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Systemic disorders and sydromes with H & N manifestation

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Presentation on theme: "Systemic disorders and sydromes with H & N manifestation"— Presentation transcript:

1 Systemic disorders and sydromes with H & N manifestation
Jan Laco, M.D., Ph.D.

2 Cardiovascular diseases
Infective endocarditis source: bacteraemia after tooth brushing or extraction < 15% IE valve defects: congenital x rheumatic fever prosthetic valves colonisation of cardiac valves  vegetations  valve destruction !!! ATB cover !!!

3 Cardiovascular diseases
Kawasaki disease = mucocutaneous LN syndrome Japan Children Mucositis cervical lymphadenopathy coronary arteritis  aneurysm  myocardial infarction

4 Cardiovascular diseases
antihypertensive drugs nifedipine  gingival hyperplasia

5 Respiratory tract diseases
Tuberculosis rare complication of open lung TBC painless ulcer on dorsum of tongue cervical lymphadenopathy Mi: caseating granulomas

6 Respiratory tract diseases
Sarcoidosis chronic granulomatous disease of unknown origin lungs, LN (hilar), salivary glands oral: painless swelling – gingivae, lips diagnosis: biopsy of labial glands Mi: non-caseating granulomas + calcifications Heerfordt´s syndrome: parotis with sarcoidosis + xerostomia + uveitis + fever

7 Lethal midline granuloma syndrome
clinically: destruction of central facial tissue + fatal outcome Wegener´s granulomatosis systemic necrotising vasculitis (ANCA+) granulomas of upper and lower RT glomerulonephritis Angiocentric T cell lymphoma

8 Gastrointestinal diseases
Crohn´s disease inflammatory disease of unknown origin ileocaecal region - thickening and ulceration oral: lips swelling cobble stone thickening of buccal mucosa with painful small ulcers Mi: small granulomas

9 Gastrointestinal diseases
Gardner´s syndrome (AD inheritance) = multiple jaw osteomas + polyposis coli with malignant potential dental defects, epidermal cysts Peutz-Jeghers syndrome pigmented macules around lips + intestinal polyposis (small bowel)

10 Nutritional deficiencies
vitamin A squamous metaplasia  keratinisation (leukoplakias ?) vitamin B2 angular stomatitis - painful red fissures at angles vitamin B12 - pernicious anaemia glossitis vitamin C - scurvy gingival swelling and bleeding vitamin D - rickets

11 Endocrine disorders and pregnancy
Pituitary hyperfunction of growth hormone gigantism acromegaly jaws (condylar growth) + hands + feet

12 Endocrine disorders and pregnancy
Adrenocortical diseases Addison´s disease = cortical insufficiency failure of cortisol and aldosteron secretion early sign – oral pigmentations – gingivae, buccal mucosa, lips Adrenal medulla MEN IIb = phaeochromocytoma + hyperparathyroidism + thyroid medullary carcinoma + oral mucosal neurofibromas

13 Endocrine disorders and pregnancy
Diabetes mellitus relative or absolute deficiency of insulin oral: candidosis acceleration of periodontal diseases dry mouth oral lichenoid reactions (drugs)

14 Endocrine disorders and pregnancy
gingivitis pregnancy epulis formation recurrent aphthae

15 Haematological disorders - anaemias
iron deficiency (microcytic a.) chronic menstrual blood loss chronic bleeding from peptic ulcer pernicious anaemia (macrocytic a.) middle aged women autoimmune chronic gastritis  vitamin B12 deficiency + neurological disease: degeneration of spinal cord

16 Haematological disorders - anaemias
mucosal and skin pallor + fatigue + breathlessness + tachycardia atrophic glossitis (B 12) - first sign atrophy of filiform papillae angular stomatitis candidosis

17 Haematological disorders - leukaemias
= neoplastic disorder of bone marrow acute x chronic lymphoblastic x myeloblastic ALL - children AML - adults anaemia + infection + bleeding tendency hepatosplenomegaly + lymphadenopathy oral: gingival swelling + mucosal ulcerations + purpura

18 Haematological disorders - haemorrhagic diseases
bleeding after tooth extraction > 1 day 1. vascular disorder 2. platelet disorders purpura, petechiae, ecchymoses imm. follow trauma  spontaneous stop 3. clotting disorders long severe bleeding after short delay

19 Haematological disorders - haemorrhagic diseases
Idiopathic thrombocytopenic purpura antibodies x platelets  low number in blood children, young women von Willebrand´s disease (AD inheritance) low level of vW factor (part of FVIII) drugs associated aspirin

20 Haematological disorders - haemorrhagic diseases
Haemophilia A (X inheritance) most common FVIII deficiency childhood bleeding into muscles or joints (haemarthros) Acquired disorders liver diseases vitamin K deficiency anticoagulant treatment - warfarin

21 Cervical lymphadenopathy - infections
Bacterial teeth, tonsils, face TBC cat-scratch disease Viral herpetic stomatitis infectious mononucleosis HIV infection Parasitic toxoplasmosis

22 Cervical lymphadenopathy - neoplasms
Primary Hodgkin´s lymphoma non-Hodgkin lymphomas Secondary carcinomas melanoma leukaemias

23 Autoimmune diseases middle aged women antibodies in blood
rheumatoid arthritis Sjögren´s syndrome systemic lupus erythematosus systemic sclerosis

24 Autoimmune diseases Systemic lupus erythematosus Systemic sclerosis
antinuclear factors 20% patients have oral symptoms skin rash (butterfly) + arthritis + pleuritis + glomerulonephritis oral: lichenoid lesions Systemic sclerosis subcutaneous and visceral fibrosis (GIT, lungs, …) mask-like face + limited oral opening

25 AIDS retrovirus HIV 1 sexual + i.v. drugs + blood transmission
deterioration of cell immunity (CD 4 T cell) opportunistic infections 75% patients have orofacial diseases infections tumors cervical lymphadenopathy

26 AIDS – oral infections Fungal Viral Bacterial
trush or other forms of candidosis 70% patients Viral HSV stomatitis EBV – hairy leukoplakia Bacterial gingivitis + periodontitis

27 AIDS – hairy leukoplakia
almost unique to AIDS !!! EBV virus lateral borders of tongue soft white painless area with corrugated surface Mi: hyperkeratosis + koilocytes No premalignant lesion indicator of low immune status  poor prognosis may regress spontaneously

28 AIDS - tumors 50% patients Kaposi´s sarcoma – HSV 8
purplish bleeding area or nodule on palate Mi: vascular tumor - minute proliferating blood vessels Non-Hodgkin lymphomas painless swelling of palate + gingiva Mi: high grade B cell lymphomas

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