Premalignant lesions of Oral cavity Dr SHANKHASHUBHRA GHOSH
Pre-malignant lesions of Oral cavity Dr. SHANKHASHUBHRA GHOSH DLO, 2 ND YR Stanley Medical College 1 Chennaiwww. nayyar. ENT. com
2 www. nayyar. ENT. com
3 Benign lesions Solid- papilloma fibroma hemangioma granuloma torus palatinus Cystic - retention cyst ranula dermoid www. nayyar. ENT. com
4 Premalignant lesions Leukoplakia Erythroplakia Submucous fibrosis Lichen planus Laryngeal keratosis Actinic cheliosis Smooth, red tongue of Plummer-Vinson syndrome www. nayyar. ENT. com
5 Predisposing factors EIGHT Ø Ø Ø Ø -- “S” Smoking syphilis spices sharp tooth submucosal fibrosis siderophenic dysphagia sepsis spirit(alcohol) www. nayyar. ENT. com
6 Leukoplakia -etiology Tobacco chewing and smoking Alcohol Local irritants Vitamin deficiency-vit A & B Endocrine disturbances Syphilis www. nayyar. ENT. com
7 leukoplakia www. nayyar. ENT. com
8 leukoplakia White patch in mucosa that does not rub off & cannot be clinically identified Most are asymptomatic, only 20% show evidence of dysplasia or carcinoma. Buccal mucosa and oral commissures are most common sites Mostly fourth decade, male>female www. nayyar. ENT. com
9 Non –homogenous leukoplakia www. nayyar. ENT. com
10 Management Proper history Prevention of cause Surgical excision of small lesion Topical chemotherapy and radiation www. nayyar. ENT. com
11 Erythroplakia Red lesion that cannot be classified as another entity. 91% shows signs of dysplasia Flat, macular, velvety appearance and may be speckled with white spots representing foci of keratosis Most common site-lower alveolar mucosa, gingivobuccal sulcus www. nayyar. ENT. com
12 www. nayyar. ENT. com
13 Types: A)Homogenous type: appears as bright red soft velvety lesions and extensive in size. commonly found-buccal mucosa and soft palate. B)Speckled type: soft red lesions, slightly elevated with irregular outline surface being granular-speckled www. nayyar. ENT. com
14 Submucous fibrosis Subepithelial inflammatory response to the irritants mainly due to betel nut chewing Arecoline-active alkaloid found in betel nutsstimulate fibroblasts to increase production of collagen by 150% White fibrotic bands extending from retromolar trigone to soft palate, buccal mucosa , tongue. It continues even after cessation of areca nut chewing www. nayyar. ENT. com
15 www. nayyar. ENT. com
16 www. nayyar. ENT. com
17 www. nayyar. ENT. com
18 Clinical features The most common initial symptom-burning sensation of oral mucosa aggravated by spicy food followed by either hypersalivation or dryness of mouth In advanced cases, the mucosa becomes tough and leathery, with numerous vertical fibrous band. www. nayyar. ENT. com
19 Clinical staging Stage 1 -stomatitis. . vesicles, mucosal ulcers, mucosal petechie Stage 2 -fibrosis in ruptured vesicles and ulcers. a)early-blanching. . b)late-vertical and circular palpable fibrous bands, trismus, blanched leathery floor of mouth, fibrotic and depigmented gingiva. Stage 3 -leukoplakia(>25%) and speech & hearing deficits. www. nayyar. ENT. com
20 Treatment Prescription of chewable pellets of hydrocortisone Absteinence from alcohol, tea, coffee Submucosal inj of hydrocortisone Submucosal inj of human chorionic gonadotropin Surgical treatment-multiple release deep to mucosa, submucosa and fibrotic tissue & suturing the gap so created by mucosal flap obtained by tongue and Z-plasty. www. nayyar. ENT. com
21 Cont…. . In this procedure, multiple deep z shaped incisions are made into fibrotic tissue and sutured in straight fashion Pentoxifylline-vasodilating properties and increased mucosal vascularity used as adjunct therapy. Stem cell therapy-intralesional inj of autologus bone marrow stem cell –angiogenesis of area and decreases fibrosis. www. nayyar. ENT. com
22 Lichen planus Malignant potential is matter of dispute Prudent practice to biopsy the lesion at first visit to confirm diagnosis or monitor changes. Lesion appear white lace like pattern in buccal mucosa. www. nayyar. ENT. com
23 www. nayyar. ENT. com
24 Relative risk factors for oral cancer None 1% Bettle nut Chewing 4% Smoking only 3 -6% Bettel chewing+Tobacco chewing 15% Bettel chewing+Smoking 25% Bettel+Tobacco+smoking 20% www. nayyar. ENT. com
25 Treatment If carcinoma-in-situ proved—excision by CO 2 or KTP 532 laser Chemoprevention-beta-carotene and retinoids as antioxidant supplements www. nayyar. ENT. com
26 Thank you For more presentations, please visit www. nayyar. ENT. com
- Slides: 26