Clerk Sarah Camille Concepcion

Clerk Sarah Camille Concepcion
ORAL CAVITY Clerk Sarah Camille Concepcion

OUTLINE INTRODUCTION EMBRYOLOGY ANATOMY PHYSIOLOGY DISEASES

ORAL CAVITY BOUNDARY: Vermilion border of the lips to junction of hard and soft palate and circumvallate papillae (tongue)

EMBRYOLOGY Derived from the embryonic foregut Stomoduem
Primitive mouth that forms the topographic center of the developing face Fusion of ectoderm & endoderm Other structures derived from the foregut: pharynx, esophagus, nasal cavity, teeth, salivary glands, anterior pituitary, thyroid, larynx, trachea, bronchi and alveoli of the lungs

EMBRYOLOGY OF ORAL CAVITY
UPPER LIP Fusion of medial frontonasal and lateral maxillary prominences 6th-8th week of fetal devt LOWER LIP Fusion of mandibular prominences 4th week of fetal devt

CHEEK Formed by the buccinator muscle SALIVARY GLANDS Develop from stomadeal ectoderm by ingrowth of oral epithelium into underlying mesenchyme Starts at a 6 weeks AOG

TONGUE from lingual swellings and tuberculum impar ~4 weeks AOG PALATE Fusion of primary and secondary plates 12th week AOG MANDIBLE Membranous ossification of Meckel’s cartilage 4 ½ weeks AOG

ANATOMY

PARTS/SUB-UNITS Lips Buccal mucosa Alveolar ridges
Anterior 2/3 of the tongue Retromolar trigone Floor of the mouth Hard palate

LIPS & CHEEK Vermillion Vestibule Orbicularis oris
Red due to thin squamous epithelium Vestibule Region between internal mucosa of cheek and teeth Orbicularis oris Foundation of lips and cheeks

LIPS & CHEEK Labial commissure Nasolabial fold Lips
Supplied by superior and inferior labial arteries Drained by facial vein Innervated by infraorbital (upper lip) and mental (lower lip) nerve LC connects upper and lower lip NF – oblique sulcus that separates lips from cheeks

LIPS & CHEEK Cheeks Muscular framework formed by buccinator
Bichat fat pad (buccal fat pad) Innervated by branches of the facial nerve LC connects upper and lower lip NF – oblique sulcus that separates lips from cheeks

MUSCLES OF MASTICAITON
Masseter muscle Temporalis muscle Medial and lateral pterygoid muscles Supplied by mandibular nerve (third division of the trigeminal nerve)

TEETH Infants: 2 I, 1 C, 2M Adults: 2 I, 1C, 2PM, 3M
Supported my maxillary and mandibular alveolar ridges Occlusal areas incisors – chisel-like canine – pointed premolar and molar - flattened Infants: 2 I, 1 C, 2M Adults: 2 I, 1C, 2PM, 3M

TEETH Deciduous Age (mo) Permanent Age (years) Medial incisors
Lateral incisors First molar Canine Second molar 7 9 15 18 20-24 1st molar 1st premolar 2nd premolar 2nd molar 3rd molar 6 6-7 8-9 10-11 11-12 12-13 17-25

Alveolar Ridge Retromolar Trigone
thickened ridge of bone that contains the tooth sockets on bones that bear teeth Retromolar Trigone Area between the upper and lower posterior molars

SURFACE ANATOMY

SURFACE ANATOMY Divisions: apex, body, and base Terminal sulcus
Papillae Filiform, fungiform, foliate, vallate Foramen cecum Frenulum lingua filiform (no taste function) fungiform (diffuse), and foliate (lateral tongue) circumvallate papillae

Extrinsic muscles (CNXII)
STYLOGLOSSUS GENIO- GLOSSUS HYOGLOSSUS GENIOHYOID MYLOHYOID

Intrinsic muscles (CNXII)
A) VERTICAL M. - FIBERS SUP & INF - FLATTEN & BROADEN TONGUE CORONAL SECTION C) LONGITUDINAL M. - FIBERS ANT-POST. - SHORTEN TONGUE B) TRANSVERSE M. - FIBERS HORIZONTAL - NARROW TONGUE

TONGUE Vascular supply: Lingual artery and vein
Motor innervation: CN XII Sensory innervation: Anterior 2/3 – lingual nerve  chorda tympani Posterior 1/3 – CN IX Lymphatic drainage ipsilateral and contralateral submandibular and submental lymph nodes filiform (no taste function) fungiform (diffuse), and foliate (lateral tongue) circumvallate papillae

PALATE HARD PALATE formed by palatine processes of the maxilla anteriorly, incisive bone, and horizontal plates of palatine bones posteriorly SOFT PALATE Seals the oral cavity posteriorly tensor veli palatini, levator veli palatini, palatoglossus, palatopharyngeus muscle

Vascular supply ascending palatine branch of the facial artery Sensory innervation greater and lesser palatine nerves from V2

SALIVARY GLANDS

PAROTID SUBMANDIBULAR SUBLINGUAL
Stensen’s Wharton’s Rivinus’ Lateral to upper 2nd molar midline floor of mouth adjacent to lingual frenulum multiple orifices draining into floor of mouth or into submandibular duct Serous Serous and mucous Supplies 1/3 saliva in resting state Supplies 2/3 saliva in resting state Supplies 2/3 saliva in stimulated state

PHYSIOLOGY Importance for food intake
Mastication (teeth, tongue) Digestion (salivary enzymes) Taste (Gustatory, chemoreception) Swallowing (Hard and soft palate) Speech (phonation and articulation) Tongue, cheeks, lips

SALIVA 1500 mL/day; pH 6.2-7.4 99.5% water
0.5% organic/inorganic solids. Na – 10 mEq/L K – 26 mEq/L Cl – 10 mEq/L HCO3 – 30 mEqlL glycoprotein and amylase

ORAL TORI - nodular or bony growth Torus Palatinus Torus Mandibularis
in the midline of hard palate Torus Mandibularis In the lingual aspect of the mandible TX: Surgery

MICROGNATHIA Congenital or acquired diminution in size of the mandible
Failure at the growth center of the condyle May be due to trauma Some associated with syndromes TX: Surgery

ROBIN ANOMALY Triad: Cleft palate + Micrognathia + Glossoptosis Symmetric lack of mandibuilar growth prevents adequate support of lingual musculature, allowing the tongue to fall downward and backward TX: mild case – keep the infant in prone position, suspend head by stocking cap severe – tongue tip sutured to anterior mandible or lower lip

PROGNATHISM Enlargement or anterior placement of lower jaw TX: Surgery

MALOCCLUSION Disturbed development of face and jaws
Underdevelopment of maxilla or mandible or overdevelopment of mandible

MACROGLOSSIA Enlarged tongue that may result in abnormal speech
Due to increase in amount of tissue Most are due to lymphangioma or hemangiolymphoma

MEDIAN RHOMBOID GLOSSITIS
Smooth to nodular, elevated or depressed area of void papillae No treatment required

LINGUAL THYROID Partial or complete embryologic failure of the thyroid gland to descend from the foramen cecum No tx for small lesions Before surgery, make certain that it is not the only throid tissue in the body

ANKYLOGLOSSIA Inability to elevate the tongue tip above a line extending through the commissures of a congenitally short lingual frenulum TX: frenulum clipped during infancy in severe forms

Unilateral incomplete
CLEFT LIP AND PALATE Unilateral incomplete Unilateral complete Bilateral complete

CLEFT LIP AND PALATE Developmental anomaly of the embryonic head
Genetic inheritance External influences: viral infections, placental oxygen deficiency, intrauterine bleeding, exposure to ionizing radiation Symptoms: Hypernasal speech (due to incomplete closure of the nasopharynx) Recurrent middle ear effusions and inflammation resulting from eustachian tube dysfunction Variable abnormalities of the nasal septum or in the shape of the external nose

CLEFT LIP AND PALATE Diagnosis: palpation of the hard palate to detect bony discontinuity Goals of surgery To achieve closure of the hard and soft palate. To provide soft palate sufficient length and mobility. Treatment: lip/velum/palate repair, rhinoplasty, speech promotion/therapy RULE OF 10 10 weeks, 10 pounds,10 g Hemoglobin

WHITE LESIONS OF THE ORAL MUCOSA
A change in color of the normally reddish oral mucosa to white. One of the most frequently encountered oral abnormalities. Leukoplakia-”white patch” that does not rub away Frequently caused by increased retention and production of keratin by mucosal stratified squamous epithelium. Biopsy may demonstrate cytologic alterations and may warrant consideration as “premalignant”

LICHEN PLANUS

LICHEN PLANUS present as fine lacework of white reticular keratotic paules (wickham’s striae) and gray plaque like or annular lesions on the dorsum of the tongue On the buccal mucosa, the lesions originate in the posterior area and spread anteriorly. Generally asymptomatic although a metallic taste or mild discomfort is common. Superficial erosions, bullous lesions, and deep, chronic, painful, ulcerations occasionally occur.

Viral infections: Herpes simplex virus
Etiology: HSV type 1 (cutaneous and oral-mucosa strain) Transmission: contact or droplet infection Primary infection Usually acquired in early childhood Predominantly affects the oral mucosa as herpetic gingivostomatitis (aphthous stomatitis) Appearance of local lesions (bullae) on the oral mucosa, preceded by fever and lethargy consistent with a flulike infection, accompanied by regional lymphadenitis

Reactivation of HSV Occurs in response to physical exertion, UV radiation, febrile infection, emotional stress, pregnancy Commonly manifested as herpes labialis Site of predilection is perioral region, especially the mucocutaneous junction of the lips

Diagnosis: history & PE, classic giant cells by Tzanck smear Complications Herpes impetiginatus - secondary bacterial superinfection by S. aureus or streptococci Postherpetic exudative erythema multiforme – skin lesions & typical ulcerative eruptions on the mucous membranes of the mouth, lips, and genitals Treatment: topical antiseptics to prevent superinfection; acyclovir; 5-7days

Viral infections: Varicella-Zoster Virus
Chicken pox Predominantly in children VZV Primary infection Symptoms skin rash consisting of erythematous papules and thin-walled vesicles with watery contents, covering the body but especially pronounced on the head and trunk

aphtha-like vesicles appear on the oral mucosa especially on the hard palate, buccal mucosa and gingiva After the cutaneous lesions have healed, the virus persists in the ganglion cells of sensory nerves

Reinfection or reactivation of the virus in response to various provocative mechanisms Segmental disease, with cutaneous and mucosal lesions distributed alon a sensory nerve segment and often accompanied by systemic signs such as lethargy, fatigue, and occasional neuralgiform pain in the distribution of the affected nerve

With involvement of the 2nd & 3rd dvisions of the trigeminal nerve, aphthae or scalloped ulcerations can be found on the buccal mucosa, palate and body of the tongue Treatment 5-7 days acyclovir or famciclovir analgesics and anti-inflammatory drugs (esp. carbamazepine) antibiotics may be indicated in elderly or immunocompromised patients to prevent superinfection

Bacterial and fungal infections
oral floor abscess lingual abscess candidiasis

Oral Floor Abscess Inflammation usually originates from the lower molars, sometimes from mucosal injuries in the oral floor, leading to abscess formation in the tongue muscles or connective-tissue spaces of the oral floor Can develop as a sign of impaired host resistance Symptoms: edematous expansion with a firm, erythematous swelling in the submental to submandibular areas Difficulty swallowing and speaking high fever

Oral Floor Abscess Downward spread of infection: dyspnea with acute respiratory distress or mediastinitis Imaging to define the extent of the oral floor abscess: UTZ or CT scan Tx: incision & drainage of the abscess via intraoral and transcervical route, concomitant antibiotic therapy

Lingual abscess Infected overt or covert mucosal injuries to the tongue Dx: clinical appearance of the tongue Tx: surgical – incision and drainage of the abscess with concomitant antibiotic therapy

CANDIDIASIS Etiologic agent — Candida albicans
Newborns may be infected by mothers w candidiasis of the vaginal tract Factors that promote infection: Age (infants, elderly) Hormonal status (diabetes, pregnancy) Heredity Local factors (edentulousness, ill-fitting dentures, lowered body resistance) Extensive use of antibiotics

CANDIDIASIS Angular cheilosis

CANDIDIASIS Superficial monilial stomatitis
Mild erythema with fine, whitish deposits to diffuse, inflamed “white mouth” In infants, first changes appear on the anterior dorsal third, edges, and ventral surfaces of the toungue and later in the oral vestibule Lesions resemble snow-white, curdled milk, diffuse pseudomembranes

CANDIDIASIS Treatment Denture stomatitis
Swelling, sensitivity and pain at points of denture contact Deep granulomatous candidiasis Treatment Improve oral hygeine and nutritional status Correct underlying disorder and irritating factor Oral nystatin susp., ointments, tablets. Clotrimazole troches (10mg q.i.d.)

HALITOSIS Fetor oris or bad breath Factors:
Decreased salivary flow rate Mucosal dryness (antihistamines, Sjogren’s syndrome, astringent mouthwashes) Poor oral hygiene (food remnants, unclean dentures) Odoriferous foods (garlic, onion, fatty diet) Periodontal disorders (periodontitis, nec ulcerative gingivitis) Heavy smoking

HALITOSIS Rarely a systemic cause (disorder of respi sys, acetone breath of DM, ammoniacal odor of uremia) Treatment — mouthwash only transient — cause must be eliminated

RECURRENT APHTHOUS STOMATITIS
Aphthae; cancer sores Mycoplasmas and pleomorphic transitional “L” form of αhemolytic streptococci Ulcer is covered by grayish white fibrinous exudate and surrounded by a bright red halo

DENTAL CARIES Disease of enamel, dentin and cementum
Demineralization of calcified area with cavity formation Areas: -cervical portion of the tooth -interproximal surfaces -pits and fissures

DENTAL CARIES Bacterial infection-common sequel to caries Sequelae:
Pulpitis (acute or chronic) Acute alveolar abscess Dental granuloma

GINGIVITIS Inflammation of the gum tissue
Irritated and swollen due to a plaque or calculus (tartar) buildup along the gumline Red, puffy, bleeding gums indicate the presence of gingivitis.

TOOTH DISCOLORATION WITH TETRACYCLINES
Yellow – gray; bright yellow; gray to brown or darker discoloration of the teeth With or without hypoplasia of the enamel Occur during period of tooth formation

DISORDERS IN TOOTH ERUPTION
Baby Bottle Tooth Decay Baby Bottle Syndrome or Nursing Bottle Mouth Rapid decay of many or all the baby teeth of an infant or child. Upper front teeth Frequent exposure of a child’s teeth for long periods of time to liquid containing sugars. Liquid pools around the front teeth. During sleep, the bacteria living in every baby’s mouth, turns the milk sugar or other sugars to acid which causes the decay.

TRUE CYSTS Cavity lined by epithelium
May be situated entirely within soft tissue or deep within bone or may lie on the bony surface, producing a saucerization.

Categories Odontogenic cyst
- proliferation cystic degeneration of odontogenic epithelium a. Dentigerous cyst b. Eruption cyst c. Gingival cyst of the newborn d. Radicular cyst e. Keratocyst

Categories Nonodontogenic and fissural cyst
- derived from epithelial remnants of the tissue covering the embryonal processes that participate in the formation of the face and jaws a. nasoalveolar cyst b. Nasopalatine or incisive canal cyst c. Palatal cyst of newborn infants d. Dermoid and epidermoid cyst e. Submental or geniohyoid dermoid cyst f. Retention cyst

Cysts of the Jaws and Oral Floor
Odontogenic Cysts Dentigerous Cyst Asymptomatic occassionally pain or swelling firm hard mass appears as if missing a tooth usually involve unerupted mandibular third molars

Eruption Cyst common particularly with premature eruption of teeth well demarcated directly over the crown on an erupting tooth soft, fluctuant swelling of the alveolar ridge blue to dark red due to blood in the cystic fluid

Gingival and Palatal Cyst of Newborn Infants alveolar mucosa of themaxilla asymptomatic multiple or solitary white nodules Epstein’s pearls occur on the midline of the hard palate Bohn’s nodules occur scattered over the hard palate near the border with the soft palate

Radicular Cyst Nevoid Basal Cell Carcinoma Syndrome

Nonodontogenic and Fissural Cysts Nasopalatine or Incisive Canal Cyst Nasoalveolar Cyst

DERMOID CYST Cyst lined by epidermis and cutaneous appendages
Result of the incorporation of the ectoderm during the closure of embryonic fissures (3rd-4th wk in utero) Commonly arise from floor of the mouth Either median/midline or lateral Evident between years of age

DERMOID CYST Sublingual/Genioglossal cyst-causes elevation and displacement of tongue Submental/Geniohyoid cyst-extends from the mandible to hyoid bone (double chin). When enlarged, it could cause a bulge in oral floor. Microscopic: keratinized squamous epithelium. 1 or more skin appendages could be present.

EPIDERMOID CYST Epidermoid cyst
-absence of skin appendages microscopically

RETENTION “CYST” (Mucocele)
Result of the duct rupture of a minor salivary gland. Occurs often on the mucosal surface of the lower lip Cyst of Blandin-Nuhn-cyst is on the ventral surface of the tongue’s tip. Ranula- cyst is large and involves sublingual salivary gland

Superficial tongue lesions
Hunter’s glossitis Fissured tongue Angioedema Fixed drug eruption

HUNTER’S GLOSSITIS Atrophic glossitis
Atrophic inflammatory condition of the tongue base An accompanying feature of pernicious anemia Symptoms: burning of the tongue, dry mouth, and altered sense of taste Tongue presents a typical smooth, shiny appearance with partial atrophy of the filiform papillae

FISSURED TONGUE presence of numerous furrows on the dorsal surface of the tongue a harmless hereditary condition that affects approximately 10–15% of the population

ANGIOEDEMA A transient, frequently pronounced vascular reaction which, in the head and neck region, can lead to swelling of the face, lips, tongue, and larynx (anaphylactic or anaphylactoid reaction) drugs such as ASA and ACE inhibitors C1-esterase inhibitor (C1-INH) deficiency: less common, may be hereditary or acquired

ANGIOEDEMA massive facial swelling: most pronounced in the periorbital region but also affects the lips, tongue, tongue base, and laryngeal area Massive tongue swelling: can cause acute obstruction of the upper airways hereditary form: swelling of the extremities and episodes of abdominal pain.

ANGIOEDEMA Tx: depends on the cause
for angioedema not induced by a C1-INH deficiency: symptomatic treatment with corticosteroids or epinephrine (especially in the form of the disease induced by ACE inhibitors). for C1-INH deficiency, direct replacement with a C1-inhibitor concentrate should be provided in acutely life-threatening cases with swelling of the tongue and larynx

FIXED DRUG ERUPTION delayed (type IV) allergic reaction
occurs at the same cutaneous or mucosal sites (e.g., the extremities, soles of the feet, palms of the hands, external genitalia, oral mucosa) following repeated drug use superficial erosions that may resemble an HSV infection due to their scalloped margins

FIXED DRUG ERUPTION may be induced by analgesics, anti-inflammatory agents (e.g., pyrazolone, phenylbutazone, phenazone), antibiotics (penicillin, tetracyclines, erythromycin), chemotherapeutic agents, sulfonamides, and by certain hypnotics (e.g., barbiturates) and laxatives (phenolphthalein) Treatment consists of avoiding the suspicious substances

Tumors of the Lips and Oral Cavity
Benign tumors Precancerous lesions Malignant tumors

BENIGN TUMORS OF THE LIPS AND ORAL CAVITY
can arise from all epithelial and mesenchymal tissues in the head and neck region Papillomas, pleomorphic adenomas, various mesenchymal tumors such as fibromas, lipomas, rhabdomyomas, leiomyomas, and chondromas Treatment generally surgical Indicated for patients who describe symptoms and in cases in which it is necessary to exclude a malignant tumor

BENIGN TUMORS OF THE LIPS AND ORAL CAVITY
Hemangiomas and lymphangiomas high rate of spontaneous remission during the first years of life: conventional surgical treatment or laser surgery is advised only if the tumor persists beyond that period, provided the patient does not have serious symptoms such as dyspnea or dysphagia that would necessitate earlier surgical intervention Radiotherapy is no longer advocated for these tumors due to the potential for adverse sequelae (malignant transformation, growth disturbance)

a Papilloma of the uvula.
b The bulge in the palate is caused by a pleomorphic adenoma arising from the palatal salivary glands.

PRECANCEROUS LESIONS: LEUKOPLAKIA
most common precancerous lesion of the lips and oral cavity Many of these lesions are asymptomatic and are detected incidentally Exogenous irritants such as denture pressure or alcohol/nicotine abuse have been most strongly implicated as causal factors Thin, thick, granular, verruciform

PRECANCEROUS LESIONS: LEUKOPLAKIA
morphologic resemblance to carcinoma in situ and invasive carcinoma potential for malignant degeneration lesions should always be investigated by biopsy Tx: complete surgical removal of the neoplasm Thin, thick, granular, verruciform

PRECANCEROUS LESIONS: BOWEN’S DISEASE
a chronic inflammatory disease caused by an intraepidermal carcinoma Rare morphologic features are similar to those of leukoplakia

MALIGNANT TUMORS OF THE LIPS
almost invariably squamous cell carcinomas most commonly affect the lower lips (approximately 90% of cases). occur predominantly in pipe smokers Prolonged, intense sun exposure is a cofactor

Sx: Early tumors often appear clinically as “intractable” ulcerations in the vermilion border of the lip but may also consist of large, exophytic lesions Dx: Whenever a tumor is suspected, a biopsy should be taken to confirm the diagnosis. Differentials: keratoacanthoma; primary syphilis chancre ; Basal cell carcinoma involves the vermilion border of the lip only by secondary spread.

Treatment: surgical excision followed by a local primary closure or plastic repair of the defect using various reconstructive techniques (using regional flap techniques) low rate of metastasis to regional lymph nodes, but a neck dissection should be performed in patients with category 2 or higher tumors

MALIGNANT TUMORS OF THE ORAL CAVITY
Squamous cell carcinomas predominate in the oral mucosa variable in their clinical appearance Approximately 90% of patients have a long history of nicotine and alcohol abuse nearly 75% of malignant tumors form in the drainage area of the oral cavity—i.e., the trough between the base of the alveolar ridge and the border of the tongue

Symptoms: vary with the location and extent of the tumor painful swallowing, blood-tinged saliva, and a fetid breath odor Some tumors are completely asymptomatic

Diagnosis: Visual inspection can raise the suspicion of a malignant neoplasm Bimanual palpation, since many tumors infiltrate deeper tissues and the visual impression of superficial findings can be misleading palpation of the regional cervical lymph nodes to exclude metastases

Imaging procedures (UTZ, CT, MRI)
only for extensive masses, as many tumors can be adequately evaluated clinically owing to their exposed location with more advanced lesions, imaging is valuable for defining the depth of tumor infiltration and assessing the involvement of adjacent structures (bone) and for excluding regional cervical lymph-node metastases

Treatment: surgical removal of the primary tumor The resulting defect is either closed primarily or reconstructed using pedicled flaps or microvascular free transfers (e.g., a radial forearm flap) a unilateral or bilateral neck dissection may be necessary, depending on the location and T category of the primary tumor Radiation to the tumor site and lymph areas is frequently indicated following surgery. Primary radiotherapy or combined radiochemotherapy may be considered as alternatives for T3 and T4 tumors.

Prognosis: Depends on the location and stage of the disease 5-year survival rate varies accordingly, ranging from 0% to 80%

SQUAMOUS CELL CARCINOMA

Clerk Sarah Camille Concepcion

Similar presentations

Presentation on theme: "Clerk Sarah Camille Concepcion"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

Clerk Sarah Camille Concepcion

Similar presentations

Presentation on theme: "Clerk Sarah Camille Concepcion"— Presentation transcript:

Similar presentations

About project

Feedback