DISEASES OF ORAL CAVITY IT IS A CAVITY

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DISEASES OF ORAL CAVITY IT IS A CAVITY WALLED BY LIPS, CHEEKS, PALATE, FLOOR

DISEASES OF ORAL CAVITY IT IS A CAVITY WALLED BY LIPS, CHEEKS, PALATE, FLOOR OF MOUTH AND OROPHARYNX

ULCERATIVE LESIONS OF ORAL CAVITY 1. 2. 3. 4. 5. APHTHOUS ULCER ( CANKER

ULCERATIVE LESIONS OF ORAL CAVITY 1. 2. 3. 4. 5. APHTHOUS ULCER ( CANKER SORES ) VINCENT’S ANGINA CANCRUM ORIS (NOMA) TUBERCULOSIS SYPHILS HSV 6. VIRAL INFECTION EBV Rubella

ULCERATIVE LESIONS OF ORAL CAVITY(CONTD) 7. TRAUMATIC ULCER ill fitting denture jagged teeth erosive

ULCERATIVE LESIONS OF ORAL CAVITY(CONTD) 7. TRAUMATIC ULCER ill fitting denture jagged teeth erosive chemicals 8. VITAMIN B COMPLEX DEFICIENCY 9. MALIGNANT ULCERS.

APHTHOUS ULCER VERY COMMON (AFFECT 40 % POPULATION ) UNKNOWN ETIOLOGY , FAMILY HISTORY

APHTHOUS ULCER VERY COMMON (AFFECT 40 % POPULATION ) UNKNOWN ETIOLOGY , FAMILY HISTORY + COMMON IN FIRST 2 DECADES OF LIFE RUCURRENT SUPERFICIAL PAINFUL ULCERS USUALLY MULTIPLE, SHALLOW HYPEREMIC ULCERS RIMMED BY ZONE OF ERYTHEMA • MICROSCOPICALLY ULCERATION WITH MONONUCLEAR INFLAMMATORY INFILTRATE • RESOLVE SPONTABEOUSLY IN 7 TO 10 DAYS • • •

“Canker” sore = Aphthous ulcer

“Canker” sore = Aphthous ulcer

VINCENTS ANGIA • Is also known as “ Acute necrotising ulcerating gingivitis ” is

VINCENTS ANGIA • Is also known as “ Acute necrotising ulcerating gingivitis ” is caused by infection of 2 symbiotic organisms : 1. Fusiform bacillus 2. A spirochete – Borrelia vincentii ( oppurtunistic infection by these normal comensals occurs in predisposing conditions like immunodeficiency , malnutrition, poor oral hygiene - begins as punched out ulcers in the inter dental papillae.

Vincents angina ( contd )

Vincents angina ( contd )

CANCRUM ORIS ( NOMA )

CANCRUM ORIS ( NOMA )

LEUKOPLAKIA IT IS A WHITE PLAQUE ON THE ORAL MUCOSA THAT CANNOT BE REMOVED

LEUKOPLAKIA IT IS A WHITE PLAQUE ON THE ORAL MUCOSA THAT CANNOT BE REMOVED BY SCRAPING AND CANNOT BE CLASSIFIED CLINICALLY OR PATHOLOGICALLY AS ANOTHER DISEASE ENTITY.

LEUKOPLAKIA (CONTD) • ETIOLOGY : 1. Tobacco usage in various forms – cigars, cigarettes,

LEUKOPLAKIA (CONTD) • ETIOLOGY : 1. Tobacco usage in various forms – cigars, cigarettes, pipes, chewing tobacco and tobacco pouches. 2. Chronic Alcoholism 3. ill fitting dentures. 4. Human papilloma virus -16 5. Chronic exposure to irritants.

LEUKOPLAKIA (CONTD) • CLINICAL FEATURES : AGE : 40 – 70 SEX : M

LEUKOPLAKIA (CONTD) • CLINICAL FEATURES : AGE : 40 – 70 SEX : M : F = 2 : 1 • COMMON SITES : Buccal mucosa, palate, floor of mouth, cheek, ventral surface of tongue etc.

LEUKOPLAKIA (CONTD) • APPEARANCE : Single or multiple white patches with indistinct or sharply

LEUKOPLAKIA (CONTD) • APPEARANCE : Single or multiple white patches with indistinct or sharply defined borders. They may be slightly thickened and smooth or wrinkled and indurated or appear as corrugated verrucous plaques.

LEUKOPLAKIA

LEUKOPLAKIA

LEUKOPLAKIA

LEUKOPLAKIA

LEUKOPLAKIA (CONTD) • MICROSCOPY : (a) EPITHELIUM : May range from moderate to severe

LEUKOPLAKIA (CONTD) • MICROSCOPY : (a) EPITHELIUM : May range from moderate to severe orderly epithelial hyperplasia to lesions with severe epithelial dysplasia , sometimes merging into carcinoma in situ. (b) SUBEPITHELIAL CONNECTIVE TISSUE : Shows chronic inflammatory infiltrate especially in lesions with epithelial dysplasia.

LEUKOPLAKIA (CONTD) • COMMON D/D : Candidiasis , lichen plannus , diphtheria , viral

LEUKOPLAKIA (CONTD) • COMMON D/D : Candidiasis , lichen plannus , diphtheria , viral infections. • MALIGNANT TRANSFORMATION : 1 % to 16 % AVERAGE : 5 % to 6 % after variable duration

LEUKOPLAKIA

LEUKOPLAKIA

CANDIDIASIS

CANDIDIASIS

CANDIDIASIS

CANDIDIASIS

CANDIDIASIS

CANDIDIASIS

ERYTHRO PLAKIA ( DYSPLASTIC LEUKOPLAKIA ) “ A RED VELVETY POSSIBLY ERODED AREA IN

ERYTHRO PLAKIA ( DYSPLASTIC LEUKOPLAKIA ) “ A RED VELVETY POSSIBLY ERODED AREA IN THE ORAL MUCOSA WHICH IS IN LEVEL WITH OR DEPRESSED FROM THE SURROUNDING MUCOSA. ” • The epithelium shows more severe atypia. • Higher risk of malignant transformation.

ERYTHRO PLAKIA

ERYTHRO PLAKIA

LEUKOPLAKIA WITH MILD DYSPLASIA

LEUKOPLAKIA WITH MILD DYSPLASIA

LEUKOPLAKIA WITH MODERTAE DYSPLASIA

LEUKOPLAKIA WITH MODERTAE DYSPLASIA

SPECKLED LEUKOERYTHROPLAKIA LESIONS WITH INTERMEDIATE FEATURES BETWEEN LEUKOPLAKIA AND ERYTHROPLAKIA.

SPECKLED LEUKOERYTHROPLAKIA LESIONS WITH INTERMEDIATE FEATURES BETWEEN LEUKOPLAKIA AND ERYTHROPLAKIA.

SPECKLED LEUKOERYTHROPLAKIA

SPECKLED LEUKOERYTHROPLAKIA

SPECKLED LEUKOERYTHROPLAKIA

SPECKLED LEUKOERYTHROPLAKIA

HAIRY LEUKOPLAKIA “ WHITE CONFLUENT AND FLUFFY ( HAIRY ) HYPERKERATOTIC THICKENING SITUATED ANYWHERE

HAIRY LEUKOPLAKIA “ WHITE CONFLUENT AND FLUFFY ( HAIRY ) HYPERKERATOTIC THICKENING SITUATED ANYWHERE ON THE ORAL MUCOSA VIRTUALLY RESTRICTED TO PATIENTS WITH HIV INFECTION. ” • Usually caused by EBV or less commonly HPV • Not a premalignant condition.

HAIRY LEUKOPLAKIA

HAIRY LEUKOPLAKIA

HAIRY LEUKOPLAKIA

HAIRY LEUKOPLAKIA

ORAL CANCER 95 % Squamous Cell Carcinoma 5 % Other ( Adenocarcinoma , malignant

ORAL CANCER 95 % Squamous Cell Carcinoma 5 % Other ( Adenocarcinoma , malignant melanoma , malignant tumours of minor salivary gland, malignant connective tissue tumours ).

ORAL CANCER ( CONTD ) • ETIOLOGY : 1. Use of tobacco in various

ORAL CANCER ( CONTD ) • ETIOLOGY : 1. Use of tobacco in various forms ( smoking , Tobacco chewing, Tobacco pouches ) 2. Chronic Alcoholism ( combination of smoking and drinking increases the risk to 6 fold to 15 fold ). 3. Use of marijuana

ORAL CANCER ( CONTD ) 4. Chewing of betel nuts and pan. 5. HPV

ORAL CANCER ( CONTD ) 4. Chewing of betel nuts and pan. 5. HPV serotypes 6, 16 and 18 6. ? Protractual irritation by ill fitting dentures, jagged teeth etc. may predispose by enhancing risk of leukoplakia. 7. Actinic radiation and pipe smoking may predispose to cancer of lower lip.

ORAL CANCER ( CONTD ) 8. Genetic Predisposition : Some of the molecular changes

ORAL CANCER ( CONTD ) 8. Genetic Predisposition : Some of the molecular changes like deletion of chromosome regions 18 q, 10 p , 8 p, 3 p; Mutations in p 53 and amplication of INT 2 and BCL oncogenes. 9. Presence of Leukoplakia and Erythroplakia.

ORAL CANCER ( CONTD ) • COMMON SITES : Floor of mouth, tongue ,

ORAL CANCER ( CONTD ) • COMMON SITES : Floor of mouth, tongue , hard palate , base of tongue , mucosa of cheek , lips angle of mouth.

ORAL CANCER ( CONTD ) • APPEARANCE : 1. Large irregular shaggy ulcer with

ORAL CANCER ( CONTD ) • APPEARANCE : 1. Large irregular shaggy ulcer with raised, rolled and firm borders. 2. Polypoid mass. 3. Raised firm pearly plaques. 4. Irregular roughened verrucous areas of mucosal thickening.

ORAL CANCER ( CONTD ) • MICROSCOPY : 1. Well differentiated carcinoma 2. Moderately

ORAL CANCER ( CONTD ) • MICROSCOPY : 1. Well differentiated carcinoma 2. Moderately differentiated carcinoma 3. Poorly differentiated or Anaplastic carcinoma.

CLINICAL, HISTOLOGIC, AND MOLECULAR PROGRESSION OF ORAL CANCER

CLINICAL, HISTOLOGIC, AND MOLECULAR PROGRESSION OF ORAL CANCER

INFILTRATING SQUAMOUS CELL CARCINOMA OF MOUTH

INFILTRATING SQUAMOUS CELL CARCINOMA OF MOUTH

WELL DIFFERENTIATED CARCINOMA

WELL DIFFERENTIATED CARCINOMA

WELL MODERATE POOR

WELL MODERATE POOR

VERRUCOUS CARCINOMA “ LOCALLY INVASIVE RARELY METASTASISING, WELL DIFFERENTIATED VARIANT OF SQUAMOUS CELL CARCINOMA

VERRUCOUS CARCINOMA “ LOCALLY INVASIVE RARELY METASTASISING, WELL DIFFERENTIATED VARIANT OF SQUAMOUS CELL CARCINOMA HAVING A VERRUCOUS APPEARANCE ”.

VERRUCOUS CARCINOMA (CONTD) • PROGNOSIS : Depends on site and stage of cancer. Spread

VERRUCOUS CARCINOMA (CONTD) • PROGNOSIS : Depends on site and stage of cancer. Spread is usually through lymphatics to local and distant lymph nodes. Rarely haematogenous spread to lungs , liver or bone. • DIAGNOSIS : 1. F. N. A. CYTOLOGY 2. EDGE BIOPSY.

VERRUCOUS CARCINOMA

VERRUCOUS CARCINOMA

VERRUCOUS CARCINOMA

VERRUCOUS CARCINOMA

APHTHOUS ULCERS • Aphthous ulcers appear as single or multiple shallow hyperemic ulcerations covered

APHTHOUS ULCERS • Aphthous ulcers appear as single or multiple shallow hyperemic ulcerations covered by thin exudate and rimmed by a narrow zone of erythema. • They tend to be familial, very painful, often recurrent and affect about 30 to 40 % of population and common in young age.

CANCRUM ORIS ( NOMA )

CANCRUM ORIS ( NOMA )