Download diseases of the oral cavity and oropharynx

DISEASES OF THE ORAL
CAVITY
Prof. İlhan TOPALOĞLU
Otolaryngology Department
Yeditepe University
School of Medicine
ANATOMY OF THE ORAL
CAVITY
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anterior : vermillion
border of the lips
posterior: oropharynx
oropharyngeal isthmus :
(superior) junction of the
hard and soft plates .
(lateral) anterior tonsillar
pillars
(inferior) the line of the
circumvallate papillae
ANATOMY OF THE ORAL CAVITY
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Lips
Anterior portion of the tongue
Buccal mucosa
Upper and lower alveolar ridges
Retromolar trigone
Floor of the mouth
Hard palate
Exam: Lips
Exam: Lips-palpation
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Color, consistency
Area for blocked minor salivary
glands
Lesions, ulcers
Pyogenic granuloma
Fibroma
Lip cancer
Lower lip carcinoma
CANCERS OF THE LIP
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88-98% lower lip
2-7% upper lip
0,09-6,1% oral commisure
Male and older than 60 years old 
SCC 
Basal cell ca, melanoma, minör salivary
gland tm.
Sensory innervation of the
tongue
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1 – chorda tympani
and lingual nerve
2 – glossopharyngeal
nerve
3 – vagal nerve
Exam: Tongue
Exam: Tongue
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You may observe
lingual varicosities
Exam: Tongue
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You may observe geographic
tongue (erythema migrans)
Exam: Tongue
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You may observe drug reaction
Exam: Tongue
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Observe signs of nutritional
deficiencies
Leukoplakia
Hemangioma
CANCERS OF TONGUE
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Lateral border
Ocult met. 30%
Stage, nodal metastases, lenfovasculer,
perineural invasion and thickness of tumor
are important prognostic factors.
CANCER OF THE ANTERIOR
PORTION OF THE TONGUE
Tongue ca.
Tongue ca.
Examination: Buccal Mucosa
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Linea alba
Stenson’s duct
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Lichen Planus
ALVEOLAR RIDGE
Ameloblastoma
Gingival cyst
Mucoepidermoid tumor
Exam: Retromolar trigone
Exam: Retromolar trigone
Edentulous
Exam: Floor of mouth
Palpation of the floor of the mouth
Exam: Floor of mouth
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Visualize, palpate - bimanually
Wharton’s duct
Must dry to observe
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Does “lesion” wipe off?
Where are the two most
likely areas for oral cancer?
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lateral border of the tongue
Floor of mouth
Squamous Cell Carcinoma
FLOOR OF THE MOUTH CA.
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Incidance of mandibular invasion rate is
high
Ocult met  10-30%
Primary resection of the floor of the mouth
is peformed with ipsilateral or bilateral
neck dissection (if the tumor is located at
the midline)
Exam: Hard palate
Median Palatal Cyst
CANCER OF THE HARD PALATE
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uncommon
SCC and Adenoid cystic ca
Misdiagnosed as maxillary sinus tm
Incidance of neck metastases is low
Elective neck treatment is unnecessary
Prostodontist
ORAL PREMALİGNANCY
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Leukoplakia
Erythroplakia
Mucosal atrophy
MALIGNANT LESIONS
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SQUAMOUS CELL CARCINOMA
VERRUCOUS CARCINOMA
MINOR SALIVARY GLAND TUMOURS
SARCOMATOID CARCINOMAS
MALIGNANT MELANOMA
ETIOLOGY
Risk factors for oral cavity and
oropharyngeal cancer include:
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Cigarette
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Alcohol
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Exposure to the human papilloma
virus (HPV) or Epstein-Barr virus
(EBV)
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ionizing radiation
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Prolonged sun exposure,
especially linked to cancer in the
lip area and skin cancer.
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Fair skin, also linked to lip cancer
and skin cancer.
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Age. People over the age of 45
years old are at increased risk for
oral cancers (though it can
develop in people of any age).
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Poor nutrition.
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Irritation from poorly fitting
dentures in people who use
alcohol and tobacco products.
Chewing betel nuts, a nut
containing a mild stimulant
popular in Asia.
Weakened immune system.
Vitamin A deficiency.
A rare condition called PlummerVinson Syndrome, which involves
iron deficiency and causes
difficulty swallowing.
Gender. Men are more likely to
get lip cancer than women.
lichen planus
discoid lupus erythematosus
dystrophic epidermolysis bullosa
Symptoms
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Otalgia
Odynofagia
Bleeding
Dysfagia
Loss of teeth
Restriction of mouth movement
Trismus
EPIDEMIOLOGY
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95 % SCC
95 % patiet  40 years old
Mean age 60 years old
After the treatment of oral cavity ca if the
patient doesn’t give up smoking, second
primary or recurrence rate is 40 %
TREATMENT
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surgery
RT
surgery + RT
KT + RT
Surgery + RT + adjuvant KT
The last cigarette
DISEASES OF OROPHARYNX
Prof. Dr. İlhan TOPALOĞLU
Otolaryngology Department
Yeditepe University
School of Medicine
ANATOMY OF THE OROPHARYNX
Anterior : oropharyngeal
isthmus;
(superior) junction of the
hard and soft plates .
(lateral) anterior tonsillar
pillars
(inferior) the line of the
circumvallate papillae
İnferior: the plane of the
hyoid bone
OROPHARYNX
SUBSIDES
 Soft palate and uvula
 Base of the tongue
 Tonsillar region
(tonsillar fossae and
pillars)
 Oropharyngeal walls
(lateral and posterior)
Waldeyer's ring
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Waldeyer's tonsillar ring (or
pharyngeal lymphoid ring) is an
anatomical term describing the lymphoid
tissue ring located in the pharynx and to
the back of the oral cavity.
It was named after the nineteenth century
German anatomist Heinrich Wilhelm
Gottfried von Waldeyer-Hartz.
Waldeyer's ring
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Pharyngeal tonsil (also known
as 'adenoids' when infected)
Tubal tonsil (where Eustachian
tube opens in the
nasopharynx)
Palatine tonsils (commonly
called "the tonsils" in the
vernacular, less commonly
termed "faucial tonsils")
Lingual tonsils
Anatomy
Tonsils
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Between arcus
palatoglossus (ant
plica) and arcus
palatofaryngeus (post
plica)
Adenoids
Common Diseases of the Tonsils
and Adenoids
Acute adenoiditis/tonsillitis
 Recurrent/chronic
adenoiditis/tonsillitis
 Obstructive hyperplasia
 Malignancy
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Acute Adenotonsillitis
Etiology
 5-30% bacterial; of these
39% are beta-lactamaseproducing (BLPO)
Streptococcus pyogenes
(Group A beta-hemolytic
streptococcus GABHS
most important pathogen
because of potential
sequelae
Differential diagnosis
Infectious mononucleosis
Malignancy: lymphoma, leukemia, carcinoma
Diptheria
Scarlet fever
Agranulocytosis
Supratonsillar Cleft
Peritonsillar Abscess
Papilloma
ICA Aneurysm
Toncil ca.
TONCIL CA
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75-80% of oropharyngeal cancer
İncidance of lymphatic metastases rate is
high 75% (mostly jugulodigastric met.)
Candidiasis
Other Tonsillar Pathology
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Hyperkeratosis,
mycosis
leptothrica
Tonsilloliths
Indications for Tonsillectomy
AAO-HNS:
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3 or more episodes/year
Hypertrophy causing malocclusion, UAO
Halitosis, not responsive to medical
therapy
UTE, suspicious for malignancy
Individual considerations
TONSIL SIZE
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0 in fossa
+1 <25%
occupation of
oropharynx
+2 25-50%
+3 50-75%
+4 >75%
Avoid gagging the patient
Principles of Surgical
Management
Numerous techniques
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Guillotine
Snare (Scissor dissection, Fisher’s knife dissection, Finger
dissection)
Electrodissection, Plasmadissection
Laser dissection (CO2, KTP)
… Surgeon’s preference
PreOp Evaluation of Adenoid
Disease
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Triad of hyponasality,
snoring, and mouth
breathing
Rhinorrhea, nocturnal
cough, post nasal drip
“Adenoid facies”
“Milkman” & “Micky
Mouse”
Overbite, long face,
crowded incisors
Indications for Adenoidectomy
Obstruction:
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Chronic nasal obstruction or obligate mouth breathing
OSA with FTT, cor pulmonale
Dysphagia
Speech problems
Severe orofacial/dental abnormalities
Infection:
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Recurrent/chronic adenoiditis (3 or more episodes/year)
Recurrent/chronic OME (+/- previous BMT)