosa
localized supportive care |
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autosomal recessive inheritance
severe, debilitating, prominent skin blisters with minimal trauma. mitten deformities oral-very fragile mucosa; microstomia sub-epithelial clefting |
recessive dystrophic epidermolysis bullosa
tx-soft foods, increased oral hygiene as possible aggressive management to reduce blistering, scarring and infection poor prognosis |
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penicillinase plus staph, strept. sporadic or complication of reduced salivary flow (dehydration, drugs, disease) may follow surgery
painful, parotid enlargement fever, local erythema, trismus, purulent exudate from parotid papilla (Stensen's) |
acude siladenitis
PCNase-resistant penicillin. culture to adjust antibiotic. hydrate, moist compresses. can be chronic or life-threatening |
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accumulation of debris, bacteria collect in excretory duct and undergo calcification. this is called what?
Where does this affect? What does this precede |
sialolith (salivary stone)
submandibular gland, but also in minor glands chronic sialadenitis (bacterial infection may also lead to chronic sialadenitis) |
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tender swelling localized to affected glands. 30-50 years old. dramatic swelling may occur at or just before eating. expressed saliva may have tiny white flects
may be palpable, hard submucosal mass. radiograph useful. sialography/US/CT to detect stones/obstruction |
sialolithiasis/chronic sialadenitis
surgical excision endoscopy/lithotripsy if gland is nonfunctional, complete removal of affected gland. |
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autoimmune process localized to parotid gland. uni or bilateral. early sjogren's syndrome
middle-aged, females more likely firm diffuse, nontender to mild parotid swelling. usually unilateral diffuse replacement of parotid tissue with lymphocytes residual epimyoepithelial islands |
benign lymphoepithelial lesion
systemic corticosteroids, surgery, immunosuppressive drugs. local irradiation. all tx have side effects and/or potential long term complications increased risk for lymphoma |
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chronic, systemic autoimmune disease
diffuse attack on salivary and lacrimal glands. females, mid-late adults |
sjogren's syndrome
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two forms of sjogren's
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primary (sicca)
secondary(sicca plus another autoimmune disease, particularly RA, SLE, systemic sclerosis |
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xerostomia, xerophthalmia, keratoconjunctivitis sicca.
dry oral mucosa, atrophy of the dorsal tongue, angular cheilitis diffuse parotid swelling, bilateral caries, candidiasis |
primary sjogren's
symptomatic relief xylitol, artificial saliva/tears. fluoride, oral hygiene, antifungals for candidiasis increased incidence of lymphoma (40X) |
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salivary gland bx is useful.
focal lymphocytic sialadenitis full blown cases essentially like BLEL Schirmer test-lacrimal gland function sialography-punctate sialectasis (fruit on branchless tree) serum-elevated rheumatoid factor, ANAs, anti-Ro (SS-A) anti-La (SS-B) all are specific, but not all are seen in every patient |
Secondary sjogren's
treat other autoimmune process, usually immunosuppressive |
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ischemic infarction of salivary gland tissue
adult males tender, non-ulcreated swelling of hard/soft palate. after a weak, portion may fall out leaving golf hole. painless ulceration mimics cancer acinar necrosis of minor glands. PEH may be seen (again mimics cancer) salivary ducts undergo squamous metaplasia |
necrotizing sialometaplasia
no treatment, healing requires several weeks |
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most common salivary gland neoplasm, 45 years old
parotid mainly affcted. palate is most common intraoral site non-tender, freely movable nodule. slow growth misture of ductal epithelial cell and myoepithelial cells can vary from myxoid, hyalinized, chondroid or even osseous tissue variety of histologic appearances (pleomorphic) encapsulated, but tumor tissue may protrude beyond capsule--recurrence? |
pleomorphic adenoma
biggest risk is malignant transformation complete surgical excision parotid--excision of tumor and involved lobe submandibular-entire gland plus tumor hard palate-overlying mucosa plus tumor, including periosteum l/b and soft palatal mucosa-simple enucleation most recurrences w/ major gland lesions |
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50s, male and female now
parotid gland almost exclusively, can be bilateral, synchronous or metachronous. 8X increased risk in smokers slow growing, non tender mass, tail of parotid. freely movable and asymptomatic encapsulated lymphoid tissue contains cystic spaces w intraluminal papillary projections of eosinophilic, columnar epithelial cells |
papillary cystadenoma lymphomatosum
Warthin's tumor simple surgical excision 10% recurrence |
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benign salivary gland tumor composed of one cell type
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monomorphic adenoma
2 forms basal cell and Canalicular adenoma |
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60s, females. uncommon
parotid, upper lip, b mucosa. slow growth, asymptomatic, multifocal, less than 3 cm encapsulated, proliferation of basaloid ductal epithelial cells. solid trabecular and membranous patterns of growth |
Basal cell adenoma
surgical excision, no recurrence or transformation |
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60s, female, uncommon. Upper lip, b mucosa.
slow grow, asymptomatic nodule, may be multifocal, less than 2 cm long canals or channels lined by single layers of epithelial cells, may be cystic, loose stroma with prominent vascularity, encapsulated |
canalicular adenoma
simple surgical excision recurrence rare |
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most common malignant salivary gland neoplasm
any age parotid and palate, some intraosseous begin asymptomatic, may have blue tinge, similar to mucocele. sometimes pain, tenderness/ulceration low-grade (well differentiated) looks like parent tissue; mucous producing cells predominate, cystic spaces, little infiltration high grade (poorly differentiated) exchibits a predominance of invasive epidermoid cells, looks and acts like squamous cell Ca cellular pleomorphism and only scattered mucous cells |
mucoepidermoid carcinoma
low grade-complete, conservative surgical excision, good prognosis high grade-wide surgical excision with radiation, poor prognosis |
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50s, parotid, submand, minor glands, palate
slow growing, non-ulcerated initialy, infiltrative mass with constant dull pain parotid-facial paralysis may occur ulceration develops intraorally small, dark cells arranged in cribriform (swiss cheese) and solid patterns perineural invasion common |
adenoid cystic carcinoma
wide surgical excision w/ radiation poor prognosis. typically metastasizes to lungs, not regional lymph nodes |
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50s, females 2:1
mostly intraoral, hard/soft palate, upper lip firm, indolent painless mass uniform ductal epithelial cells in lobules basaloid or spindle-shaped cells. many patterns (polymorphous) perineural invasion common. sometimes confused w/ pleomorphic adenoma or adenoid cystic carcinoma peripheral infiltration, nuclei less hyperchromatic |
polymorphous low grade adenocarcinoma (PLGA)
wide surgical excision, good prognosis some lymph node metastasis |
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any age, mean in 40s
parotid main site, b mucosa, lips well demarcated, slow growing. asymptomatic-local tenderness pseudo capsule, well circumscribed proliferation of cells, resemble acinar cells microsystic/micropapillary patterns also |
acinic cell carcinoma
wide surgical excision 35% recurrence, some metastasis to regional lymph node prognosis better for minor glands |
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rare, but related to pleomorphic adenoma
50s -70s parotid main site, palate long-standing, asymptomatic salivary gland mass suddenly becomes tender/painful facial paralysis or paresthesia (clinical signs of malignant transformation ulceration may occur residual pleomorphic adenoma w/ transformation |
carcinoma-ex pleomorphic adenoma
wide surgical excision if invasion less than 6 mm-good prognosis if more than 8 mm, all died 50% recurrence or metastasis |
