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Pre-malignant lesions of Oral cavity Dr.SHANKHASHUBHRA GHOSH DLO,2 ND YR Stanley Medical College Chennai www.nayyarENT.com1.

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Presentation on theme: "Pre-malignant lesions of Oral cavity Dr.SHANKHASHUBHRA GHOSH DLO,2 ND YR Stanley Medical College Chennai www.nayyarENT.com1."— Presentation transcript:

1 Pre-malignant lesions of Oral cavity Dr.SHANKHASHUBHRA GHOSH DLO,2 ND YR Stanley Medical College Chennai

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3 Benign lesions  Solid- papilloma fibroma hemangioma granuloma torus palatinus  Cystic - retention cyst ranula dermoid 3

4 Premalignant lesions  Leukoplakia  Erythroplakia  Submucous fibrosis  Lichen planus  Laryngeal keratosis  Actinic cheliosis  Smooth,red tongue of Plummer-Vinson syndrome 4

5 Predisposing factors  EIGHT -- “ S ”  Smoking  syphilis  spices  sharp tooth  submucosal fibrosis  siderophenic dysphagia  sepsis  spirit(alcohol) 5

6 Leukoplakia -etiology  Tobacco chewing and smoking  Alcohol  Local irritants  Vitamin deficiency-vit A & B  Endocrine disturbances  Syphilis 6

7 leukoplakia 7

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 8

9 Non –homogenous leukoplakia 9

10 Management  Proper history  Prevention of cause  Surgical excision of small lesion  Topical chemotherapy and radiation 10

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 11

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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 13

14 Submucous fibrosis  Subepithelial inflammatory response to the irritants mainly due to betel nut chewing  Arecoline-active alkaloid found in betel nuts-stimulate 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 14

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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. 18

19 Clinical staging  Stage1-stomatitis..vesicles,mucosal ulcers, mucosal petechie  Stage2-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.  Stage3-leukoplakia(>25%) and speech & hearing deficits. 19

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. 20

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. 21

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. 22

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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% 24

25 Treatment  If carcinoma-in-situ proved—excision by CO2 or KTP532 laser  Chemoprevention-beta-carotene and retinoids as antioxidant supplements 25

26 Thank you For more presentations, please visit 26

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