of Oral cavity DrSHANKHASHUBHRA GHOSH DLO2 ND YR Stanley Medical College Chennai wwwnayyarENTcom 1 wwwnayyarENTcom 2 Benign lesions Solid papilloma ID: 329745
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Pre-malignant lesionsof Oral cavity
Dr.SHANKHASHUBHRA GHOSH DLO,2ND YR Stanley Medical College Chennai
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Benign lesions
Solid- papilloma fibroma hemangioma granuloma torus
palatinus Cystic - retention cyst
ranula
dermoid
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Premalignant lesions
LeukoplakiaErythroplakiaSubmucous fibrosisLichen planusLaryngeal keratosisActinic cheliosis
Smooth,red tongue of Plummer-Vinson syndrome
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Predisposing factors
EIGHT -- “S” Smoking syphilis spices
sharp tooth
submucosal
fibrosis
siderophenic
dysphagia
sepsis
spirit(alcohol)
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Leukoplakia -etiology
Tobacco chewing and smokingAlcoholLocal irritantsVitamin deficiency-vit A & BEndocrine disturbancesSyphilis
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leukoplakia
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leukoplakia
White patch in mucosa that does not rub off & cannot be clinically identifiedMost are asymptomatic,only 20% show evidence of dysplasia or carcinoma.Buccal mucosa and oral commissures are most common sitesMostly fourth decade, male>female
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Non –homogenous leukoplakia
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Management
Proper historyPrevention of causeSurgical excision of small lesionTopical chemotherapy and radiationwww.nayyarENT.com
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Erythroplakia
Red lesion that cannot be classified as another entity.91% shows signs of dysplasiaFlat, macular, velvety appearance and may be speckled with white spots representing foci of keratosisMost common site-lower alveolar mucosa, gingivobuccal sulcus
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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
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Submucous fibrosis
Subepithelial inflammatory response to the irritants mainly due to betel nut chewingArecoline-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
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Clinical features
The most common initial symptom-burning sensation of oral mucosa aggravated by spicy food followed by either hypersalivation or dryness of mouthIn advanced cases,the
mucosa becomes tough and leathery, with numerous vertical fibrous band.
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Clinical staging
Stage1-stomatitis..vesicles,mucosal ulcers, mucosal petechieStage2-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.
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Treatment
Prescription of chewable pellets of hydrocortisoneAbsteinence from alcohol,tea,coffeeSubmucosal inj of hydrocortisoneSubmucosal inj
of human chorionic gonadotropinSurgical treatment-multiple release deep to mucosa,submucosa
and fibrotic tissue & suturing the gap so created by mucosal flap obtained by tongue and Z-
plasty
.
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Cont…..
In this procedure,multiple deep z shaped incisions are made into fibrotic tissue and sutured in straight fashionPentoxifylline-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.
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Lichen planus
Malignant potential is matter of disputePrudent practice to biopsy the lesion at first visit to confirm diagnosis or monitor changes.Lesion appear white lace like pattern in buccal mucosa.
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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%
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Treatment
If carcinoma-in-situ proved—excision by CO2 or KTP532 laserChemoprevention-beta-carotene and retinoids as antioxidant supplementswww.nayyarENT.com25Slide26
Thank you
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