Download Oral Cavity ORAL CAVITY Oral Cavity Applied Anatomy

Oral Cavity
ORAL CAVITY
Oral Cavity
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Applied Anatomy
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Symptomatology
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Inflammatory and ulcerative conditions
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Ulcerative condition
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Other benign conditions
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Edited by
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Dr. Murtaza Ahsan Ansari
ANATOMICAL REGION & SITES OF THE ORAL CAVITY
Buccal Mucosa
Mucosal surface of upper & lower lip
Mucosal surface of cheek
Retro molar area
Bucco-alveolar sulci, upper & lower
Upper Alveolus & Gingiva
Lower Alveolus & Gingiva
Hard Palate
Tongue
Dorsal surface & lateral borders
Anterior to vallate papillae (ant. 2/3rd)
Floor Of Mouth
Lining:
Non-keratinizing Stratified Sq. Epithelium
containing taste buds, and many minor salivary
glands
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SYMPTOMATOLOGY
Pain including Referred pain
Ulcers and Bleeding
Halitosis (foetor oris)
Dysphagia , Odynophagia
Difficulty in Speech
Xerostomia
Dribbling of saliva or Increased salivation
Taste (bad taste or loss of taste)
Trismus
CAUSES OF THE ULCERS OF THE
ORAL CAVITY
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Infection
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Immune Disorders
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Trauma
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Neoplasms
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Skin Disorders
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Drug Allergy
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Vitamin Deficiencies
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Miscellaneous
CAUSES OF ULCERS OF ORAL CAVITY
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Infections
Viral:
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Herpangina
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Herpes simplex primary and secondary
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HPV
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Epstein B virus
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Hand-foot and mouth disease
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AIDS
HERPENGINA
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Coxsackie virus
Children
Multiple small vesicles rupture to form ulcers.
Yellow base with red areola
HERPES
Primary
• Children
• Clusters of multiple vesicles, rupture to form ulcers.
• Fever, malaise
• Lymphadenopathy
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• Treatment
• Acyclovir 200mg 5 times a day for 5 days.
Secondary
• Adults
• Milder
• Mostly at vermilion border of lip
• Virus remains dormant in trigeminal ganglion.
• Activated by fever fatigue and emotional stress
CAUSES OF ULCERS OF ORAL CAVITY
BACTERIAL:
Non-Specific
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Staph aureus
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Streptococci
Specific
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Vincent’s infection
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Tuberculous granuloma
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Syphilis
FUNGAL:
• Candidiasis
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VINCENT’S INFECTION
(Acute necrotising ulcerative gingivitis)
Fusiform bacillus+ Spirochete (Borrelia vincenti)
Young and middle aged persons
Gingivae become red edematous and necrose.
Also affects Tonsils (Vincent’s angina)
Treatment
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Improve oral hygiene
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Mouth washes with Na HCO3
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Penicillin / Erythromycin
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Metronidazole
CANDIASIS
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Candida albicans
White grey patch on oral mucosa and tongue
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Common in children and immuno-compromised (diabetics, malignancy)
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Treatment
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Nystatin
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Clotrimazole
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IMMUNE DISORDRES
Aphthous ulcer
Recurrent multiple about 2—10 mm
Affecting movable mucosa
Central necrotic area with red halo
No constitutional symptoms
Etiology
Stress?
Autoimmune?
Nutritional?
BECHET’S SYNDROME
(Occulo-oro-genital syndrome)
Aphthous like ulcers with punched out margins affecting:
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Oral cavity
Genital ulcers
Uveitis
TRAUMATIC ULCER
PHYSICAL:
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Cheek Bite
Jagged teeth
Ill-fitting denture
CHEMICAL:
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Silver nitrate
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Phenol
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Aspirin burn
THERMAL:
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Hot food or fluid
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Reverse smoking
ORAL ULCERS ASSOCIATED WITH SKIN DISORDERS
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Erythema multiforme
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Lichen planus
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Bullous pemphigoid
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Lupus erythematosus
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ORAL ULCERS ASSOCIATED WITH BLOOD DISORDERS
Leukaemia
Agranuloycytosis
Pancytopenia.
Cyclic neutropenia
Sickle cell anaemia
DRUG ALLERGY
Mouth washes
Tooth paste
Denture
Aspirin
Penicillin
Sulphonamides
Barbiturates
Phenytoin
Steven Johnson Syndrome due to Sulphonamides
NUTRITIONAL DEFICIENCIES
• Iron deficiency anemia
• Vitamin A
• Vitamin C
• Folate
• Vitamin B1, B2, B6, and B 12
ACUTE EXANTHEMAS
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Chickenpox
Measles
Glandular fever
MISCELLANEOUS
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Radiation mucositis
Cancer chemotherapy
Diabetes mellitus
Uraemia.
MOUTH ULCERS
(Management)
History
Examination
Depending upon the diagnosis
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Attention to oral hygiene
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Removal of local Irritants
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Antibiotics, antiseptics &
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Analgesics
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Local Anaesthetics
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Steroids
Correction of nutritional deficiencies
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Replacement of blood
RETENTION CYSTS
Result due to blockage of ducts of minor salivary gland
RANULA
DEFINITION:
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Uni or multilocular mucous filled cyst in the floor of the mouth due to
blockage of duct of sub-lingual salivary gland, resembles belly of
frog.
PRE CANCEROUS CONDITIONS
Various pre-malignant lesions of oral cavity are:
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Leukoplakia
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Erythroplakia
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Lichen planis
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Leukokeratosis nicotina palati
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Leukoderma
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Submucous fibrosis
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―PAAN‖ or betel stomatitis
LEUKOPLAKIA
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Raised white patch
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5 mm or more
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Cannot be scrapped off
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ERYTHROPLAKIA
Red patch, interwoven with leukoplakia, definitely pre-malignant
Red colour is because of capillary engorgement & absence of keratin
Overlying ca. in early stage
PAAN STOMATITIS
Consupmtion of tobacco & ―Qivam‖ is carcinogenic
Repeated chewing produces very early epithelial changes
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Varies histologically from dysplasia to malignancy
Bizarre appearance of mucosa
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SUB-MUCOSAL FIBROSIS
Incidious chronic condition affecting any part of oral cavity and pharynx
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Unknown etiology
SUB-MUCOSAL FIBROSIS
Probable factors
Chewing of betel nuts
Tobacco
Lime & Paan
Anaemia
Genetically predisposed patients
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PREVENTIVE MEASURES AGAINST MALIGNANCY
Antioxidants – Vegetables & Fruits are rich source
Micronutrients are anti-carcinogenic
Fibre intake
Avoidance of smoking
Avoidance of supari, paan, tobacco, lime etc.
Improving dental & oral hygiene
Correct fitting of dentures
SUB-MUCOSAL FIBROSIS (Treatment)
Avoidance of causative factor (betel nut etc.)
Improvement of oral hygiene
Correction of vitamins & mineral deficiencies
Mouthwashes
Topical corticosterods
Anxiolytic Drugs ?
Very resistant to treatment
Refer to ENT Surgeon
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ENT SURGEON / SPECIALIZED CARE
For early stage cancer surgical excision is the therapy of choice
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CO2 laser has added advantage
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Partial thickness skin grafting following excision
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Temporo-mandibular condylectomy in S M F
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Nasolabial flap after excision of mucosa
Physiotherapy
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